In telling man he would soon die, technology overwhelms humanity

The world of medicine is still trying to figure out how to incorporate the wonders of technology with the need and importance of human interaction and comfort.

It’s still got a way to go, if the story of Kaiser Permanente Medical Center in Fremont, Calif., is any indication.

They use technology and video conference there, which works pretty well most of the time, according to reports.

Where it fails, according to one family, is when technology overwhelms the humanity.

Annalisia Wilharm was in the room when the “robot” — as she called it — with a video screen, and a nurse who stayed silent came into her grandfather’s room last Monday night, CNN reports.

Appearing on the video screen, a doctor, whom Wilharm did not recognize, told Ernest Quintana, 78, he was likely never going home.

For the record, the doctor nailed the prognosis. Quintana died the next day.

“I just figured it was routine,” Ms. Wilharm tells the New York Times. “I didn’t think he’d get his death sentence here.”

“This secure video technology is a live conversation with a physician using tele-video technology, and always with a nurse or other physician in the room to explain the purpose and function of the technology,” a hospital spokesperson said, saying ‘robot’ is not an accurate term in this case. “It allows a small hospital to have additional specialists such as a board-certified critical care physician available 24/7, enhancing the care provided and bringing additional consultative expertise to the bedside.

“It should have been a human,” Catherine Quintana, Ernest’s daughter, tells the Times. “It should’ve been a doctor who came up to his bedside.”

“We understand how important this is for all concerned, and regret that we fell short of the family’s expectations,” she said.

“We should all remember the power of touch — simple human contact — can communicate caring better than words,” said American Medical Association president Dr. Barbara McAneny.

  • kat

    This is the area of healthcare I work in- I talk to patients in remote sites via a camera/screen in the patient’s room. The NYT article really didn’t cover the story well- the man already knew his diagnosis. The doctor on screen was providing care to a dying man and the medical team can’t do that without making sure the patient knows what is going on and what the prescribed treatment means. It would be awesome to have an MD at every bedside at all times, but that is impossible. Previously these hospitals would put patients through long ambulance rides to get the same prognosis and treatment. I commend the on screen doctor for meeting the patient’s needs- it’s very difficult to have these discussions at anytime and it’s more difficult to have them remotely but it is not poor care.

    • // It would be awesome to have an MD at every bedside at all time

      So this was a “yep,you’re still going to die” meeting? I’d say that would be one of the times. Otherwise, what was the point of the meeting?

      Also, Fremont , Calif, isn’t Bugtussle.

      • kat

        End of life care is complicated and often urgent. There isn’t time to make sure the setting is perfect before you intervene. Talking about death is still taboo for most Americans, but that doesn’t mean we just don’t talk about it. Healthcare workers don’t have that luxury.

        • I don’t think not talking about is an issue in this case at all.

          • kat

            I’m not sure what you think the healthcare team should have done- said nothing until the pt was unconscious and then just let the family know he wouldn’t wake up? Working with this situation every day- I can say with confidence the healthcare team did not do this lightly. I do think there was a lack of communication before this hospital visit. We use terms like palliative care, no further treatment options, poor prognosis- but rarely do we say “dying” because of course we can rarely say it with %100 certainty regarding the time. I wish this patient’s primary doctor had a plan in place for when this patient would begin to actively die. I’m very sorry his last days were so stressful

          • I think you answered your own question. Let them know ahead of time that the doc will be visiting by videoconference so that the widow-to-be can be there. I’m not sure why you see “say nothing” as the “or” to the “either” of this situation.

          • kat

            The wife was at home, not in the next room. People don’t die on our schedule. But I hear you- this is a sensitive issue that should be dealt with carefully. I think the NYT article misrepresents the actions of the health care team by reporting only what the patient’s family percieved in a time of great duress.

          • Al

            I’m not sure their perception isn’t what’s most important here, anyways, though. I appreciate you guys are between a rock and a hard place, many, many times during a patient’s care, and I don’t believe in absolutes in any situation–we can’t say telemedicine would always work for some, and never for others. In this case, it feels like a bit of extra review in the care plan would’ve gone a long way.

            A lot of the time, it seems health care is just a shitty situation, all around.

      • kat

        And to be clear- I don’t fault the family for their perspective. They have the right to grieve and do what they need to do.

      • AL287

        Mr. Quintana should have been sent home with hospice care when his condition was determined to be terminal.

        Had that been done, the whole sterile, impersonal interaction could have been avoided.

        “a hospital spokesperson said, saying ‘robot’ is not an accurate term in this case.”

        The computer is a machine and no different than a robot in that regard.

        As one of those who grew up in the era of rotary dial telephones, and cars with carburetors, I prefer hearing bad news up close and personal.

        I don’t even like “Merry Christmas” sent via text message which my family did for the first time this past holiday.

        As a nurse, there is no way I could have stood silently by and watched the whole mechanical thing unfold, protocol or not.

        Human beings are flesh and blood, not mechanical machines and this type of interaction reduces them to just that.

        The family had every right to be incensed.

  • vahawkman

    In the next 10 years there is going to be an estimate 100k physician shortage in the US. Robots/technology will be used more and more. Our healthcare system would become even more stressed, more physician shortages, if free health care comes about in the next 10 years. No easy answers.

    • BJ

      > even more stressed, more physician shortages, if free health care comes about

      Free health care doesn’t exist, I think you meant universal health care where providing financial risk protection, improved access to health services, and improved health outcomes is the goal.

      It would probably increase demand for doctors because people might go to them instead of dying or getting everyone else around them sick. oh wait, if they get go to doctor and don’t spread flu maybe they will create less stress on the system? Maybe if they get preventive health coverage the end of life terminal coverage that takes an excessive amount of current resources would not be as needed, creating less stress on the system? Perhaps..

    • jon

      You have to start at the why. Why is there a physician shortage?
      Boomers are retiring because they are old.
      Millennials aren’t becoming doctors because it’s prohibitively expensive to get a MD.

      So the issue here is both that we let boomers retire, and that we aren’t doing enough to keep education costs low.

      Crazy suggestion: cancel social security benefits for retirement and dump that money into education. Boomers can’t retire, Millenials get money for school… it’s a win/win (unless your a boomer…)

      Realistic suggestion: Fixing such a broken system is going to have some short term pain, there is no way around it. And we’ve avoided that short term pain for so long while the system got worse and worse, we are eventually going to have the bite the bullet and make some sort of drastic change. Nothing can run this broken for this long and not have it be a challenge to fix, if it was easy we would have fixed it already.

      • Karl Crabkiller

        The number of medical doctors in the USA has been increasing faster than the general population over the last 40 years. The doctor shortage issue is local not national.

      • William_TellAll

        Physicians who want a specialty beyond primary care physician require up to 12 years from bachelors to med school to specialty training. Many physicians now won’t take Medicare patients because their reimbursement rate has been chopped so many times by the government.They can’t afford to take new Medicare patients and pay off their loans.

      • Frank

        PAs and NPs can do a lot of that work.

  • Guest

    ALSO, every other approach would have taken more time. This man did not have time as shown by the facts.

    No single answer to be applied across the board is gonna work every time.

    • Where was the doctor that it would’ve taken 12 hours to get to where the patient was and where was the wife that she would not have been able to get there before the doctor would have?