4 Thoughts on Telemedicine and Robot Doctors
March 21, 2019
Occasionally we’re fortunate enough to share the perspectives of others on this blog, along with our own. This post is co-written by Dr. Ben Panwala, a hospitalist and founder/CEO of Telshur.
Earlier this month, there was a stir about a ‘robot doctor’ giving the family of a terminally ill man some difficult news about his condition. Evidently, a remote physician appeared on a screen and was positioned at the patient’s bedside to discuss his case. The family took to social media to share the experience and state that this is no way to tell a patient he’s about to die.
The team at Cloudbreak use the phrase “humanize healthcare” a lot, and along with Telshur, we both believe that technology has tremendous potential to help us meet that goal. So, what went wrong in this situation? Likely several things.
Quite a few physicians have spoken out to defend the doctor in this story (and technologists have defended the tech as well). But maybe this misses the point. We sympathize with the family but also acknowledge the challenges of the remote doctor in delivering high quality care over distance and pushed by time constraints. Scenarios like this can happen anywhere and do happen numerous times a day across the country, and around the world—whether it’s in-person or remotely.
When these events occur, we should always look at opportunities they present to look for insights and areas of improvement. We suggest four takeaways to ponder—
- Core to a clinician’s role is talking to the family and delivering news. This is true regardless of whether the doctor is in the room or hundreds of miles and two iPad screens away. With demanding clinical assignments, it can be tempting to take shortcuts and not engage patients on a deeper level. In this way, a doctor may not fail medically, but may still fail the patient. But care providers need to connect with their patients and their families over media just as we would in person.
- There is a “digital etiquette” that’s different from face to face interactions. This one should be obvious. Think of two friends hanging out together. One utters a sarcastic comment but does so with a smile and a wink. While the words on their own may offend, there’s an understanding that this is sarcasm and no real offense is intended. Now think about that same remark uttered in an e-mail to a colleague (and no emojis allowed!). The perception would be very different. Fortunately, it’s certainly possible for doctors to ‘read the room’ virtually, but it takes a different set of skills and steps.
- Training is needed to ensure clinicians make the best use of the technology provided. Imagine you started a new job and your first assignment was to lead a webinar with multiple participants, on a platform that you’d never used before. Without some foundational training, how likely are you to conduct that webinar without a hiccup? Remote physicians, mental health professionals, language interpreters, and others need to be trained on things like: positioning the equipment for the best view and sound; coaching the person(s) on the other end who may be incredulous; and acting with intention, knowing that some of the non-verbal cues may not make it across the ether. Such training should be built into any robust telemedicine program. When you do this, it results in more precise communications, often shorter interactions, and improved patient and provider satisfaction.
- Telemedicine, or “distributed healthcare” if you prefer, is the future. Actually, it’s the present, but the future promise is even greater. The facts are plain. We’re facing very real doctor shortages, with the gaps in some practice areas much wider than others. And for patients remote from large metro hospitals or who arrive in the ER or ICU before a specialist can be on-site, the promise of telemedicine is that we can deploy more expertise to the patients who need it, and in a timelier manner. We hope both doctors and patients shift from tolerating this reality to embracing it.
When we say “humanize healthcare” it means that technology is at its best when it’s enabling or improving personal medical interactions. We believe the key to this is not focusing on the technology alone, but also the protocols, procedures, and workflows that are being employed by caregivers when using the technology, and then ensuring the technology is supportive of those things that make the difference. Or, put another way, the culture is more important than the communication modality.
We believe, if given the opportunity, being in person to inform patients and families of serious health issues is optimal. But sometimes that’s simply not possible, and for urgent life and death situations, worried families are looking for timely answers and guidance to make decisions.
We know humanized telemedicine can work because we’ve seen it. We’ve experienced provider teams specifically requesting telemedicine interactions on behalf of family members who can’t make it to the bedside in time. They want what’s best for the patient and family, and so do we. And that’s what we hope to achieve with a distributed healthcare future.