“ROBOT” Doctor Delivers Bad News | Wednesday Checkup
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“ROBOT” Doctor Delivers Bad News | Wednesday Checkup

– Robots delivering bad news to a patient? Is that really what happened? Let’s talk about it on this
week’s Wednesday Checkup. (bouncy music) Earlier this week you guys
tagged me in a story on Twitter. You sent it to my DM’s, about
a family that was complaining about Kaiser Permanente Hospital
in Freemont, California, where their family
member was given bad news by what they perceive to be a robot. I did these at the wrong time. The story goes as follows, and again this is not gonna be 100% factually accurate because I
didn’t speak to the family. I’m reading reports from
various news agencies and we know how those can
be inaccurate at times. Also Kaiser Permanente
the hospital system itself released a statement, but
the report itself was limited on information, and rightfully so, because that patient privacy, HIPAA Law, that we always talk about. Basically what happened
was there was a family that went to the Kaiser
Permanente Hospital with one of their elderly family members who was diagnoses with COPD. It was very advanced COPD. There’ve been many
hospitalizations in the past. The patient was brought
to the Intensive Care Unit where he was being cared for,
seen by in-person doctors, nurses, given an initial diagnosis. At some point, most of the
family left for the night to get some rest, but
one of the family members ended up sticking around. In the midst of this night,
I don’t know at what point in the night this happened
in, a robot, or machine, however you wanna call it,
that had a video connection to a doctor sitting at
the other end of wherever this machine connects
to, with a headset on, was giving the results
of the scan that came in. This doctor came on saying
that the scan results did not look good, there was
basically no lung tissue left, that comfort care was likely
to be the only option. The family member was
actually trying to translate all these details to her grandfather ’cause he had trouble hearing. It didn’t look like the
interaction was happening smoothly. There was also a nurse in the room, but I did not see the nurse
having any kind of engagement or interaction with the
patient or the family while the doctor was
making the conversation via the video conference. So after this event happened,
the rest of the family rushed back at the request
of the granddaughter, they found out that based
on this conversation, their family member was dying and had only hours or days left to live. And they were very
unhappy because the news of this terminal illness, diagnosis. and comfort care treatment
plan, was given by a human, but through a piece of technology where it didn’t feel human. And I think that’s a really
important distinction that we’re gonna talk about throughout the rest of this video. The family went on to contact some media, letting them know they were unhappy with the treatment they received. They didn’t feel like it
was compassionate care. And media ran with this story, I mean, talking about robots, healthcare, victim, there was just like all the
trending things that are needed for a story to go viral were all there. Then Kaiser Permanente,
the hospital system, put out a release saying they were unhappy with the coverage that this was getting, they couldn’t give details out because of health privacy for the patient. Which is, at times, unfair
to the hospital system but also very important for the patient. But what they did say
was they were unhappy that people were calling
the machine a robot, because it sounded like a
robot like you are gonna die came out and said something like that. It wasn’t that, it was
a doctor on a screen doing a video conference. I wanna talk about the
family’s side of things, of how they experienced it as well as Kaiser Permanente’s
side ’cause I think both parties are right to some extent. But I’ll tell you ideally how I’d like for these situations to happen. I’ll start with Kaiser Permanente because that’s a simpler
portion of the story. I think they have a right to be upset, ’cause media often gets
healthcare stories wrong. They don’t report accurately, they like to have a sense of outrage ’cause it gets more clicks, views, likes, tweets, all of that stuff. So I can see why they’re
upset ’cause there was a lot of misinformation shared. Now, from the families side of things, there are certain situations that require a human touch in medicine, and
life or death conversations certainly falls into that subset. If I’m gonna be giving life changing news, I want that person sitting in front of me. Now they can choose to not do that, but ideally this is how you should handle these moments as a physician. This is the way we were trained to do it. Because there are some subtleties that a video conference or a
telephone can’t pick up. You can’t pick up if it’s
smelling in the room, you can’t pick up sight, sounds, you can’t pick up subtle
gestures and facial expressions or body movements that
the patient’s making. It’s a suboptimal approach
that should be used in extenuating circumstances. And based on my limited
knowledge of the situation, I don’t think this was an
extenuating circumstance, I also don’t know how much
the family knew beforehand. Telemedicine is just not the way we start a comfort care discussion. And it may have been, you
know, brought up in the past, but it was clear in this
video that the doctor was instituting, or starting
to institute comfort care, asking the patient what they wanted without the patient fully
grasping the concept and without the family members present. To me, it even little sense
why the teleconference machine had to be there at night. Could’ve the scan results
waited til morning when the doctor came in in person, or when the family members
were gonna be present? If it couldn’t wait, let’s say, you know, it was an emergency situation. The labs were looking really bad, the scan was looking really bad, and an emergency situation happened. A, the entire family should be contacted because the change of
status was about to happen. B, the nurse should go in and discuss that with either the family
member or the patient or both and tell them that because of
the sudden change of status, they’re gonna get the video
teleconference machine to have this intimate
discussion with the patient that’s not ideal, but because
this happened late at night, it’s a rural center,
they don’t have a doctor, this is the only way to make it happen. I could understand that. I could get behind why they
need to make that happen. But if that wasn’t the condition, if they were just relaying
the results of the test, and that’s the way they chose to do it without informing the family, without having proper understanding
of what comfort care is or when to make the
decision for comfort care. That’s not an ideal way to do it and family members are right to get upset. Now, that does not mean I’m
saying the media is right, because the media is wrong,
they’re overblowing the story, they’re saying a robot
gave a terminal diagno. That’s not exactly what happened. I’m also not saying that
telemedicine is evil. In fact, it’s necessary. But it needs to be used
in very specific cases and you need to understand what it lacks and it lacks that ability
to catch subtleties, it cannot do a perfect physical exam, it cannot grasp the
emotion of a given moment through a computer screen. Until we understand that,
until we perfect that, we’re gonna have cases like
this come up every now and then that we need to learn from
as health professionals. We need to see at times
when we can use technology to our advantage and when we cannot. And I think this is a great
time to broach the subject of AI in medicine, because
I feel like doctors will never be replaced by AI. Humans trust another human
sitting in front of them, even if they’re less likely to
be accurate than the machine, we still want the human. Because the human can
understand our emotions. And humans, we’re imperfect creatures. That’s why medicine is as
much art as it is a science, because the art is understanding
the human in front of you. Understanding that they may have emotions that’s causing them to
misunderstand the situation. Having emotions that’s gonna make them incorrectly follow a treatment plan, and only when you can
grasp a person’s emotions, their state, their body language, their capacity to reason and understand, only then can you give a
diagnosis, a treatment plan. Will we have AI technology
at some point reading scans, or doing pathology? Yeah it’s possible. But replacing doctors? I don’t think so. This is a tricky conversation, and I know people have
their own thoughts on it, so I encourage you to jump
into my comments section so we can continue that conversation. You know, I stand with
the Quintana family. I think that humanity
should be kept at all times within medicine to get
the best result possible for the patient and the patients family. I send my condolences
to the Quintana family and I wish you guys at home
to stay happy and healthy. Thanks for watching. (upbeat electronic music)

About Bill McCormick

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100 thoughts on ““ROBOT” Doctor Delivers Bad News | Wednesday Checkup

  1. In my hospital in Tunisia, all hell breaks loose during the night shifs. It's like a horror movie. People everywhere, there are one or two security gards and only interns and residents to care for an average of at least 500 patients in the ER. the scariest thing ever is to delier bad news to the family members. Many doctors are subject to moral and physical violence with not so much they can do.
    Last week a patient was brought in already dead and he had four brothers threatening to "destroy the hospital" and "kill everyone" if we did'nt save him.
    I wish I had a robot to deliver the news to these people.

  2. https://www.nytimes.com/2019/03/16/world/africa/tunisia-health-care-babies-infections.html?fbclid=IwAR18wp-cTCe1c8j5zJ6BgwM9cszkQy09hZF3UzChuOCHrRzPcez-uUa9oh4
    Last week eleven new born died in the hospital and they were given to their parents in cardboard boxes 🙁

  3. Grey's Anatomy Episode Recommendation
    Season 6 Episode 6 "I saw what I saw"
    Episode is great! And would love your opinion from your point view! Plus the style it was directed in is pretty awesome!

  4. Kaiser is trash I’d never have Kaiser as my provider. I’ve had enough experience to know they are never who I would go to. My dad died of complications from COPD and Kaiser was horrible with him. Their hospice nurses except for one was horrible. Other people I was with when they had an emergency and went to kaiser had horrible experiences. One time I became the entire ERs advocate. I have Blue Shield and have more of a choice, which is nice. Kaiser is awful you can never really have a second opinion with them. And I love Blue Shields Teledoc. Soooooooo convenient like when I had a spider bite, a chronic cough, etc

  5. I am starting to have feelings of light sadness but I don’t think it is depression. I was wondering what would be some good over the counters to help lighten my mood before just going to the doctor with hopes of getting antidepressants

  6. I'll start by saying that I am not a doctor, but I am a healthcare professional. I have also been on the family's side of similar news. In both positions, I have to agree that humanity has such a big part to play when it comes to interaction between the family and doctor/nurses/etc. There's more empathy and it helps the family and patient feel more cared for and feel as though you are more devoted to the patient's case, and most are more likely to trust and actual person than a robot. And it's a comfort of sorts to have that professional in the room to speak with, as opposed to talking through a screen. It's like a phone call; you have this life changing news that you are going to hear; most people would appreciate that being in person.

    If someone had told me through a video call that we had to take my Cousin off of life support, I would have been upset as well.

    (My opinion, anyway. Others are welcome to differ, obviously. A good discussion often needs opinions from both sides.)

  7. Honestly the video cam is great for some situations but maybe with sensitive information person to person is great. That’s just my opinion.

  8. I mean, they are KP. They dont always have the most personal of doctors. I have been a patient there for 13 years. KP does have many great things about them, but sometimes I think they can get a little ahead of themselves. When I saw the headline I automatically thought it was Kaiser, and it didn't shock me that it was.

  9. Hi Doctor Mike ..! How to prevent gritted teeth during sleep.. coz its so shame when u sleep someone and your teeth is so noise and disturbing.. i hope u read this and can advise me.😊😊😊 thank u..!

  10. I've actually had a talk about it with my parents (both doctors) the other day after watching a video on youtube : "Humans Need not Apply". They basically used the same arguments. And I definitely agree with it. In my opinion a human factor is essential in doctors' interactions with patients. At the end of the day it's easier to talk with someone who we can emphatise with. Personally, as a future doctor I cannot imagine telling sad news to someone through a screen.
    P.S. love your videos 💕

  11. While I'm probably an outlier, I'd rather have a robot deliver this kind of news. I never could connect with other people well, just give me the facts and let me process it my own way, the typical 'sympathies' come off to me as fake…

  12. I wish all doctors were honest and open like you. I live in northern california and its so hit and miss with the Kaiser permanente healthcare system. In fremont and the south bay as a whole there is a severe shortage of doctors and facilities so I can imagine that this hospital was probably strapped and was trying to get this patient in and out of their facility, typical kaiser. smh.

  13. So… can I have a brain surgery that removes the part of me that wants human doctors? And while your at it, could you remove the part of my brain that slowly kills my body when I feel lonely?

  14. My employer and insurance company is really pushing telemedicine services for basic stuff including diagnosing a UTI or bronchitis. HOW would that work without a physical examination?

  15. Would love to hear your opinion on this: Teen escapes from Mayo Clinic https://edition.cnn.com/2018/08/13/health/mayo-clinic-escape-2-eprise/index.html

  16. Thanks for making my dream job even stronger. This is why I want to become a paediatrician. To help children and comfort them. You truly inspire me.

  17. Well done sir, I feel you handled what could be a delicate topic with care and fineness, well done once again sir, if I was wearing a hat, it would be of to you. 🙂

  18. i mean to be honest

    if your family member is dying and your first idea after this happened is to contact media and make a story out of it
    you know what the priorities are

  19. Last year my father was having sezuires back to back and we waited for neuro to come by, once they calmed down they let us know that we were seen by a tele doctor and my family was put under an extreme amount of stress. My father ended up passing all tests and was sent home, it turned out it was Anti- Gaba B Encephalitis. My family and I petitioned for a doctor to be physically present but there was no choice.

    It is important to have a doctor that is physically there and fully engaged with the patient and their family.
    In some cases it may be necessary, but my family prefer a physical doctor to be present and if not the patient and family should have notification of the lack of a doctor physically being there prior to waiting for a doctor to come with results.

  20. I agree with you 100%, technology has its time and place but we shouldn't be leaning on it in all situations.

  21. I've just used this video as a debate in my class in Portugal! Thank you for your insight! Cheers from Portugal

  22. Maybe this isn’t the scenario everywhere , but I am a medical student in India and here the doctors often get BEATEN up for giving bad news especially delivering the news about death of the patient admitted. Often they’re admitted very late and however doctors try, they aren’t able to save the patient due to obvious acceptable reasons . Instead of understanding the situation the people accuse doctors of not doing their job properly and beat them up – unhesitatingly. So I feel having a robot deliver bad news is acceptable here, atleast the doctor who did his job is safe behind a screen! There were also instances where the hospital windows have been shattered and broken, so yes medical field now requires safety of the doctors and care of their health more than the patient’s.

  23. Your video on MD vs DO spurred me to switch my PCP from an MD to a DO! I see her a month from now and I'm excited to see if she can give me the help I need that my previous PCP wasn't.

  24. My mom died in December from COPD/emphysema….I would be so upset if that is how they told my mom and our family her prognosis thru a "web cam"!!!! Wow!!

  25. I've had one experience with telepresence in a medical setting: with a psychiatrist to discuss my Generalized Anxiety Disorder. It was the mold cold, distant, and uncomfortable interaction I've ever had with a medical professional and ironically sent my anxiety through the roof. I don't know how much of the blame falls on the use of telepresence vs. the psychiatrist's poor bedside manner, but it was enough to keep me from coming back to see them again.

  26. It's unfortunate the family feels this way, but the doctor made the choice to use the robot. The news doesn't change, and we don't know how busy the doctor was (however, he is likely incredibly busy). A nurse delivering the news may have comforted the family, but the nurse likely doesn't have the results/knowledge to answer follow up questions. We don't even know where the doctor was. I support the doctor, but I don't support the family or media in this.

  27. If I were the patient, I would not have liked this. I would have waited until the morning when the doctor is in person unless it was an emergency situation. (Like was about to die before morning) It feels like the dr. was getting out of an uncomfortable situation.

  28. Media's main goal is to get clicks, not to inform. It's really sad that we can't rely on journalists nowadays

  29. I was in the hospital not that long ago and they had me there for a week. I was nbm the entire time because I was waiting to get surgery (gallbladder removal. it was kinda emergency, I didnt know I had gallbladder issues until 11 or 12 hours after being admitted)
    With how long I had to wait for results for tests and to find if I could eat that day (I never found out until the last day I was there, they sent me home for a week because the pain settled and had me come back for the removal surgery) I would have LOVED if they sent the "robot" to me

  30. How the F can u leave ur relative get soooo bad with COPD (sure, they didn't know the diagnosis but the person can't breathe properly… there are only a few things to do in a case like this) that he comes to the ER and has less than 24h to live, that's like EXTREMELY acute COPD…? Like… what the…

  31. When he did the the robot voice “you. are. gonna. die.” 😂🤣😭😩 I’m sorry but that had me cry laughing!!!

  32. I don’t think “extenuating” is the word you wanted. Maybe “extreme” or “exceptional” would have been better?

  33. that robot doctor reminds me of an episode of bobs burgers when tina broke her ankle and used a robot version of herself to go to class and around town

  34. Personally I hate the tele com things. They do make a person feel very removed from everything. It makes things feel very impersonal and can make a person feel unimportant.

  35. I think if anything then maybe a robot and a human can work together on diagnosing a patient. Like both of them can listen and ask the questions and together they make the diagnosis. I think this is best because robots make less mistakes and are good at remembering information while humans notice more emotions and relate to the patient more.

    Though if I had to pick one or the other I would go with the human.

  36. My doctor told me over the phone that the pathologist had made a positive diagnosis of Hurthle Cell Cancer. After two AUS/FLUS FNAs and a suspicious AFIRMA result, we both knew going into surgery that there was a high likelihood of a Cancer diagnosis. In my case, I don't see where it would have made any difference whether or not I had to take time off work and drive an hour to his office to get the results or hear it over the phone, as we had already discussed possible treatment plans before hand. I don't think that it is always a bad thing to get this type of news if you are not physically with the Doctor.

  37. The way you are as a doctor (don't want to give detail because I can be here all day) reflects the way I want to be when I become one. I love the fact that you're a D.O. because that's what I'm falling into and REALLY believe in. CAN YOU BE MY MENTOR 😫 😫

  38. That is insanity indeed but as it should be proper communication shouldn't been carried out IF the unit should had been use in the first place (as a last resort).

  39. Not ONE mention of telemedicine's real failure: entirety of US diagnosticians jobs going overseas: Doctors, radiologists, lab work- all gone overseas. Whoosh!

  40. The family knew already, unless they never paid any attention to the patient's medical history. COPD is not an acute medical issue. They just wanted something or someone to blame to make themselves feel better.

  41. Well when you hear you are dying I know I would want the doctor in the room. By allowing a doctor to give bad news in person basically is just a slap in the face and basically say you are not worthy of me to show up while I give you this horrible news that the patient cannot even understand completely. It is and really unbelieveable. While the doctor was in who knows where and he is giving me information and he does not have the empathy to tell me in person is horrible and then the doctor is going to charge of burdens of dollars for the consult or so called visit is appalling. The fact that any hospital would think this is OK see medicine and patients as nothing but body part instead of the emotional and mental health aspect for the patients. This is not the direction we should be going towards. I know I would be pissed if my doctor pulled this on me .

  42. There is a time and a place for telemedicine, but in this case (unless there we're extenuating circumstances) I do feel it was not the time or place. Also, I do have a question for an upcoming video about deodorant, specifically the aluminum found in most conventional deodorants. How harmful is it actually, and why is everyone making such a big deal about it?

  43. AI "nurses" will be a thing. Something that monitors data instead of interpreting that data. For instance, you could plug in facts about a patient like medications and vital signs and the AI could monitor known complications and send out warning signs in case the doctor misses those complications. You always need someone who can verify whether a machine is working correctly and with medicine that means there is no benefit for creating an AI that can diagnose. The only benefit is in creating logs and warning signs to prevent emergency situations.

  44. Doctor Mike: talks while using air quotations

    Me: Just STOP! You always use them wrong!

    Btw, I love your videos 😁😆

  45. Hi, I work in the healthcare field as a Spanish Medical Interpreter. I work as an interpreter at home through video. Most people always prefer to have someone in person and I understand that. The ability to connect with an interpreter almost right away is the biggest perk compared to the delay in having to track down an interpreter. Another advantage of having a career through video is because I have a physical disability and working from home has been amazing! I just wanted to say I'm a huge fan and love all your videos. It would be great if more doctors were like you!

  46. I think the place of AI in healthcare is for very specific circumstances when a specialists expertise is needed. No single doctor can provide the same quality of care as a specialist would, for every single topic. If you want to have the world's best doctors on a specific disease to be involved with a patients healthcare, bringing that expert to meet every patient in person is impossible. So by either using remote communication, or AI is needed. So I think that an AI should be consulted by another human doctor that actually deals with the patient, but not be the only 'doctor' a patient deals with. Especially with emotionally sensitive topics like a prognosis of a terminal illness.

  47. If the AI robot can scan the environment and is able to recognize patterns in human behaviour it would be able to take a person's emotions into consideration probably much better than a human can

  48. I think it would have been better to give the info to the nurse so she or he could pass on the info to the family and make sure the family could make their decisions. It would be much more efficient and less confusing for the patient and family

  49. doctors arent moral support, if you think they should be you are in the wrong business, change profession to 'spiritual healer'

  50. Dr. Mike, how do you feel about the apps and websites where you can order or prescribe yourself birth control medication?

  51. I am all for telemedicine, I’ve been on the same medication for 10 years but I have to get blood work every six months. My blood work has always been the same and we have never had to change my medication but my doctor insists on me coming into the office for a literally five minute visit oh me everything looks good see you in six months. I drive a semi truck I don’t have Time to takeoff work to come into your office for five minutes for you to tell me the same thing you’ve been telling me for 10 years.

  52. Buenas tardes Mike.
    Buena información va hacer difícil que el humano acepte que un robot o máquina diagnostique a el enfermo. La ciencia acabas la tecnología avanza y nosotros tenemos que avanzar también. Gracias por los subtítulos de este video. Que tengas una excelente tarde.👋🙂💖👣

  53. This family just wanted something to bitch about. We use video chatting all the time in our lives. Why should this be seen any differently than any other video call?

    It's not like they didn't have other staff on hand to help explain what the doctor was telling the family and provide the emotional support they were wanting and needing at the time.

    If there was not an appropriate doctor available at the time, would you rather have someone who is not qualified, or a qualified individual who is telecommunicating with you? I would definitely choose the latter.

    Telemedicine is a great thing. It gives us access to specialists that we would otherwise not have access to, especially at night. What I often see with specialists that are in town and on call is that they'll do anything they can to let the patient wait till morning. They don't want to come in. But a telemedicine doctor is being paid to be available right now and give you answers right away and in a much closer to "in person" way.

    I hate the way the media overblows stuff like this. They can really set healthcare back with their terrible reporting. I used to want to be a journalist. So glad I avoiding becoming a disgusting snake for my job.

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