Monday, March 11, 2019

The problem with ambition in medicine - don't implement solutions till people are ready for them!

Disclaimer: I work in Surgical Robotics currently, and Kaiser Permanente, featured in the story below is my current insurance provider.

The Story: CNN just picked up a rather sad and disturbing story of a patient and at least one of his family members being given sad news, perceived to be delivered in an insensitive manner, through a telepresence robot.

I suspect the story will gather steam, and much alarm and machination will ensue about robotics, AI, the practice of medicine and so on. Well, the discussion is due, and as much as all of us wish more caution had been applied, the first of hopefully, a small number of such incidents has come to pass.

The link for the story itself is available below.

The Summary: After determining that a 78 year old patient with COPD had but days or hours to survive, the Doctor chose to make that alarming and pithy revelation to the patient's granddaughter, in his presence, remotely.

The patient did die the next day, and the family is rightfully quite unhappy. The hospital has apologized and attempted to mend the situation, but I am sure the issue is not over. Now that at least one news outlet has picked it up, as well as other possibilities that I am shy to speculate here, this issue will probably persist in the public eye, and will most likely lead to arguments that drag technology in medicine in several directions.

I wanted to present a few thoughts of my own.

Timing and Technology: To serve patients and their families better, to make medicine more effective
and cost efficient, technology is always being used to push boundaries. The latest agents of change include, but are not limited to robots in pharmacies, surgeries,  comfort (it has been proven time and again to work wonders with autistic people) and other areas.

There is already immense fear of AI and robotics "taking over". It doesn't help that seemingly intelligent people like Musk and Hawking have said some incredible things about Artificial General Intelligence and Artificial Super Intelligence, while we are at a minimum, decades away from achieving such feats.

That said, it is very important to pick and choose how new technologies are implemented. Clearly the Doctor and Hospital Staff lacked sensitivity in this issue. They might have chose expediency, but that is no excuse for what happened here. It would have been so much easier to ask another Doctor to go up and deliver the news in person. I really don't want to hear nonsense about patient privacy being used as an excuse here.

All Fear and Animosity is NOT Ludditism: The other day, I saw a video posted by the passenger of a car, showing their neighboring driver in a Tesla, in a state in between, quite distracted and fast asleep at about 75mph an hour!

The problem is that, "auto-pilot" and "self-driving cars" are far from reality. Tesla has marketed the false notion that their cars can do this well (they can only do this up to a very limited level, and driver attention is very much required).

This distracted driver, and some of the others who have actually succumbed in Teslas tend to anger, just not me, but several people. This is not Ludditism. This is just a criticism of the lack of responsibility with those who use this particular piece of technology.

The Path Forward: We should start with responsibility, in medicine, as much as everything else. Patients are not soldiers. Neither are their loved ones! You can't command them to adapt to technology. A patient and his or her relatives are already quite anxious, and you can't really expect them to adjust to your attempts at unthinking efficiency.

Responsible, gradual, measured introduction of technological solutions and improvements is essential. Yes, it is very difficult to to time things. But rushing in is not the answer.

As technology moves the needle, we expect AI, robotics, telepresence, AR, VR and paradigms we haven't even visualized yet, to become part of the medical toolkit. This behooves us to make sure that the human side is not lost. Solutions must be implemented with care, caution and compassion. In a heightened state of anxiety, most people will not respond to new, shocking delivery mechanisms thrown at them.

Being Uncaring and Careless have Consequences: When people perceive a technology or solution negatively, it can have serious consequences. Patients can revolt, and that cannot be a good thing.

Heard of bedside manners? Not all lessons are new. Doctors are supposed to have the training, no matter what they treat, how they treat it, and who they treat. This is something that medical schools and residency programs are supposed to cultivate. So clearly, some are not getting the basics right!

The problem is that when too much is being dumped on Doctors, Nurses and the Hospital Administrators as well as Healthcare Systems, things get muddled quite quickly. In fact, this is the kind of chaos by fragmented distraction that some politicians and charlatans are using quite effectively, even as we speak.

Every actor in the healthcare network, including patients and their loved ones, have a responsibility to make sure that there is an effective balance. To this extent, I applaud the family, despite their sorrow, in bringing this to the public eye, so that we get a chance to talk about it, think about it and learn from it. Onward we must march, but with care, caution and compassion. 

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1. The CNN Article:

2. Image of Robot:

3. Image of Watch:

4. Image of Patient:

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