Robot tells man he'll be dead in hours

[Emergent, RN]

This is deplorable.

https://abc7ny.com/health/man-learns-hes-dying-from-doctor-on-robot-video/5179413/

SAN FRANCISCO -- Ernest Quintana's family knew he was dying of chronic lung disease when he was taken by ambulance to a hospital, unable to breathe.

But they were devastated when a robot machine rolled into his room in the intensive care unit that night and a doctor told the 78-year-old patient by video call he would likely die within days.

"If you're coming to tell us normal news, that's fine, but if you're coming to tell us there's no lung left and we want to put you on a morphine drip until you die, it should be done by a human being and not a machine," his daughter Catherine Quintana said Friday.

Ernest Quintana died Tuesday, two days after being taken to the Kaiser Permanente Medical Center emergency department in Fremont.

Michelle Gaskill-Hames, senior vice president of Kaiser Permanente Greater Southern Alameda County, called the situation highly unusual and said officials "regret falling short" of the patient's expectations.

But the hospital also defended its use of telemedicine and said its policy is to have a nurse or doctor in the room at the time of remote consultations.

"The evening video tele-visit was a follow-up to earlier physician visits," Gaskill-Hames said in a written response. "It did not replace previous conversations with patient and family members and was not used in the delivery of the initial diagnosis."

Hospital officials say the technology doesn't replace in-person conversations with the patient and loved ones.

Granddaughter Annalisia Wilharm, 33, was alone with Quintana when a nurse popped in to say a doctor would be making his rounds. A robot rolled in and a doctor appeared on the video screen.

Wilharm figured the visit was routine. She was astonished by what the doctor started saying.

"This guy cannot breathe, and he's got this robot trying to talk to him," she said. "Meanwhile, this guy is telling him, 'So we've got your results back, and there's no lung left. There's no lung to work with.'"

Wilharm said she had to repeat what the doctor said to her grandfather, because he was hard of hearing in his right ear and the machine couldn't get to the other side of the bed.

"So he's saying that maybe your next step is going to hospice at home," Wilharm is heard saying in a video she recorded of the visit. "Right?"

"You know, I don't know if he's going to get home," the doctor says.

Steve Pantilat, chief of the palliative medicine division at University of California, San Francisco, said he doesn't know the details in the case but that the robot technology has done wonders for patients and their families, some of whom are too far away for in-person visits.

The video meetings are warm and intimate, he said, adding that not all in-person discussions have empathy and compassion.

"No matter how well we deliver very difficult news, it's sad and it's hard to hear," he said.

Wilharm said her grandfather, a family man who kept every childhood drawing he ever gave her, deserved better. She said that after the visit, he gave her instructions on who should get what and made her promise to look after her grandmother.

"He was such a sweet guy," she said.

[Sour Lemon]

There's the headline, and then there's the first sentence of the article:

"Ernest Quintana's family knew he was dying of chronic lung disease when he was taken by ambulance to a hospital, unable to breathe."

I'm not feeling the outrage that so many others seem to be.

[Daisy4RN]

Without knowing all the details this sounds pretty heartless. However, we all know how family can be sometimes and maybe the MD had already been there multiple times with different family answering the same questions over and over. It was the granddaughter that was in the room so maybe the MD had already talked to the pt's son/daughter. And the granddaughter who was distraught immediately whipped out her phone and started recording. I am not sure that would be my first thought if I was getting that horrible news for the first time. Either way sounds like it could have been handled better but we don't know all the details.

[pixierose, BSN, RN]

I was especially bothered that the physician couldn’t appropriately and effectively communicate with the patient d/t his impaired hearing (and the fact that the robot couldn’t get to his “good” ear).

Given news like that, regardless, is just devastating. Media certainly sensationalizes. But ensuring that your patient understands what you’re saying is critical.

[NICU Guy, BSN, RN]

13 hours ago, Daisy4RN said:

However, we all know how family can be sometimes and maybe the MD had already been there multiple times with different family answering the same questions over and over.

Yes, it was not the first time that it was discussed but it makes for a better story.

"The evening video tele-visit was a follow-up to earlier physician visits," Gaskill-Hames said in a written response. "It did not replace previous conversations with patient and family members and was not used in the delivery of the initial diagnosis."

[Night__Owl, BSN, RN]

I've got a wild idea. Maybe, considering this man had just hours of time left, the MD did not want to delay his visit whatever amount of time it would have taken for him to physically arrive there. If youve got three hours left, and it takes the specialist just 45 minutes to get to the hospital, well, that's a quarter of the man's remaining life.

[Oldmahubbard]

I greatly disagree that there is anything wrong with this. The patient had been told many times that his condition was very serious, and probably terminal.

The controversy is all about the bull malarkey that surrounds inevitable death in our society, which many refuse to accept.

The messenger is blamed.

The doctor's other choice was to give him false hope. With which I greatly disagree.

We need to start talking about death a whole bunch more than we do.

Otherwise, maybe we just don't do any telemedicine with people who are really sick.

[DowntheRiver]

I think this is a new grey area.

Personally, I would not want to be told via computer unless it was an absolute must, such as the doctor was two hours away and I had an hour to live. Even then, just seems impersonal.

Oh, and for the person who complained about the granddaughter recording the conversation - she stated that she did it so that she would be able to show it to her parents so she didn't miss any important pieces. Really not a problem as long as the doctor consented.

[Oldmahubbard]

To me, it is the same old nonsense where we never talk about death.

[pixierose, BSN, RN]

1 hour ago, Oldmahubbard said:

To me, it is the same old nonsense where we never talk about death.

I’m not getting that from the article, mostly because the article is so poorly written and sensationalized.

But as a society, I agree: we don’t talk about death. There are some great books out there that address this that I highly recommend - Caitlin Doughty’s ‘Traveling the World to Find the Good Death’ is fantastic.

Getting back to the article, and I think someone here on the thread brushed on it too ... I still feel that the way it was communicated sounds poorly done, not the method itself per se. I’ve seen and had physicians with the poorest bedside manner give me tough diagnoses in person and take off without answering any questions of mine or react rather brusque. This robot communicated poorly by not even speaking loud enough or using the “good” ear, for example (we’ve all had those hard of hearing patients).

The article doesn’t elaborate, was the nurse present? The hospital (I believe) stated that one was to remain present. If so, then I don’t see how this could be that horrific. It was better to save the man time.

And I think any way you get the news, to someone who can’t accept death (and I’m *not* going to blame them; I’m not and don’t want to be in their shoes), you’re GOING to blame the messenger. Any messenger.

[Sassy-RN]

We use telehealth monitors at our hospital during stoke codes to get directly connected to a neurologist.

My guess is this doctor was a specialist that was consulted due to this man’s condition. He could have died before they found out what his prognosis was waiting for a specialist face-to-face.

I see nothing wrong with this!

[Sour Lemon]

The more I think about it, I have a problem with the "robot" aspect of the claim, too. A "robot" didn't tell anyone anything at anytime. It was a video call from a human being.