Whenever there’s a discussion of efficiency or immediacy, the next question always has to be, “Efficient or immediate for whom?”
Last weekend, a news story broke of a woman named Annalisa Wilharm in Northern California whose grandfather, Ernest Quintana, was hospitalized with COPD. A mobile, videoconferencing “robot” came into the room, displaying a two-way video feed of a physician who had just read the latest MRI results.
Mr. Quintana was given bad news: that there was little of his lungs left, and that all the hospital could do was make him comfortable. He passed away the next day.
I happened to hear a longer portion of the interview with Ms. Wilharm that the BBC World Service conducted. I think its worth mentioning exactly what the family’s complaints were.
There was a (face-to-face) physician they had been in contact with. This physician told the family that he would review the MRI results with them as soon as possible. If the results came in before he left, he would review them that day. Otherwise, he would review them the next morning. The physician which was displayed via videoconference was not this physician. Mr. Quintana’s wife was not present. He just got the worst news of his life without his wife of 58 years,
his granddaughter said. In addition, Mr. Quintana’s wife and Ms. Wilharm complained of the way the news was delivered, and in their words, they were told, this is our policy, this is how we do things
.
From a clinical perspective, yes, I’m sure the hospital was only trying to be efficient and prompt. That having been said, this news was a major piece of the patient’s story. Even though bad news, this is clearly a part of Mr. Quintana’s story his family wanted to share with him, and with a care team who had been a part—however briefly—of his story.
Clinical efficiency and immediacy can’t replace that.
You can read the BBC article on the incident, as well as listen to the news podcast with the interview until April 7, 2019, and read Kaiser Permanente’s response.