A telemedicine ‘robot’ delivers end of life news to patient: is there an ethical problem here, Kaiser Permanente?

Curated Telehealth and Telemedicine Article http://telecareaware.com/a-telemedicine-robot-delivers-end-of-life-news-to-patient-is-there-an-ethical-problem-here-kaiser-permanente/ It doesn’t require much thought to think that there may be an issue of cultural inappropriateness.
Bad, bad media for in-hospital telemedicine. He has end-stage chronic lung disease and is accompanied with his granddaughter. A nurse wheels at an InTouch Telemedicine ‘robot’ (manufacturer is definitely visible on the movies; KP is one of the marquee customers). The mobile monitor display is related to a live doctor on audio/video to get a virtual consult. The doctor is providing terminal news: this not much can be achieved for Mr. Quintana besides to keep him comfortable from the hospital on a morphine drip, and that he would probably be not able to come home to hospice care.
Another open question: why was extra comfort care along with a ventilator unavailable in the home if Mr. Quintana was truly terminal?
“We utilize video technology as an proper enhancement to the care team, and a way to bring additional consultative expertise to the bedside. “This video technologies is a live conversation with a doctor using tele-video technology, and consistently using a nurse or other physician in the area to describe the purpose and use of the technologies. It doesn’t, and didn’t, replace ongoing in-person evaluations and discussions by a patient and family .” The family also was well aware of Mr. Quintana’s status but is equally angry at his treatment during this important moment.
There’ll certainly be more to the story.
It is not the telemedicine technologies, but it is how it’s used. In cases like this, with all insensitivity. The attribute will be laid, in this shallow period, at the toes of this ‘robot’. Rightly, blame must also be laid at the foot of the progressively ‘autonomous ’ practices of big health programs.
The monitor is in the base of the mattress, not close to the individual. The patient may not be able to find the screen at the distance because of poor eyesight.
End-of-life news this serious has to be delivered by a human. Period.
The video has gone viral here in the united states, together with the family going to local media first (KTVU).
Despite Ms. Gaskill-Hames’s announcement, the video consult was not intermediated by a human. There is somebody in scrubs supporting the InTouch mobile monitor, but there isn’t any standing from the monitor nor any attempt to interpret what the physician is saying. Explaining the technology isn’t explaining what the individual and family can perform.
An opinion at some variance, but winding up at exactly the same area, is expressed by Dr. Jayne at HIStalk.
The display is high above the mattress, the doctor is wearing headphonesand is awaiting. The physician ’s voice has been emphasized and difficult to understand through the speakers–is your quantity low because it’s place low or due to privacy regulations? Whatever the case, the doctor is asked repeatedly to replicate himself by the granddaughter since the individual cannot hear or comprehend the physician. Another factor evident on the video to this Editor is that the individual has been on a ventilator–and ventilators make sound that mask other noises.
There is no patient advocate or even a chaplain present. Whether you visited later isn’t known.
Mr. Quintana passed off in the hospital last Tuesday 5 March, following a two-day stay.
The favorite takeaway about Kaiser, the VA, and other health systems that are deploying telemedicine with their patients is the fact that robots are replacing doctors. We might know better, but this is what the customer media runs with–a psychological video that, BTW, breaks patient-doctor confidentiality by showing the (unnamed, but maybe not for long) doctor giving medical instructions to Mr. Quintana.
The individual had trouble understanding the physician ’s voice, either through hearing or language understanding. A ventilator could be blocking or concealing the audio. Even so, the audio, depending on the origin, is muddy, and the video worse than you’re on a smartphone. 

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Thanks !

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