The promise and the peril of Dr. Robot

There are robots that deliver the mail and robots that work assembly lines. Some have even pulled duty in the operating room. A doctor in California recently used a mechanical being to tell a patient he had just days to live. It left critics wondering if the pace of medical progress needs to slow down just a bit.

Earlier this month, a man in his seventies named Ernest Quintana was hospitalized in Fremont, Calif. The account of what happened comes from his granddaughter Annalisa Wilharm who was with him at the time. On March 4, a video monitor mounted on wheels appeared at the door to his hospital room. The mobile monitor entered Quintana's room under its own power. The granddaughter says a doctor appeared on the video screen and told the man that his lungs were failing and that he would not be able to go home. The doctor told the man his death was imminent. Because Quintana was partially deaf, the granddaughter says she had to explain what the doctor was saying.

The man died the next day on March 5.

His granddaughter took a video of the encounter and a family friend posted a screenshot of the video on Facebook. The friend said this might be okay for some situations but not to tell a man he is going to die.

In a statement, Michelle Gaskill-Hames, a spokesperson for Kaiser Permanente Greater Southern Alameda County, gave condolences to Quintana's family, and expressed regret for "falling short in meeting the patient's and family's expectations in this situation."  

At the same time, the spokesperson said that the mobile video screen is not actually a robot but a secure video device that enabled the doctor to speak to Quintana without being in the room physically.

Kaiser Permanente says there is always a nurse or physician in the room with the patient when the tele-video technology (as it was referred to in the statement) is in use. It said said the video system did not and does not replace ongoing conversations with patients and family members.

The company said it will use this as an opportunity to review how to improve the patient experience with tele-video.

The denial that this was a robot did not ring true to me. As a physician, I have given many families bad news like that. In my view, in an emotionally charged conversation like the one involving Quintana, if the family thought it was a robot, then it was.

To the institution, telling Quintana that he had a life-limiting disease may have seemed like an exchange of information. To the family, it was something much more. John Banja, a medical ethicist at Emory University in Atlanta, said when talking about end-of-life issues, healthcare providers should not rely on technology in preference to the human touch. He told the New York Times that having a physician talking to the patient via a remote link may not have been sensitive enough to pick up on the family's distress and other emotional and social cues.

Dr. Barbara L. McAneny, president of the American Medical Association, told the Times that delivering bad news electronically should be a doctor's "last choice." She said healthcare providers should remember that simple human contact or the power of touch can communicate with patients better than words.

The story comes out at a time when robots are starting to motor their way into hospital and nursing home corridors. In January, the MAKO Rio Surgical Robotic System guided by orthopedic surgeon Dr. Anthony Adili performed Canada's first robotically-assisted partial knee replacement on a 66-year old man named Peter Sporta. The operation took place at St. Joseph's Healthcare in Hamilton, Ont. 

The da Vinci Surgical System is a robot is operated by a surgeon from a nearby room or farther away. Tested in Canada, da Vinci has been used in 3 million patients worldwide.

Medical robot invasion not imminent

Japan is leading the drive to design carebots that assist seniors and people with disabilities. RIBA or Robot for Interactive Body Assistance can lift up or set down a senior from bed to wheelchair. TWENDY-ONE can transfer a patient from bed to a wheelchair, take things out of the refrigerator and toast a slice of  bread.

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Then, there are social robots.The Paro Therapeutic Robot looks and vocalizes like a baby seal. It's a mechanized form of pet therapy. Paro can be trained to respond to the voice of a particular patient. It has been shown to engage patients with dementia and reduces patient stress.

Telenoid is another social robot. It's the size of a preschooler and is tele-operated by a human care provider nearby who operates the controls and who supplies the Telenoid with its voice. Studies show the robot engages people with advanced dementia.

All of that sounds promising. Still, we won't be seeing a wholesale invasion of medical robots anytime soon. Right now, the da Vinci robots have few competitors. Expect a careful rollout of da Vinci. The benefits will have to be proven for each type of surgery.

Cost is another factor. A prototype of the TWENDY-ONE carebot cost a quarter of a million Canadian dollars to build. Its designer calls it a "concept car." We won't be seeing TWENDY-ONE  at a long-term care facility in the near future. On the other hand, we will see social robots a lot sooner. The Telenoid costs $20,000 Canadian. We are already seeing Paro in Canada. The mechanized seal, which costs $6,500 Canadian is being tested on clients at the Centre for Addiction and Mental Health in Toronto.

The historic increase in the number of people over 65 will help fuel the demand for carebots. I hope they come equipped with the human touch.