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

115 点作者 turtlegrids大约 6 年前

26 条评论

nkoren大约 6 年前
For anybody who is confused about why this is an issue:<p>There&#x27;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.<p>The wrong way involves doing none of those things, because you are talking to them via a shitty Skype connection on wheels.<p>Technology has a huge role to play in healthcare. It&#x27;s invaluable in diagnosis and treatment. In the long run it&#x27;ll probably put a lot of people who do those kind of things out of work. But it should <i>not</i> be used to replace the empathic, emotional aspects of healthcare. If anything, the labour efficiencies generated by technology ought to <i>increase</i> the resources put into empathy -- not be used to eliminate it.
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wlesieutre大约 6 年前
If you have 40 minutes, 99% Invisible did an episode last year on some of the history of how doctors deliver news like this.<p><a href="https:&#x2F;&#x2F;99percentinvisible.org&#x2F;episode&#x2F;breaking-bad-news&#x2F;" rel="nofollow">https:&#x2F;&#x2F;99percentinvisible.org&#x2F;episode&#x2F;breaking-bad-news&#x2F;</a><p><i>&gt; 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.</i><p><i>&gt; 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.</i><p><i>&gt; 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><p>I don&#x27;t think &quot;through a video screen with poor audio quality&quot; came up, but I&#x27;m guessing Buckman wouldn&#x27;t have recommended it.
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miesman大约 6 年前
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 &quot;save&quot;. Dealing with this sort of thing day after day the staff becomes numb to a lot of things.<p>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&#x27;t want to go there.<p>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&#x27;t feel delivering this sort of news via a video screen is appropriate though.
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dougmwne大约 6 年前
I think this article deserves visibility on HN because it&#x27;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.<p>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.<p>So this might have been just another fleck of clickbait if it weren&#x27;t for the fact that it&#x27;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&#x27;t dissociate from the impact of your work. Own it.
Nomentatus大约 6 年前
Maybe it&#x27;s just me, but I&#x27;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&#x27;m dead.<p>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&#x27;s gonna be a bad enough day as it is.<p>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.
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AnIdiotOnTheNet大约 6 年前
As it is a Doctor&#x27;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&#x27;s life, to the doctor it&#x27;s tuesday.<p>I sometimes wonder if the patient demand for &quot;bedside manner&quot; has led to having doctors with less actual medical skill. I mean, I wouldn&#x27;t choose my mechanic based on how comforting they could be. I wouldn&#x27;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&#x27;t true.<p>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&#x27;t know. I just think it is worth reconsidering how this works in today&#x27;s world.
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otras大约 6 年前
I’m reminded of the NYT piece <i>How to Tell a Mother Her Child Is Dead</i> by Naomi Rosenberg, an ER doctor in Philadelphia. Highly recommend reading it for insight into the relationship between doctors, death, and patients.<p><a href="https:&#x2F;&#x2F;www.nytimes.com&#x2F;2016&#x2F;09&#x2F;04&#x2F;opinion&#x2F;sunday&#x2F;how-to-tell-a-mother-her-child-is-dead.html" rel="nofollow">https:&#x2F;&#x2F;www.nytimes.com&#x2F;2016&#x2F;09&#x2F;04&#x2F;opinion&#x2F;sunday&#x2F;how-to-tel...</a>
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droithomme大约 6 年前
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.<p>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.<p>It&#x27;s a pity the journalist didn&#x27;t follow up by asking Kaiser where the specialist was physically located.
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elpakal大约 6 年前
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&#x27;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&#x27;s lost forever. I don&#x27;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.
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danso大约 6 年前
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 &quot;the doctor was going to make rounds&quot;. Was this particular doctor actually at the facility?He didn&#x27;t look he was dressed to work at the ICU that day.
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sodosopa大约 6 年前
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.
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uberman大约 6 年前
I&#x27;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
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ryanmarsh大约 6 年前
I remember the day the doctors told us my daughter wasn&#x27;t going to live. My wife didn&#x27;t even want to be in the room, she knew what was coming. It was something we were prepared for so frankly it doesn&#x27;t matter if it would have come through a video conference. So long as the doctors are respectful I&#x27;m not sure what someone expects. Death is coming. It&#x27;s horrible news. We talk about so much through glass these days anyway I feel like this won&#x27;t be a concern for long. Death is coming. There&#x27;s no good way to spin this or make it go away. Just, prepare.
ldargin大约 6 年前
I would prefer this over getting the news even a day later.
onetimemanytime大约 6 年前
&gt;&gt;<i>&quot;Devastated. I was going to lose my grandfather. We knew that this was coming and that he was very sick. But I don&#x27;t think somebody should get the news delivered that way. It should have been a human being come in,&quot; Wilharm said.</i><p>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 &#x2F;girl is very different for obvious reasons.<p>If his life was measured in minutes (&quot;might not make it home&quot;) maybe they had no other choice by Skype? Maybe another doctor at the hospital but he isn&#x27;t his doctor
kbos87大约 6 年前
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.
pkaye大约 6 年前
I&#x27;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.
yellowapple大约 6 年前
&gt; &quot;We offer our sincere condolences,&quot; said Kaiser Permanente Senior Vice-President Michelle Gaskill-Hames in a written statement, &quot;We use video technology as an appropriate enhancement to the care team, and a way to bring additional consultative expertise to the bedside.&quot;<p>You keep using that word, &quot;appropriate&quot;. I do not think it means what you think it means.
jordache大约 6 年前
there are plenty of terrible doctor&#x27;s out there... Why should we expect doctor&#x27;s to be any better than the avg population? Same goes for other jobs that we put on a pedestal, like police etc..<p>should a personality qualifier be required for certain jobs?
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writepub大约 6 年前
@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.
_aleph2c_大约 6 年前
Like this: <a href="https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=b9PyR71Aefk" rel="nofollow">https:&#x2F;&#x2F;www.youtube.com&#x2F;watch?v=b9PyR71Aefk</a>
mcguire大约 6 年前
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.<p>Really poor idea, though.
spease大约 6 年前
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.<p>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 &quot;saw&quot;.<p>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 &#x27;personal space&#x27; like I would a person.<p>So I personally wouldn&#x27;t be offended as long as I felt like the doctor was doing everything they could. In fact I&#x27;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.<p>So I don&#x27;t know why the doctor wasn&#x27;t there that day, but I do understand that he has his own life and other patients to get to. If he&#x27;s sick, or his kids were sick, or something else came up, I understand that just because he&#x27;s a doctor who makes life or death decisions doesn&#x27;t free him from the responsibility of the rest of his life. He may be dealing with a dozen other delicate cases that can&#x27;t easily be handed off, and it just so happens that mine is the one he can&#x27;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.<p>I suspect Kaiser will revise their policy based on the publicity this has gotten. But while it might show more <i>empathy</i> to have someone else deliver the news in-person, I&#x27;m not convinced that it will overall result in better patient <i>outcomes</i>.<p>(I&#x27;m also assuming that since it was Fremont, CA, it&#x27;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&#x27;s no hope rather than having a GP try to make the call).
naicuoctavian大约 6 年前
1st world problem<p>I used to live in Romania where hospitals are full of deadly bacteria, doctors are corrupt, nurses are corrupt. There&#x27;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.
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neom大约 6 年前
The ridiculousness of the society we are building is moving from sad joke to an utter tragedy.
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kiba大约 6 年前
The headline confused me. I thought it was a doctor telling his patients that he&#x27;s dying?
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