That being said - I agree that the empathetic and emotional aspects are lost when communicating remotely. Heck, I already feel that even in a work setting. It’s hard to imagine what it would be like when handling a crisis.
The OP article describes a situation where the patient is waiting in the intensive care unit.
If my time on this earth is now measured in hours or days instead of years, every minute is precious. I don't want to wait for the doctor to drive in to the hospital. And I don't want to hear from a stand-in doctor who isn't familiar with my case. I have questions, and I need to compress both 1) acclimating to this new reality and 2) enjoying what remains of my life into a painfully short period.
Email is insufficiently interactive, but Skype is fine. I have family for emotional support, let me spend as much time as possible with them instead of waiting for test results.
It's possible/likely that better technology will make this kind of remote interaction much more palatable and useful. But it's obvious that that better technology is not quite here, and yet the hospital seems to have OKed it, as if they were doing internal beta testing an experimental feature.
I find it comical actually, in a grotesque way. It's a situation I would expect in the Simpsons: family huddled around a very ill relative, when the door opens and a tragic robot vaguely reminiscent of a Dyson vacuum cleaner rolls in and announces that the patient is going to die in short order.
The entire scene could be more bizarre only if upon this announcement, a small tray popped open with a tranquilizer pill that expedites the demise of the suffering person and prints a receipt for the "care" rendered.
I also liked that the machine must have run on sunshine and gumdrops and cost $0 to use because of course that is how health care works, we definitely have the means to heal every person on the planet, the only thing preventing us from doing so is evil white people.
If you can't, I'll do you one better - worldwide, infant diarrhoea is the second leading cause of death in children under five years old. It can be treated with pennies worth of clean water, sugar, and salt. It can be prevented just by providing access to clean water. We absolutely have the resources to heal every child on the planet of this disease, if we cared.
Hepatitis C is curable, but it is purposefully priced out of reach for much of the affected population, hoping that the local government will pick up the tab. Epi Pens have skyrocketed in price over the past few years, and the manufacturer that makes them has claimed that there is a shortage of the generic version, while plentiful supplies of the on brand version.
This is Late Stage Capitalism.
Gilead did pay $11 billion to acquire Pharmasset and at one point was facing a $2.5 billion patent infringement ruling (later overturned) for that same drug.
AbbVie’s a new entrant which can treat certain strains at at about a third the cost.
Damn that Late Stage Capitalism developing a miracle cure for Hep C which is painless and effective.
Companies making tens of billions a year while poor people suffer and die does seem to be a fairly negative situation, however you care to label it.
There are absurdly massive inefficiencies if as you say they aren't making profits.
What if the doctor couldn't get back to the hospital in time and this was the only way to tell them?
If it's over Skype or nothing. I choose Skype.
"But it should not be used to replace the empathic, emotional aspects of healthcare"
I've been to hospitals different parts of the world and this is pretty much the norm (low empathy). Most Doctors are very busy/overloaded with patients, they don't have any time to sugar-coat results or make you feel better.
This is one aspect of government-run healthcare that I'm not sure many people are willing to accept.
Well, that's not what's happened in this particular instance, nor will it be anywhere near the common case.
And if the doctor actually can't be there, then at least have the attending nurse break the news. As long as it's a warm body with good bedside manner.
We're big, squishy monkeys hardcoded to have contact with each other. We're particularly bad at making connections with people through a low-quality screen. It actually makes a difference when the person is there and present with you.
Maybe he or she can, umm... send someone else?
Enough people on this thread disagree with you that I think it's safe to say that there is no "right" method, just one that most (but not all) prefer. What's wrong with actually giving people a choice?
"Would you like critical medical news delivered to you
[x] Through teleconference (faster) [ ] In-person (depends on doctor's availability)"
Honesty is better than empathy as a job.
Subject: You're dying. Message: 2-3 weeks. Cancer. Please see attached invoice.
Some people would prefer a theater of acting sad, holding your hand and pretending to be an old friend in a strange environment, other would prefer to receive the hit at their home and cry in private. Each people is different.
"First, do no harm."
Physicians, at least in Western medicine, are bound to the principle of non-maleficence. Their obligation is to take the approach (by action or inaction) that does the least harm to most people, NOT what helps the most people. This is an important, but subtle distinction.
This principle prevents, e.g. administration of a treatment that would cure 51 of 100 patients of a chronic but not debilitating condition while killing the other 49.
It's hard to imagine the quantifiable positive ill of telling someone something in person that they'd rather receive in email. But the underlying principle here is not in helping as many as possible but, overall, hurting as few.
After begin attacked by an enraged patient (or their relatives) I can understand how the physician could develop a phobia to put him/herself in a similar situation again. Just being forced to return to the same workplace day after day can be emotionally draining and very difficult for the physician.
The biggest problem of using e-mail in this case is keeping the privacy of the patient.
This was just them pulling a stupid, and the hospital apologizing for it.
Not only is email not able to be kept private, you also can't guarantee the patient is going to get it in any sort of timely manner, or in fact, at all. It's also ensuring that no follow up questions can be asked in a timely manner.
It'd be prime material for a Tom Lehrer song involving lawyers, malpractice law, ISPs, IT professionals, email protocols, and similar related ilk. Just this simple "proposal" is blowing my mind.
The news was going to hurt one way or another, but they appreciated that other humans empathized with their situation, taking a completely less efficient means of giving them the information directly.
Granted, it's different than hearing you have a terminal disease, but both are jaw-dropping, numbing realizations few people could be mentally prepared for, especially with the swelling of emotions.
Perhaps there is no 'right' way, but IMO there is a humane way.
@polly "bad news by email?" "hell no" "just post it on twitter"
The world has changed. People are tried and sent to prison over video chat, surgeons remotely control surgery.
Telemedicine improves the quality of life for millions of people, allowing them access that they wouldn't have had in the past. It provides decreased morbidity and mortality as a whole.
Quick reminder: everyone is dying. everyone.
As are we all.
I truly do not understand why people want doctors to be required to hold hands and make eye contact, when telling there's no cure. I'd prefer doctors to be chosen based on their ability to cure illness, instead of the ability to demonstrate empathy to thousands of patients that will die during their career.
And i wonder how many of the people who are outraged by lack of the empathy from a doctor, also think that extending human lifespan to several centuries is a bad thing
There'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.
The wrong way involves doing none of those things, because you are talking to them via a shitty Skype connection on wheels.
Technology has a huge role to play in healthcare. It's invaluable in diagnosis and treatment. In the long run it'll probably put a lot of people who do those kind of things out of work. But it should not be used to replace the empathic, emotional aspects of healthcare. If anything, the labour efficiencies generated by technology ought to increase the resources put into empathy -- not be used to eliminate it.