12 ms·

Doctor tells patient he doesn't have long to live through video screen

115 points by turtlegrids 8y ago

sodosopa 8y ago
It didn’t matter who gave them the news, that’s a helluva impact. A doctor could be in the room and give the same message in a cold manner as many do each day and the family would have felt the same. The blame on reading the screen is more technophobic and sensationalized.
- Mizza 8y ago
  > technophobic Welcome to 2019, everybody! Won't somebody _please_ think of the robots!
  - baggsie 8y ago
    You're assuming that they identify as robots!
  - whymauri 8y ago
    This is a weird comment. When people are claustrophobic the implication is not that we need to sympathize with closed-spaces. You're injecting a meaning that was almost surely unintended to make a shaky ironic point.
    - presscast 8y ago
      You're feeding a troll.
      - Mizza 8y ago
        I'm not a troll, I'm seriously objecting to the idea that we should reject the concerns of a dying person as "technophobic", as if that's some kind of silver bullet in an argument in favor of technology. I've never heard anybody seriously say "technophobic" before and I found it rather shocking and naive.
        presscast 8y ago
        Ah, I do apologize then. I misinterpreted your post.
- eli 8y ago
  That telepresence robot looks ridiculous. I would absolutely not want to have a serious conversation through it.
- potta_coffee 8y ago
  Or the doctor could be in the room and act like somewhat of a human being and break the difficult news in a professional and socially accepted way.
  - sodosopa 8y ago
    But that’s also a problem with a lot of physicians, from my experience they provide vague answers and hint around. For one of my recent family members, I pulled her social worker aside and said this is a binary yes or no, Should we call hospice? And even then after much handwringing, the physician blurted it out to my family member despite having health care PoA In a perfect scenario as it is on television a scholarly physician sits on the bedside, pats the patient’s knee and looks them in the eye and says, “we’ve done all we could”. I worked in health care for decades, while not in a care role, I went through and managed some of the training programs to improve bedside manner/customer service. I had to document each physician as they spoke with my family member. Because of two of the three experiences they were eager to turn over the bed instead of providing compassionate care
- danso 8y ago
  The point of having a doctor in the room versus a video screen is that the presence of the human is generally less "cold". Besides the audio quality problems the family describes, the manner of delivery has connotations of mass-produced automated service, which also feels cold.
  - plants 8y ago
    "We're sorry, you have termin -kshhhh- cer. Our models estimate you have -kshhhh- to live. Have a nice day!"
- mc32 8y ago
  I don’t think so. While the results don’t change, a lot of human sociability is about doing the nothings in life. Like going through the motions of offering to pay yet knowing it’s the other person who’s going to pay (maybe they invited you, have more money, etc.,) still it’s consideted bad manners not to at least feign an offer. Same here. The doctor and hospital should strive to be as human and empathetic as possible given the bad news. Adding an electronic intermediary created distance and adds coldness and the artifice of bureaucracy to the event.
  - sodosopa 8y ago
    Couple each experience with social workers, religious staff and the patient’s care team. While a physician isn’t physically in the room, a caring influence over the discussion could help despite being a cold doc or a cold robot.
- plants 8y ago
  Is "technophobic" really a bad word now? If so, I'm an outright technophobe. If you're going to break hard news to anyone (whether it be a breakup, telling someone their loved one has died, or telling someone they are dying) you might as well give them the benefit of being there in person. You can hug a person, you can't hug a screen.
  - potta_coffee 8y ago
    It's just an ad hominem attack. I don't agree with you, so you're a "phobe". Technology isn't really the issue here.
  - pas 8y ago
    People are in general have a very bad handle on fundamental parts of life, like death. (And personal finances, metacognition and so on.) And sure, doctors can play the emergency psychologist while delivering the news, but people don't just go to the hospital and get a random death sentence. They knew there was a very significant chance that the news will be bad. Yes, when the uncertainty evaporates together with the favorable outcome, that's fucking harsh, and there's a process for dealing with that (the good old Kübler-Ross stages come to mind). People should be better prepared for these eventualities. (And I'm not saying it's easy, and people must be perfect stoics, but these theatrics we assign to conveying a few bits of information coupled with the human touch is just a psychology theater.)
    - ripsawridge 8y ago
      "these theatrics we assign to conveying a few bits of information..." Really? You really are of the opinion that news about death is just "a few bits of information?" And you are capable of describing the ways humans attempt to be empathic with each other as "these theatrics?" I'm not sure I want to live in this world. :(
      - pas 8y ago
        Yes. You already have an expected lifespan. Getting sick, makes you reevaluate that, and getting a concrete diagnosis with an expert opinion should not be a big change. Of course, we can do the be positive, be optimistic, you can fight it, you can do it mantra, and then watch as their heart breaks when they get the diagnosis. Empathy shouldn't mean helping people to delay facing the hard problems and truths. This is the same world that largely considers suicide a crime, and denies a dignified and conscious end of life to a lot of suffering people. I watched as a family member went through the stages of physiological and mental decline, dementia, muscle atrophy, and eventually even breathing was a full time job, and it became too much. And it was a relatively painless end. (And there were others with different, faster ends. Recently one with cancer.) And taking it for what it is seemed the healthier mindset and approach. Accepting the inevitable led to those last days and months better spent. And preparing for it is just as important. We already drag doctors into enough futile quarrels of our own. At least that's my opinion.
- ergothus 8y ago
  Agreed - While I have HUGE sympathy for doctors that have to deliver this kind of news, I have numerous complaints about the care and attention I get from my doctors today when they AREN'T remote - I don't see remote as really being relevant here: Attitude and behavior count for a lot more.
- vividtulips 8y ago
  "Daughter Catherine Quintana says the family is also upset because her father had trouble hearing the doctor through the robot's speaker forcing Wilharm to relay the terrible news." The blame is on the full device, not just the screen.
- rthomas6 8y ago
  Do you think it would be possible to deliver the news well via robot? I don't believe so. The news could be delivered well or poorly in person, but it could only be delivered poorly via robot. But it really doesn't matter what we think about the robot. It matters what that family thought, and they had a problem with it. To say it's okay is to ignore their voice, because in their specific case, they weren't okay with it. It seems cold and lacking in compassion to not allow even such a simple request for the sake of comfort for someone in such a difficult place.
  - sodosopa 8y ago
    I believe it could be delivered good or bad by both. It depends on so many factors.
- Darkstack 8y ago
  It's true that it didn't matter who gave them the news, but a lot of what we call "communication" is non verbal, so I think the screen did not help. You can forgive someone for something if he's in front of you, i doubt you would forgive him the same way by SMS/Phone call.
- sp0rk 8y ago
  > A doctor could be in the room and give the same message in a cold manner as many do each day and the family would have felt the same. So you think we should systematically bring this poor experience to everyone via robots because some human doctors perform the same task poorly?
  - sodosopa 8y ago
    I think we should make it agnostic to where it doesn’t matter how the person gets the message. Couple either experience with support groups.
kiba 8y ago
The headline confused me. I thought it was a doctor telling his patients that he's dying?
- waterside81 8y ago
  Yeah it is ambiguous. As Vince McMahon would say "Pronouns, pal"
- ajdfn92 8y ago
  Honestly, you are a moron and need to seek help.
danso 8y ago
I had thought maybe this was needed because of the patient being treated remotely, but the article says it was at the ICU and the family was told "the doctor was going to make rounds". Was this particular doctor actually at the facility?He didn't look he was dressed to work at the ICU that day.
- jcrawfordor 8y ago
  My best guess is that he was a specialist not currently available at that hospital, so they had him consulting via telepresence. It makes sense then that the news might come from him but it seems obvious that another physician from the hospital should have at least been present, if not read the results themselves with the specialist available by video for questions.
- stevenwoo 8y ago
  I haven't had a chance to talk to him about this, but an acquaintance of mine is an ER doctor for Kaiser and he showed me training material for this system at home last year he was required to learn, he groaned when he talked about. Not sure if he could use it from home. Possibly Kaiser is trying to cover more hospitals with less doctors.
  - ken 8y ago
    Kaiser bought my healthcare co-op a couple years ago. They promised that prices wouldn't increase, and that they could provide better service for everyone under a unified system. Each year since then, my personal premiums (on the cheapest plan they offer) have gone up by 20%, with no improvement in service, and with no cheaper options added. I don't know how low-income people are supposed to be able to afford this. I've never even used my plan, except for flu shots and dental checkups, but I'm involved in dangerous work and play so I can't exactly cancel. I assume Kaiser today is just a generic big company run by bean-counters. This doesn't surprise me in the least.
wlesieutre 8y ago
If you have 40 minutes, 99% Invisible did an episode last year on some of the history of how doctors deliver news like this. https://99percentinvisible.org/episode/breaking-bad-news/ https://99percentinvisible.org/episode/breaking-bad-news/ > That’s why many medical schools now offer training for students on how to break bad news, bringing in actors to help them learn how to navigate this critically important and very high-stakes moment. And that’s not the only connection between acting and this particular facet of medicine. > It turns out that one of the first doctors to recognize the challenges of this particular kind of doctor-patient communication wasn’t just a physician — he was also a comedian. And he drew on that experience to transform the way that doctors break bad news. > His name was Dr. Rob Buckman, and his very unusual life experiences prepared him to tackle what might be the hardest part of a very hard job. Radio reporter and part-time medical school videographer John Fecile went back to trace the strange journey of this comedic doctor, and discovered unexpected connections along the way. I don't think "through a video screen with poor audio quality" came up, but I'm guessing Buckman wouldn't have recommended it.
- 2sk21 8y ago
  This podcast is a treasure!
jordache 8y ago
there are plenty of terrible doctor's out there... Why should we expect doctor's to be any better than the avg population? Same goes for other jobs that we put on a pedestal, like police etc.. should a personality qualifier be required for certain jobs?
- danso 8y ago
  The family's complaint isn't about the doctor's personality.
  - smacktoward 8y ago
    It is if the decision to use the robot in this circumstance was made by the doctor, rather than being standard Kaiser policy.
    - ken 8y ago
      > Catherine Quintana said she and her mother asked hospital staff about how the robot was used. "It's policy, that's what we do now. That's what we were told," said Catherine Quintana.
- dpark 8y ago
  Lots of jobs have personality qualifiers. If you work in a service industry, in a position that involves customer/client interaction, you're going to need some reasonable amount of social skills. The more esteemed your position is, the more your social skill level will matter.
  - AnIdiotOnTheNet 8y ago
    Sure, but I guess the question is, is that a doctor's value? Being good at interacting with people? Is that really the primary thing we want from them?
    - jordache 8y ago
uberman 8y ago
I'm not sure what definition of appropriate Kaiser is using when they describe it as being appropriate to tell a 79 year old that he is dying via a robot
- tantalor 8y ago
  Assuming no other doctors were available (hence the robot) the alternative would be to not the patient. Which is worse?
  - neom 8y ago
    If it was me: The doctors tells literally ANY OTHER human there first, and THAT human tells me. Robodoc can be in the room, I don't care, but robodoc does not tell me I am about to die, I would be livid.
    - reidjs 8y ago
      I wouldnt really mind either way. Why do you need the doctor to be there? How would that change anything? You’re still going to die, why waste the doctors time by forcing them to drive over and deliver the news personally?
      - neom 8y ago
        Because dying tends to be a process, certainly if I was about to drop dead I might not care, but generally I would want to know about any pain treatment, changes in my meds, explain the process of dying to me. I would want to hear it from a specialist.
      - nkrisc 8y ago
        Maybe you haven't been in a position where you're days away from death, but most people would probably want to have that devastating news delivered to them by a real person who is present with them. It's not a rational thing. Of course it changes nothing, apart from the fact they might feel better having the doctor there instead of receiving it through a crappy matte screen with tinny speakers. If you still can't understand that, perhaps you can't empathize with most people.
nkoren 8y ago
For anybody who is confused about why this is an issue: There's a right way and a wrong way to talk to someone about their death. The right way involves making eye contact, making sure that they can hear you, and if they are comfortable with it, holding their hand. The wrong way involves doing none of those things, because you are talking to them via a shitty Skype connection on wheels. Technology has a huge role to play in healthcare. It's invaluable in diagnosis and treatment. In the long run it'll probably put a lot of people who do those kind of things out of work. But it should not be used to replace the empathic, emotional aspects of healthcare. If anything, the labour efficiencies generated by technology ought to increase the resources put into empathy -- not be used to eliminate it.
- chr1 8y ago
  Why is eye contact and holding hand the right way? For instance I would prefer an email. Honesty is better than empathy as a job.
  - SketchySeaBeast 8y ago
    Ah, the classic "why is this email a meeting"? Subject: You're dying. Message: 2-3 weeks. Cancer. Please see attached invoice.
    - pvaldes 8y ago
      Literature is more complex than that supposedly comic sketch. People is expressing all kind of really complex feelings since a lot of time with written language so that wouldn't need to be a problem. Is not a fair comparison. Some people would prefer a theater of acting sad, holding your hand and pretending to be an old friend in a strange environment, other would prefer to receive the hit at their home and cry in private. Each people is different.
      - SketchySeaBeast 8y ago
        As the physician doesn't get to know the ins and outs (emotionally, not physically) of a person, they have to adopt the approach that they hope helps the most people.
ldargin 8y ago
I would prefer this over getting the news even a day later.
droithomme 8y ago
For some of these tele-specialists their main specialty is that they live in another country and are willing to work for a small fraction of what an on site doctor charges. For some time, many xrays have had their initial reading done by a radiologist overseas. Tele-doctors bedside via a robot screen is just a continuation of this. It's a pity the journalist didn't follow up by asking Kaiser where the specialist was physically located.
- danso 8y ago
  The article includes the full statement from KP's PR department. No where do they try to claim that the specialist's physical location, or other logistical consideration, was the reason for the use of telemedicine. Furthermore, the family themselves said they didn't realize what was going on until afterwards. Which strongly suggests the doctor, for whatever reason, decided at no point to tell them, "I'm a specialist at Kaiser's radiological department in Boston...", if that were actually the case.
elpakal 8y ago
I worked at Kaiser IT, and there are definitely some well intentioned IT folk there trying to make revolutionary changes to healthcare. However, the company's internal infrastructure (inventory, expenses etc) is a giant cluster running on deprecated versions of XYZ. At one point we heard the metric that almost half of the inventory they have in hospitals was just lost in the system so they have no idea where it could be. Gets off the truck, scanned in, the inventory system craps out and it's lost forever. I don't know if that was accurate or just the remarks of a crusty manager, but I left after a short time because they definitely made me believe it.
- potta_coffee 8y ago
  Most hospitals are running on woefully outdated and/or inadequate technology. I've had a few different friends in healthcare IT and every story has been a nightmare. I'm not sure why it's this way.
  - nradov 8y ago
    In hospitals, most back end IT improvements don't directly drive revenue or care quality. So funding tends to be diverted to other things like new surgery centers, higher resolution MRI machines, nicer patient rooms, free care for the indigent, etc.
    - elpakal 8y ago
      This. Backend IT was most definitely a cost center and even more so one that was very poorly run and incentivized to not change. They have a pension program there and there are soo many people who made it and are pensioned that the only incentive they have is to ensure things do not change.
  - Balgair 8y ago
    Certification. You CANNOT have bugs in your ventilators, pill dispensers, heart-rate monitors, etc. As such, they are typically only certified on some old version of Windows. As such, they can't be updated, or they have to re-cert that new version of windows. By certification, it goes anywhere from the bugs in the compiler all the way to the EMI interference from a cell-phone that may interact and cause a fault. It can be very intense. Re-doing a cert is an incredible mess. So, they stay on the old version and that makes integrating with all the various versions of mainframes, windows, DOS, UNIX, etc. a total disaster of a task.
NoblePublius 8y ago
If you want to imagine “Medicare for all”, it looks no better than this, as Kaiser’s non profit HMO is about as functionally close to the best you could expect from AOC & co.
- dpark 8y ago
  Kaiser is a non-profit in the same sense that the NFL is a non-profit. Funding for the "non-profit" is funneled to the for-profit wings. In Kaiser's case, the actual medical groups are for-profit. Also, how desperate are you to drag politics into the discussion? For-profit groups are capable of making the same shitty decisions as non-profit groups.
- dang 8y ago
  "Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
_aleph2c_ 8y ago
Like this: https://www.youtube.com/watch?v=b9PyR71Aefk https://www.youtube.com/watch?v=b9PyR71Aefk
neom 8y ago
The ridiculousness of the society we are building is moving from sad joke to an utter tragedy.
- dang 8y ago
  Maybe so, but can you please not post unsubstantive comments here? It just makes this place a bit worse each time.
  - neom 8y ago
    Noted. Sorry Dang.
mcguire 8y ago
Was the doctor local? If he was an outside consultant, specialized in the disease, he may have been the most appropriate to break the news. Really poor idea, though.
Nomentatus 8y ago
Maybe it's just me, but I'd vastly prefer to be alone, in privacy when I get the news, thanks so much. Text, mail, even a skybanner pulled by a small plane would suit me more than someone seeming to stare me down while telling me I'm dead. Not to mention that I have no wish to put another human being through the tough experience of breaking the news. Why would I want to cause them distress? It's gonna be a bad enough day as it is. It might be a favor to both doctors and patients to have patients register their preferences in this event in advance; as we register our preferences re organ donation in many jurisdictions; or perhaps better allow people to register a preference.
- kaybe 8y ago
  Mhm, here, when you take part in an experiment than involves an MRI (especially of the head), there is a checkbox on the form that asks whether you want to informed about any funny things in the images at all just in case.
  - Nomentatus 8y ago
    Interesting, but then the question remains, just how you want that message delivered.
dougmwne 8y ago
I think this article deserves visibility on HN because it's such a vivid example of technology without ethics. The technology is incredible. It can reduce costs and improve access to specialists. These tools should be a part of our medical system. But this man and his family are flesh and blood people. And the doctor too. They have feelings. They have mental health and spiritual health needs. In the rush to deploy the technology, the human dimension was ignored. So this might have been just another fleck of clickbait if it weren't for the fact that it's another example of a deep problem we technologists have. When we create the tool, we are also responsible for its ethical use and the impact, positive or negative, it has on the world. Don't dissociate from the impact of your work. Own it.
naicuoctavian 8y ago
1st world problem I used to live in Romania where hospitals are full of deadly bacteria, doctors are corrupt, nurses are corrupt. There's a shortage of equipment, vaccines, cancer treatment, important medicine, you name it. There is no place in the country to treat a seriously burned man, they all die. Obviously, lifespan here is shorter than in the US by about 4-5 years.
- ball_of_lint 8y ago
  Sure, thinks are worse in other places. That doesn't make this right or make it less newsworthy.
- danso 8y ago
  I think it's reasonable for people who aren't living in Romania to expect conditions that are different than Romania's.
- minipci1321 8y ago
  > 1st world problem I suspect it isn't. You didn't tell us how human are all those corrupt nurses and doctors? Maybe they offer first-rate compassion and spiritual support, once they pocketed their bribe? People die everywhere, and even in poor countries people not always die because of shortages of equipment and treatments... hope in Romania terminal patients are accompanied to death with all due compassion -- this has no material costs that only 1st world can afford.
miesman 8y ago
I was training as a paramedic in a hospital. A doctor needed to give this kind of news to a family. He took me aside and told me to come in the room 3 minutes after he went in and say that he was needed elsewhere. Apparently this was used quite often and the staff there called it a "save". Dealing with this sort of thing day after day the staff becomes numb to a lot of things. Later in the week I was with someone who knew she was gonna die soon. I was talking to her and was trying to be with her. It was very difficult and I could feel part of myself slipping elsewhere. I was messed up the rest of the day. My preceptor had come into the room and left quickly, he didn't want to go there. Anyway it does go both ways. Hospital staff need to do things to protect themselves so they can keep functioning. Ideally someone needs to be empathetic but they are also human. I don't feel delivering this sort of news via a video screen is appropriate though.
- nkoren 8y ago
  It's definitely something you should be trained for.
- PhasmaFelis 8y ago
  Every now and then there's a scandal where doctors are caught saying mean shit about a patient, behind closed doors or during surgery. (As if surgical awareness wasn't horrible enough.) There's always a lot of talk about whether such heartless people can be trusted to do their best and not cut corners. Something I heard years ago, and have never heard mentioned since, is that doctors are trained to do that, to talk shit about their patients in private, to give them emotional distance. If they let themselves care deeply about every suffering, dying person, they'd crack under the stress.
AnIdiotOnTheNet 8y ago
As it is a Doctor's time is scarce, which is why systems like this exist in the first place I imagine. One wonders if expecting them to be comforting when delivering bad news, or taking the time to explain things properly to a patient, is realistic. After all, even though this is one of the most important events in the patient's life, to the doctor it's tuesday. I sometimes wonder if the patient demand for "bedside manner" has led to having doctors with less actual medical skill. I mean, I wouldn't choose my mechanic based on how comforting they could be. I wouldn't even choose my veterinarian on that criteria. One could argue that doctors are all roughly equal in diagnosis and prescription I suppose, making bedside manner the only real differentiation, but my personal experience is that that isn't true. Maybe a different person should be handling the role of interacting with the patient in these ways, Someone who can take the time to do it properly? I don't know. I just think it is worth reconsidering how this works in today's world.
- zentiggr 8y ago
  I'd say a mechanic's manner is almost off topic... anything mechanical ranks far far below life and death notifications. But I do get why you included them in the comparison. I would want my vet (and so far HAVE had my vets) be even more compassionate than my own doctor. I know enough to talk at least basic jargon with my PCP and specialists as needed. None of my animals has been able to communicate about their trouble, and have relied on that extra bit of comfort and care when they are terminal, or even just very ill. Again, personal preference.
- Balgair 8y ago
  >I mean, I wouldn't choose my mechanic based on how comforting they could be. I grew up in an auto-shop in the SF Bay, my family still owns one of them. You may not choose a mechanic based on their empathy, but the large majority (~90%) of people do. Trust is a thing that is hard to establish, but incredibly easy to break. One bad part, one snippy phone call, will totally ruin the relationship that you've built up over decades with a customer and their family. They'll never walk in the door again. We've experimented with all forms of customer communication. From texts, to online booking, to Groupon and Yelp. Nothing works anywhere near as good as an inperson chat. When you've got to deliver the message that their car needs a $3k new transmission, despite the family road-trip in a week's time, it's best to do it face to face. Most of the time, that's not realistic, so a phone call is the next best thing. When the estimate is high like that, then it usually takes over 10 minutes per call. There's a lot of yelling and crying, usually. People get very attached to their cars. Hell, they'll abandon their house and home before they abandon their cars[0]. When you do extensive surgery on the car they drove their new wife home in, that they drove their first-born in, that they cried in when their Mom died, that they spilled innumerable sodas in, well, you can understand why they throw money into the repairs even when it makes no sense. Providing that 'deft hand', those years of knowledge and experience, has helped the business not just survive the Dot-Com and Housing crashes, but has let us thrive despite those economic catastrophes. Knowing how to tell someone that the car is no longer worth the repair does take some experience and care. Customers have come to trust us in helping them make decisions they have a hard time with. The majority of what trust is made of, what it can be partitioned out into, is empathy. [0] one reason I'm not bullish on self driving car services that are all rentals and leases.
otras 8y ago
I’m reminded of the NYT piece How to Tell a Mother Her Child Is Dead by Naomi Rosenberg, an ER doctor in Philadelphia. Highly recommend reading it for insight into the relationship between doctors, death, and patients. https://www.nytimes.com/2016/09/04/opinion/sunday/how-to-tell-a-mother-her-child-is-dead.html https://www.nytimes.com/2016/09/04/opinion/sunday/how-to-tel...
- simonswords82 8y ago
  Now that's a beautiful piece of writing on a terribly tragic subject.
- zeveb 8y ago
  That is, indeed, a beautiful piece of writing, but this bit here got me to thinking: > You are here for her. She is his mother. Does it really make sense that the person whose job is operating on physical trauma victims is also the person who deals with emotional trauma victims? Seems to me that those are two entirely different skill sets, and even mindsets. On a human level, yes I'd want to hear the news from the surgeon who operated on my loved one. But on a practical level, I think I'd rather my loved one be operated on by the surgical equivalent of House than by someone less talented at surgery but with a greater capacity for empathy.
ryanmarsh 8y ago
I remember the day the doctors told us my daughter wasn't going to live. My wife didn't even want to be in the room, she knew what was coming. It was something we were prepared for so frankly it doesn't matter if it would have come through a video conference. So long as the doctors are respectful I'm not sure what someone expects. Death is coming. It's horrible news. We talk about so much through glass these days anyway I feel like this won't be a concern for long. Death is coming. There's no good way to spin this or make it go away. Just, prepare.
pixelpp 8y ago
This bean counter run country is so fucked.
writepub 8y ago
@turtlegrids - genuinely curious about the secret behind multiple submissions from a new account making it to the top 60, and racking up ~500 karma points in 10 days.
spease 8y ago
I worked for a few years at a company whose exclusive product line was office-oriented telepresence robots, so I probably have a different perspective than most people here. The model in the article is from a company that was medical-oriented. Sort of a competitor to us, but they got the robot certified as a medical device and sold it at a medical-grade price point whereas we did not go for certification and sold it at an enterprise price point to more office-oriented customers. We had a store in downtown Palo Alto that was a novelty for people visiting. A lot of people were weirded out by the robots at first. Usually they understood a lot better once they drove one around and could understand what they "saw". Most of our customers were regular remote workers and they loved them because they felt like people respected them more than just being a disembodied voice on a speakerphone. Interactions were much more natural and you could use body language to a certain extent. We had several remote workers ourselves and I felt like I could communicate almost as well as if they were there, and found myself giving the robots 'personal space' like I would a person. So I personally wouldn't be offended as long as I felt like the doctor was doing everything they could. In fact I'd much rather deal directly with the doctor so I could pick up on if they had misunderstood something about the case history, rather than to play a game of telephone with a human proxy instead and potentially be left wondering what exactly the doctor had said. So I don't know why the doctor wasn't there that day, but I do understand that he has his own life and other patients to get to. If he's sick, or his kids were sick, or something else came up, I understand that just because he's a doctor who makes life or death decisions doesn't free him from the responsibility of the rest of his life. He may be dealing with a dozen other delicate cases that can't easily be handed off, and it just so happens that mine is the one he can't solve. Pulling another doctor in means that doctor is interrupting that other doctor. He does the triage and sends the nurse in with the robot instead. I suspect Kaiser will revise their policy based on the publicity this has gotten. But while it might show more empathy to have someone else deliver the news in-person, I'm not convinced that it will overall result in better patient outcomes. (I'm also assuming that since it was Fremont, CA, it's not like the robot was the only way to have a relevant specialist there. If it was a second- or third-world country, by all means send in the robot with a pulmonary oncologist to tell me there's no hope rather than having a GP try to make the call).
yellowapple 8y ago
> "We offer our sincere condolences," said Kaiser Permanente Senior Vice-President Michelle Gaskill-Hames in a written statement, "We use video technology as an appropriate enhancement to the care team, and a way to bring additional consultative expertise to the bedside." You keep using that word, "appropriate". I do not think it means what you think it means.
onetimemanytime 8y ago
>>"Devastated. I was going to lose my grandfather. We knew that this was coming and that he was very sick. But I don't think somebody should get the news delivered that way. It should have been a human being come in," Wilharm said. Well, when you are ready to clock out at a certain age, people should celebrate the life you lived and make peace with the fact that this is part of life. Now a 15 year old boy /girl is very different for obvious reasons. If his life was measured in minutes ("might not make it home") maybe they had no other choice by Skype? Maybe another doctor at the hospital but he isn't his doctor
pkaye 8y ago
I've and some family members have been going to that particular hospital. Generally had good experience especially if getting admitted. Most of the nurses are so compassionate. However its been getting more and more busy. These days their entire parking lot is filled during daytime. I sometimes have to drive around for 10-15 minutes to find a spot. Its quite the change from even 2 years ago.
aaron695 8y ago
You might like watching Bleed Out (2018) in 2X if this interests you. It mostly diverts from the interesting bit but the unaccountability for when remote medicine fails is scary. Having one person watching over 100 people in ICU remotely is not the remote medicine dream I expected.
kbos87 8y ago
I have a relative who recently passed away after a short battle with cancer. In the weeks and months following her surprising diagnosis, she didn’t want to know the details of her prognosis, which I’ve come to respect and understand. While her physicians also understood and respected that, during an emergency room visit due to her cancer, she was quite coldly and clinically told what her prognosis was. I’ve come to recognize how important proper communication - communication that respects the parties most deeply affected - really is.

115 points by turtlegrids 8y ago

It didn’t matter who gave them the news, that’s a helluva impact. A doctor could be in the room and give the same message in a cold manner as many do each day and the family would have felt the same. The blame on reading the screen is more technophobic and sensationalized.

Mizza 8y ago
> technophobic Welcome to 2019, everybody! Won't somebody _please_ think of the robots!
- baggsie 8y ago
  You're assuming that they identify as robots!
- whymauri 8y ago
  This is a weird comment. When people are claustrophobic the implication is not that we need to sympathize with closed-spaces. You're injecting a meaning that was almost surely unintended to make a shaky ironic point.
  - presscast 8y ago
    You're feeding a troll.
    - Mizza 8y ago
      I'm not a troll, I'm seriously objecting to the idea that we should reject the concerns of a dying person as "technophobic", as if that's some kind of silver bullet in an argument in favor of technology. I've never heard anybody seriously say "technophobic" before and I found it rather shocking and naive.
      - presscast 8y ago
        Ah, I do apologize then. I misinterpreted your post.
eli 8y ago
That telepresence robot looks ridiculous. I would absolutely not want to have a serious conversation through it.
potta_coffee 8y ago
Or the doctor could be in the room and act like somewhat of a human being and break the difficult news in a professional and socially accepted way.
- sodosopa 8y ago
  But that’s also a problem with a lot of physicians, from my experience they provide vague answers and hint around. For one of my recent family members, I pulled her social worker aside and said this is a binary yes or no, Should we call hospice? And even then after much handwringing, the physician blurted it out to my family member despite having health care PoA In a perfect scenario as it is on television a scholarly physician sits on the bedside, pats the patient’s knee and looks them in the eye and says, “we’ve done all we could”. I worked in health care for decades, while not in a care role, I went through and managed some of the training programs to improve bedside manner/customer service. I had to document each physician as they spoke with my family member. Because of two of the three experiences they were eager to turn over the bed instead of providing compassionate care
danso 8y ago
The point of having a doctor in the room versus a video screen is that the presence of the human is generally less "cold". Besides the audio quality problems the family describes, the manner of delivery has connotations of mass-produced automated service, which also feels cold.
- plants 8y ago
  "We're sorry, you have termin -kshhhh- cer. Our models estimate you have -kshhhh- to live. Have a nice day!"
mc32 8y ago
I don’t think so. While the results don’t change, a lot of human sociability is about doing the nothings in life. Like going through the motions of offering to pay yet knowing it’s the other person who’s going to pay (maybe they invited you, have more money, etc.,) still it’s consideted bad manners not to at least feign an offer. Same here. The doctor and hospital should strive to be as human and empathetic as possible given the bad news. Adding an electronic intermediary created distance and adds coldness and the artifice of bureaucracy to the event.
- sodosopa 8y ago
  Couple each experience with social workers, religious staff and the patient’s care team. While a physician isn’t physically in the room, a caring influence over the discussion could help despite being a cold doc or a cold robot.
plants 8y ago
Is "technophobic" really a bad word now? If so, I'm an outright technophobe. If you're going to break hard news to anyone (whether it be a breakup, telling someone their loved one has died, or telling someone they are dying) you might as well give them the benefit of being there in person. You can hug a person, you can't hug a screen.
- potta_coffee 8y ago
  It's just an ad hominem attack. I don't agree with you, so you're a "phobe". Technology isn't really the issue here.
- pas 8y ago
  People are in general have a very bad handle on fundamental parts of life, like death. (And personal finances, metacognition and so on.) And sure, doctors can play the emergency psychologist while delivering the news, but people don't just go to the hospital and get a random death sentence. They knew there was a very significant chance that the news will be bad. Yes, when the uncertainty evaporates together with the favorable outcome, that's fucking harsh, and there's a process for dealing with that (the good old Kübler-Ross stages come to mind). People should be better prepared for these eventualities. (And I'm not saying it's easy, and people must be perfect stoics, but these theatrics we assign to conveying a few bits of information coupled with the human touch is just a psychology theater.)
  - ripsawridge 8y ago
    "these theatrics we assign to conveying a few bits of information..." Really? You really are of the opinion that news about death is just "a few bits of information?" And you are capable of describing the ways humans attempt to be empathic with each other as "these theatrics?" I'm not sure I want to live in this world. :(
    - pas 8y ago
      Yes. You already have an expected lifespan. Getting sick, makes you reevaluate that, and getting a concrete diagnosis with an expert opinion should not be a big change. Of course, we can do the be positive, be optimistic, you can fight it, you can do it mantra, and then watch as their heart breaks when they get the diagnosis. Empathy shouldn't mean helping people to delay facing the hard problems and truths. This is the same world that largely considers suicide a crime, and denies a dignified and conscious end of life to a lot of suffering people. I watched as a family member went through the stages of physiological and mental decline, dementia, muscle atrophy, and eventually even breathing was a full time job, and it became too much. And it was a relatively painless end. (And there were others with different, faster ends. Recently one with cancer.) And taking it for what it is seemed the healthier mindset and approach. Accepting the inevitable led to those last days and months better spent. And preparing for it is just as important. We already drag doctors into enough futile quarrels of our own. At least that's my opinion.
ergothus 8y ago
Agreed - While I have HUGE sympathy for doctors that have to deliver this kind of news, I have numerous complaints about the care and attention I get from my doctors today when they AREN'T remote - I don't see remote as really being relevant here: Attitude and behavior count for a lot more.
vividtulips 8y ago
"Daughter Catherine Quintana says the family is also upset because her father had trouble hearing the doctor through the robot's speaker forcing Wilharm to relay the terrible news." The blame is on the full device, not just the screen.
rthomas6 8y ago
Do you think it would be possible to deliver the news well via robot? I don't believe so. The news could be delivered well or poorly in person, but it could only be delivered poorly via robot. But it really doesn't matter what we think about the robot. It matters what that family thought, and they had a problem with it. To say it's okay is to ignore their voice, because in their specific case, they weren't okay with it. It seems cold and lacking in compassion to not allow even such a simple request for the sake of comfort for someone in such a difficult place.
- sodosopa 8y ago
  I believe it could be delivered good or bad by both. It depends on so many factors.
Darkstack 8y ago
It's true that it didn't matter who gave them the news, but a lot of what we call "communication" is non verbal, so I think the screen did not help. You can forgive someone for something if he's in front of you, i doubt you would forgive him the same way by SMS/Phone call.
sp0rk 8y ago
> A doctor could be in the room and give the same message in a cold manner as many do each day and the family would have felt the same. So you think we should systematically bring this poor experience to everyone via robots because some human doctors perform the same task poorly?
- sodosopa 8y ago
  I think we should make it agnostic to where it doesn’t matter how the person gets the message. Couple either experience with support groups.

kiba 8y ago

The headline confused me. I thought it was a doctor telling his patients that he's dying?

waterside81 8y ago
Yeah it is ambiguous. As Vince McMahon would say "Pronouns, pal"
ajdfn92 8y ago
Honestly, you are a moron and need to seek help.

danso 8y ago

I had thought maybe this was needed because of the patient being treated remotely, but the article says it was at the ICU and the family was told "the doctor was going to make rounds". Was this particular doctor actually at the facility?He didn't look he was dressed to work at the ICU that day.

jcrawfordor 8y ago
My best guess is that he was a specialist not currently available at that hospital, so they had him consulting via telepresence. It makes sense then that the news might come from him but it seems obvious that another physician from the hospital should have at least been present, if not read the results themselves with the specialist available by video for questions.
stevenwoo 8y ago
I haven't had a chance to talk to him about this, but an acquaintance of mine is an ER doctor for Kaiser and he showed me training material for this system at home last year he was required to learn, he groaned when he talked about. Not sure if he could use it from home. Possibly Kaiser is trying to cover more hospitals with less doctors.
- ken 8y ago
  Kaiser bought my healthcare co-op a couple years ago. They promised that prices wouldn't increase, and that they could provide better service for everyone under a unified system. Each year since then, my personal premiums (on the cheapest plan they offer) have gone up by 20%, with no improvement in service, and with no cheaper options added. I don't know how low-income people are supposed to be able to afford this. I've never even used my plan, except for flu shots and dental checkups, but I'm involved in dangerous work and play so I can't exactly cancel. I assume Kaiser today is just a generic big company run by bean-counters. This doesn't surprise me in the least.

wlesieutre 8y ago

If you have 40 minutes, 99% Invisible did an episode last year on some of the history of how doctors deliver news like this. https://99percentinvisible.org/episode/breaking-bad-news/ https://99percentinvisible.org/episode/breaking-bad-news/ > That’s why many medical schools now offer training for students on how to break bad news, bringing in actors to help them learn how to navigate this critically important and very high-stakes moment. And that’s not the only connection between acting and this particular facet of medicine. > It turns out that one of the first doctors to recognize the challenges of this particular kind of doctor-patient communication wasn’t just a physician — he was also a comedian. And he drew on that experience to transform the way that doctors break bad news. > His name was Dr. Rob Buckman, and his very unusual life experiences prepared him to tackle what might be the hardest part of a very hard job. Radio reporter and part-time medical school videographer John Fecile went back to trace the strange journey of this comedic doctor, and discovered unexpected connections along the way. I don't think "through a video screen with poor audio quality" came up, but I'm guessing Buckman wouldn't have recommended it.

2sk21 8y ago
This podcast is a treasure!

jordache 8y ago

there are plenty of terrible doctor's out there... Why should we expect doctor's to be any better than the avg population? Same goes for other jobs that we put on a pedestal, like police etc.. should a personality qualifier be required for certain jobs?

danso 8y ago
The family's complaint isn't about the doctor's personality.
- smacktoward 8y ago
  It is if the decision to use the robot in this circumstance was made by the doctor, rather than being standard Kaiser policy.
  - ken 8y ago
    > Catherine Quintana said she and her mother asked hospital staff about how the robot was used. "It's policy, that's what we do now. That's what we were told," said Catherine Quintana.
dpark 8y ago
Lots of jobs have personality qualifiers. If you work in a service industry, in a position that involves customer/client interaction, you're going to need some reasonable amount of social skills. The more esteemed your position is, the more your social skill level will matter.
- AnIdiotOnTheNet 8y ago
  Sure, but I guess the question is, is that a doctor's value? Being good at interacting with people? Is that really the primary thing we want from them?
  - jordache 8y ago

uberman 8y ago

I'm not sure what definition of appropriate Kaiser is using when they describe it as being appropriate to tell a 79 year old that he is dying via a robot

tantalor 8y ago
Assuming no other doctors were available (hence the robot) the alternative would be to not the patient. Which is worse?
- neom 8y ago
  If it was me: The doctors tells literally ANY OTHER human there first, and THAT human tells me. Robodoc can be in the room, I don't care, but robodoc does not tell me I am about to die, I would be livid.
  - reidjs 8y ago
    I wouldnt really mind either way. Why do you need the doctor to be there? How would that change anything? You’re still going to die, why waste the doctors time by forcing them to drive over and deliver the news personally?
    - neom 8y ago
      Because dying tends to be a process, certainly if I was about to drop dead I might not care, but generally I would want to know about any pain treatment, changes in my meds, explain the process of dying to me. I would want to hear it from a specialist.
    - nkrisc 8y ago
      Maybe you haven't been in a position where you're days away from death, but most people would probably want to have that devastating news delivered to them by a real person who is present with them. It's not a rational thing. Of course it changes nothing, apart from the fact they might feel better having the doctor there instead of receiving it through a crappy matte screen with tinny speakers. If you still can't understand that, perhaps you can't empathize with most people.

nkoren 8y ago

For anybody who is confused about why this is an issue: There's a right way and a wrong way to talk to someone about their death. The right way involves making eye contact, making sure that they can hear you, and if they are comfortable with it, holding their hand. The wrong way involves doing none of those things, because you are talking to them via a shitty Skype connection on wheels. Technology has a huge role to play in healthcare. It's invaluable in diagnosis and treatment. In the long run it'll probably put a lot of people who do those kind of things out of work. But it should not be used to replace the empathic, emotional aspects of healthcare. If anything, the labour efficiencies generated by technology ought to increase the resources put into empathy -- not be used to eliminate it.

chr1 8y ago
Why is eye contact and holding hand the right way? For instance I would prefer an email. Honesty is better than empathy as a job.
- SketchySeaBeast 8y ago
  Ah, the classic "why is this email a meeting"? Subject: You're dying. Message: 2-3 weeks. Cancer. Please see attached invoice.
  - pvaldes 8y ago
    Literature is more complex than that supposedly comic sketch. People is expressing all kind of really complex feelings since a lot of time with written language so that wouldn't need to be a problem. Is not a fair comparison. Some people would prefer a theater of acting sad, holding your hand and pretending to be an old friend in a strange environment, other would prefer to receive the hit at their home and cry in private. Each people is different.
    - SketchySeaBeast 8y ago
      As the physician doesn't get to know the ins and outs (emotionally, not physically) of a person, they have to adopt the approach that they hope helps the most people.

ldargin 8y ago

I would prefer this over getting the news even a day later.

droithomme 8y ago

For some of these tele-specialists their main specialty is that they live in another country and are willing to work for a small fraction of what an on site doctor charges. For some time, many xrays have had their initial reading done by a radiologist overseas. Tele-doctors bedside via a robot screen is just a continuation of this. It's a pity the journalist didn't follow up by asking Kaiser where the specialist was physically located.

danso 8y ago
The article includes the full statement from KP's PR department. No where do they try to claim that the specialist's physical location, or other logistical consideration, was the reason for the use of telemedicine. Furthermore, the family themselves said they didn't realize what was going on until afterwards. Which strongly suggests the doctor, for whatever reason, decided at no point to tell them, "I'm a specialist at Kaiser's radiological department in Boston...", if that were actually the case.

elpakal 8y ago

I worked at Kaiser IT, and there are definitely some well intentioned IT folk there trying to make revolutionary changes to healthcare. However, the company's internal infrastructure (inventory, expenses etc) is a giant cluster running on deprecated versions of XYZ. At one point we heard the metric that almost half of the inventory they have in hospitals was just lost in the system so they have no idea where it could be. Gets off the truck, scanned in, the inventory system craps out and it's lost forever. I don't know if that was accurate or just the remarks of a crusty manager, but I left after a short time because they definitely made me believe it.

potta_coffee 8y ago
Most hospitals are running on woefully outdated and/or inadequate technology. I've had a few different friends in healthcare IT and every story has been a nightmare. I'm not sure why it's this way.
- nradov 8y ago
  In hospitals, most back end IT improvements don't directly drive revenue or care quality. So funding tends to be diverted to other things like new surgery centers, higher resolution MRI machines, nicer patient rooms, free care for the indigent, etc.
  - elpakal 8y ago
    This. Backend IT was most definitely a cost center and even more so one that was very poorly run and incentivized to not change. They have a pension program there and there are soo many people who made it and are pensioned that the only incentive they have is to ensure things do not change.
- Balgair 8y ago
  Certification. You CANNOT have bugs in your ventilators, pill dispensers, heart-rate monitors, etc. As such, they are typically only certified on some old version of Windows. As such, they can't be updated, or they have to re-cert that new version of windows. By certification, it goes anywhere from the bugs in the compiler all the way to the EMI interference from a cell-phone that may interact and cause a fault. It can be very intense. Re-doing a cert is an incredible mess. So, they stay on the old version and that makes integrating with all the various versions of mainframes, windows, DOS, UNIX, etc. a total disaster of a task.

NoblePublius 8y ago

If you want to imagine “Medicare for all”, it looks no better than this, as Kaiser’s non profit HMO is about as functionally close to the best you could expect from AOC & co.

dpark 8y ago
Kaiser is a non-profit in the same sense that the NFL is a non-profit. Funding for the "non-profit" is funneled to the for-profit wings. In Kaiser's case, the actual medical groups are for-profit. Also, how desperate are you to drag politics into the discussion? For-profit groups are capable of making the same shitty decisions as non-profit groups.
dang 8y ago
"Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents." https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

_aleph2c_ 8y ago

Like this: https://www.youtube.com/watch?v=b9PyR71Aefk https://www.youtube.com/watch?v=b9PyR71Aefk

neom 8y ago

The ridiculousness of the society we are building is moving from sad joke to an utter tragedy.

dang 8y ago
Maybe so, but can you please not post unsubstantive comments here? It just makes this place a bit worse each time.
- neom 8y ago
  Noted. Sorry Dang.

mcguire 8y ago

Was the doctor local? If he was an outside consultant, specialized in the disease, he may have been the most appropriate to break the news. Really poor idea, though.

Nomentatus 8y ago

Maybe it's just me, but I'd vastly prefer to be alone, in privacy when I get the news, thanks so much. Text, mail, even a skybanner pulled by a small plane would suit me more than someone seeming to stare me down while telling me I'm dead. Not to mention that I have no wish to put another human being through the tough experience of breaking the news. Why would I want to cause them distress? It's gonna be a bad enough day as it is. It might be a favor to both doctors and patients to have patients register their preferences in this event in advance; as we register our preferences re organ donation in many jurisdictions; or perhaps better allow people to register a preference.

kaybe 8y ago
Mhm, here, when you take part in an experiment than involves an MRI (especially of the head), there is a checkbox on the form that asks whether you want to informed about any funny things in the images at all just in case.
- Nomentatus 8y ago
  Interesting, but then the question remains, just how you want that message delivered.

dougmwne 8y ago

I think this article deserves visibility on HN because it's such a vivid example of technology without ethics. The technology is incredible. It can reduce costs and improve access to specialists. These tools should be a part of our medical system. But this man and his family are flesh and blood people. And the doctor too. They have feelings. They have mental health and spiritual health needs. In the rush to deploy the technology, the human dimension was ignored. So this might have been just another fleck of clickbait if it weren't for the fact that it's another example of a deep problem we technologists have. When we create the tool, we are also responsible for its ethical use and the impact, positive or negative, it has on the world. Don't dissociate from the impact of your work. Own it.

naicuoctavian 8y ago

1st world problem I used to live in Romania where hospitals are full of deadly bacteria, doctors are corrupt, nurses are corrupt. There's a shortage of equipment, vaccines, cancer treatment, important medicine, you name it. There is no place in the country to treat a seriously burned man, they all die. Obviously, lifespan here is shorter than in the US by about 4-5 years.

ball_of_lint 8y ago
Sure, thinks are worse in other places. That doesn't make this right or make it less newsworthy.
danso 8y ago
I think it's reasonable for people who aren't living in Romania to expect conditions that are different than Romania's.
minipci1321 8y ago
> 1st world problem I suspect it isn't. You didn't tell us how human are all those corrupt nurses and doctors? Maybe they offer first-rate compassion and spiritual support, once they pocketed their bribe? People die everywhere, and even in poor countries people not always die because of shortages of equipment and treatments... hope in Romania terminal patients are accompanied to death with all due compassion -- this has no material costs that only 1st world can afford.

miesman 8y ago

I was training as a paramedic in a hospital. A doctor needed to give this kind of news to a family. He took me aside and told me to come in the room 3 minutes after he went in and say that he was needed elsewhere. Apparently this was used quite often and the staff there called it a "save". Dealing with this sort of thing day after day the staff becomes numb to a lot of things. Later in the week I was with someone who knew she was gonna die soon. I was talking to her and was trying to be with her. It was very difficult and I could feel part of myself slipping elsewhere. I was messed up the rest of the day. My preceptor had come into the room and left quickly, he didn't want to go there. Anyway it does go both ways. Hospital staff need to do things to protect themselves so they can keep functioning. Ideally someone needs to be empathetic but they are also human. I don't feel delivering this sort of news via a video screen is appropriate though.

nkoren 8y ago
It's definitely something you should be trained for.
PhasmaFelis 8y ago
Every now and then there's a scandal where doctors are caught saying mean shit about a patient, behind closed doors or during surgery. (As if surgical awareness wasn't horrible enough.) There's always a lot of talk about whether such heartless people can be trusted to do their best and not cut corners. Something I heard years ago, and have never heard mentioned since, is that doctors are trained to do that, to talk shit about their patients in private, to give them emotional distance. If they let themselves care deeply about every suffering, dying person, they'd crack under the stress.

AnIdiotOnTheNet 8y ago

As it is a Doctor's time is scarce, which is why systems like this exist in the first place I imagine. One wonders if expecting them to be comforting when delivering bad news, or taking the time to explain things properly to a patient, is realistic. After all, even though this is one of the most important events in the patient's life, to the doctor it's tuesday. I sometimes wonder if the patient demand for "bedside manner" has led to having doctors with less actual medical skill. I mean, I wouldn't choose my mechanic based on how comforting they could be. I wouldn't even choose my veterinarian on that criteria. One could argue that doctors are all roughly equal in diagnosis and prescription I suppose, making bedside manner the only real differentiation, but my personal experience is that that isn't true. Maybe a different person should be handling the role of interacting with the patient in these ways, Someone who can take the time to do it properly? I don't know. I just think it is worth reconsidering how this works in today's world.

zentiggr 8y ago
I'd say a mechanic's manner is almost off topic... anything mechanical ranks far far below life and death notifications. But I do get why you included them in the comparison. I would want my vet (and so far HAVE had my vets) be even more compassionate than my own doctor. I know enough to talk at least basic jargon with my PCP and specialists as needed. None of my animals has been able to communicate about their trouble, and have relied on that extra bit of comfort and care when they are terminal, or even just very ill. Again, personal preference.
Balgair 8y ago
>I mean, I wouldn't choose my mechanic based on how comforting they could be. I grew up in an auto-shop in the SF Bay, my family still owns one of them. You may not choose a mechanic based on their empathy, but the large majority (~90%) of people do. Trust is a thing that is hard to establish, but incredibly easy to break. One bad part, one snippy phone call, will totally ruin the relationship that you've built up over decades with a customer and their family. They'll never walk in the door again. We've experimented with all forms of customer communication. From texts, to online booking, to Groupon and Yelp. Nothing works anywhere near as good as an inperson chat. When you've got to deliver the message that their car needs a $3k new transmission, despite the family road-trip in a week's time, it's best to do it face to face. Most of the time, that's not realistic, so a phone call is the next best thing. When the estimate is high like that, then it usually takes over 10 minutes per call. There's a lot of yelling and crying, usually. People get very attached to their cars. Hell, they'll abandon their house and home before they abandon their cars[0]. When you do extensive surgery on the car they drove their new wife home in, that they drove their first-born in, that they cried in when their Mom died, that they spilled innumerable sodas in, well, you can understand why they throw money into the repairs even when it makes no sense. Providing that 'deft hand', those years of knowledge and experience, has helped the business not just survive the Dot-Com and Housing crashes, but has let us thrive despite those economic catastrophes. Knowing how to tell someone that the car is no longer worth the repair does take some experience and care. Customers have come to trust us in helping them make decisions they have a hard time with. The majority of what trust is made of, what it can be partitioned out into, is empathy. [0] one reason I'm not bullish on self driving car services that are all rentals and leases.

otras 8y ago

I’m reminded of the NYT piece How to Tell a Mother Her Child Is Dead by Naomi Rosenberg, an ER doctor in Philadelphia. Highly recommend reading it for insight into the relationship between doctors, death, and patients. https://www.nytimes.com/2016/09/04/opinion/sunday/how-to-tell-a-mother-her-child-is-dead.html https://www.nytimes.com/2016/09/04/opinion/sunday/how-to-tel...

simonswords82 8y ago
Now that's a beautiful piece of writing on a terribly tragic subject.
zeveb 8y ago
That is, indeed, a beautiful piece of writing, but this bit here got me to thinking: > You are here for her. She is his mother. Does it really make sense that the person whose job is operating on physical trauma victims is also the person who deals with emotional trauma victims? Seems to me that those are two entirely different skill sets, and even mindsets. On a human level, yes I'd want to hear the news from the surgeon who operated on my loved one. But on a practical level, I think I'd rather my loved one be operated on by the surgical equivalent of House than by someone less talented at surgery but with a greater capacity for empathy.

ryanmarsh 8y ago

I remember the day the doctors told us my daughter wasn't going to live. My wife didn't even want to be in the room, she knew what was coming. It was something we were prepared for so frankly it doesn't matter if it would have come through a video conference. So long as the doctors are respectful I'm not sure what someone expects. Death is coming. It's horrible news. We talk about so much through glass these days anyway I feel like this won't be a concern for long. Death is coming. There's no good way to spin this or make it go away. Just, prepare.

pixelpp 8y ago

This bean counter run country is so fucked.

writepub 8y ago

@turtlegrids - genuinely curious about the secret behind multiple submissions from a new account making it to the top 60, and racking up ~500 karma points in 10 days.

spease 8y ago

I worked for a few years at a company whose exclusive product line was office-oriented telepresence robots, so I probably have a different perspective than most people here. The model in the article is from a company that was medical-oriented. Sort of a competitor to us, but they got the robot certified as a medical device and sold it at a medical-grade price point whereas we did not go for certification and sold it at an enterprise price point to more office-oriented customers. We had a store in downtown Palo Alto that was a novelty for people visiting. A lot of people were weirded out by the robots at first. Usually they understood a lot better once they drove one around and could understand what they "saw". Most of our customers were regular remote workers and they loved them because they felt like people respected them more than just being a disembodied voice on a speakerphone. Interactions were much more natural and you could use body language to a certain extent. We had several remote workers ourselves and I felt like I could communicate almost as well as if they were there, and found myself giving the robots 'personal space' like I would a person. So I personally wouldn't be offended as long as I felt like the doctor was doing everything they could. In fact I'd much rather deal directly with the doctor so I could pick up on if they had misunderstood something about the case history, rather than to play a game of telephone with a human proxy instead and potentially be left wondering what exactly the doctor had said. So I don't know why the doctor wasn't there that day, but I do understand that he has his own life and other patients to get to. If he's sick, or his kids were sick, or something else came up, I understand that just because he's a doctor who makes life or death decisions doesn't free him from the responsibility of the rest of his life. He may be dealing with a dozen other delicate cases that can't easily be handed off, and it just so happens that mine is the one he can't solve. Pulling another doctor in means that doctor is interrupting that other doctor. He does the triage and sends the nurse in with the robot instead. I suspect Kaiser will revise their policy based on the publicity this has gotten. But while it might show more empathy to have someone else deliver the news in-person, I'm not convinced that it will overall result in better patient outcomes. (I'm also assuming that since it was Fremont, CA, it's not like the robot was the only way to have a relevant specialist there. If it was a second- or third-world country, by all means send in the robot with a pulmonary oncologist to tell me there's no hope rather than having a GP try to make the call).

yellowapple 8y ago

> "We offer our sincere condolences," said Kaiser Permanente Senior Vice-President Michelle Gaskill-Hames in a written statement, "We use video technology as an appropriate enhancement to the care team, and a way to bring additional consultative expertise to the bedside." You keep using that word, "appropriate". I do not think it means what you think it means.

onetimemanytime 8y ago

>>"Devastated. I was going to lose my grandfather. We knew that this was coming and that he was very sick. But I don't think somebody should get the news delivered that way. It should have been a human being come in," Wilharm said. Well, when you are ready to clock out at a certain age, people should celebrate the life you lived and make peace with the fact that this is part of life. Now a 15 year old boy /girl is very different for obvious reasons. If his life was measured in minutes ("might not make it home") maybe they had no other choice by Skype? Maybe another doctor at the hospital but he isn't his doctor

pkaye 8y ago

I've and some family members have been going to that particular hospital. Generally had good experience especially if getting admitted. Most of the nurses are so compassionate. However its been getting more and more busy. These days their entire parking lot is filled during daytime. I sometimes have to drive around for 10-15 minutes to find a spot. Its quite the change from even 2 years ago.

aaron695 8y ago

You might like watching Bleed Out (2018) in 2X if this interests you. It mostly diverts from the interesting bit but the unaccountability for when remote medicine fails is scary. Having one person watching over 100 people in ICU remotely is not the remote medicine dream I expected.

kbos87 8y ago

I have a relative who recently passed away after a short battle with cancer. In the weeks and months following her surprising diagnosis, she didn’t want to know the details of her prognosis, which I’ve come to respect and understand. While her physicians also understood and respected that, during an emergency room visit due to her cancer, she was quite coldly and clinically told what her prognosis was. I’ve come to recognize how important proper communication - communication that respects the parties most deeply affected - really is.