I heard about that. Unacceptable.

Just awful. But also wrong. Morphine is regularly used for those in end-stage respiratory failure as it EASES breathing. It does NOT make breathing more difficult.

So basically Skype on a robot, unbelievable.

Unreal. Someone should have taken a baseball bat to that thing.

What an ickhead doctor. You can't tell his age from the screenshot, but really, how could anyone think it would be OK to discuss the outcome of those tests remotely?

From the article the patient had already been told while the granddaughter was there so this sounds more like a money grab by the family. Other than it being told by a machine the information had already been given by a person.

"Wilharm told CNN that a doctor had visited Quintana in person earlier in the day.

Wilharm said the in-person doctor was "very sweet" and held her grandfather's hand as she spoke with him about hospice care and his options."

I do not think that the use of this machine unless it is used for long distance medicine is that good of an idea.

Morphine does slow the muscles that are used for breathing and other functions so it could make breathing more difficult however at the end of life comfort is the most important.

K-P is a one of a kind in this area, a health insurance company, a hospital operator and a related medical group practice combined into one very large operation. It started in the 1940s. It has a mixed reputation and it seems over the years not too much time passes before yet another unusual K-P story hits the press. Like this one.

In its defense, it has been a low cost provider of medical services for many decades. It's long been the cheapest provider available. Going the other way, it was one of the earliest practitioners of cost reduction by rationing care in an HMO sense, sometimes making it very difficult for patients to see a specialist. And, not surprisingly, with too many instances of mistreated and wrong handling of patient problems by the PCPs as a result. And also by others.

Maifleur, the “very sweet doctor” was earlier in the day, before the patient’s test results were in. They were discussing possible options in a more general way.

Since the Skype doctor was alleged by the hospital to be part of their effort at making things more efficient, I fail to see how this would help. The doctor can only Skype one patient at a time, so s/he might as well get off his backside and personally visit.

colleenoz the patient had already been told that there was nothing that could be done. The robot was repeating what had already been discussed and may have been mentioning the lab result.

You apparently do not understand tele-medicine as is practiced in many areas of this country. When the specialist is hundreds if not thousands of miles away from the patient there is little getting off the backside and personally visiting. Some of the towns in Kansas west of here can be hours from the nearest airport for a doctor to fly to so they rely on remote doctors.

I guess I am too pragmatic to get emotional about this. If hospice was already discussed earlier in person then this does just seem like a follow-up. It was certainly not NEWS to the family. They may have heard only what they wanted to hear earlier in the day or even much earlier. The family member stated they knew he was going to die soon. Perhaps they should should have brought hospice in earlier and avoided this.

"You apparently do not understand tele-medicine as is practiced in many areas of this country. When the specialist is hundreds if not thousands of miles away from the patient there is little getting off the backside and personally visiting."

But this gentleman was IN the hospital, so a doctor should have made a personal visit to his room. Telemedicine is inappropriate for inpatients.

I understand tele-medicine. But, this incident took place in Fremont, CA; this is a large, suburban area! The pt was in the ICU! I am a bit shocked that a physician was not on the premises to speak in person with the pt and family! What kind of hospital anywhere has an ICU without a MD on the physical grounds of the hospital?

But this gentleman was IN the hospital, so a doctor should have made a personal visit to his room.

Sounds like a doctor did make a personal visit to the room to discuss hospice and the fact the man was on his deathbed. That is pretty much informing them that there is nothing left to do. The telecommunication was a follow-up. I don't understand why this is so hard to understand for some. They did not give the bad news via the robot. It seems like they were confirming the earlier visit and advising that the time was near. In another article the GD is complaining that the video robot didn't speak clearly enough for her grandfather to hear. Something different in every news statement. But the one above makes it clear the family was aware he was on his deathbed. So to say a robot delivered that new is simply untrue.

The media is treating this like the family was completely blindsided by the news he was terminal. That is unfair to Kaiser. I am not a fan of Kaiser BTW. It's fine for getting treatment known illnesses but if you have something that needs to be diagnosed forget about it. To much red tape and hoops to jump through to get timely tests and being referred to the proper care team. Managed care. Ugh.

Accepting that this was a follow up call as explained above, I still think as the pt was expected to die, the physician should have visited the room. I think this is unacceptable. I don't think this can be laid at the feet of KP, though. I think this is probably the way medicine is going. Strap on your seat belt!

In the interview with the granddaughter which I heard on the radio, when the doctor spoke with them earlier in the day, he told them that if the results came in before he left at the end of the day, he'd come in and tell them. Otherwise he'd tell them when he saw them Monday morning. I had the impression that the tele-doctor was a different doctor.

The family knew Grandpa's days were numbered but didn't know how small the number was. The patient's wife and daughter had gone home to get some rest as they clearly were not expecting his death to occur that night.

I still think that for such important news (and considering how much medical costs are in the US), delivering such bad news in person is the only way to go.

If someone was fired or asked for a divorce by a spouse by Skype, the Skyper would be vilified. This is no different.

Suggesting to immediate family that they should go have some rest is something that some doctors and hospice do when the end is near. While I already knew it I was told by hospice that some people will fight to stay alive until their loved ones are at least out of the room. It may not be that the doctors did not recognize the end was near but that they did and wanted to give their patient the ability to not put additional stress on their loved ones.

It was the granddaughter who suggested her mother and grandmother go home to get some rest, not the doctor.

Yes, as maddie says, this Kaiser hospital is in Fremont, California. That's as central and populated a location as any in the East Bay district of the San Francisco Bay Area metropolitan region.

This isn't a small regional facility in a remote or small town. Even if it were, any such messages need to be delivered in person. That Kaiser uses video robots at all, for whatever purpose, is shocking to me.

Robots are The way of the future. So is outsourcing.

My son-in-law is a pathologist, the managing partner in his practice. He is very concerned that his hospital will begin outsourcing the reading of slides, diagnosing, etc., to India because they will do it for a fraction of the cost, and so far, they get things just as right as he does! He also says that reading of ct and PET scans, mammography, most radiology may soon be outsourced to India as well.

He thinks that because most patients never see or have contact with those pathologists, radiologists, etc. who work in the background, they are expendable, but currently most patients assume all their physicians are on staff so hospitals are treading carefully about this. However, considering the enormous cost savings, insurance companies may start demanding such changes.

Not much is immune to replacement in today's world economy.

I think telemedicine is the wave of the future, and can be appropriate in some settings and circumstances.

I'm having a hard time wrapping my head around it being appropriate in this setting and under these circumstances.

I agree, patriceny, but we've gotten used to many things we didn't think we would. We will adjust to many more as we go along, some good, some infuriating.

Back up a few steps, I think some of you are missing the point. For me this is about patient communication and not at all about technology. Telephones were invented over 100 years ago. What if the doctor had phoned the patient's room and had the conversation over the phone? Would you feel differently about the inappropriateness? I wouldn't. To me that would have been equally bad.

I've read of several efforts to train AI programs to read x-rays and perhaps other types of scans. In some instances these programs are achieving results as good as the radiologists they are being compared to, and in some cases they seem able to spot abnormalities on an x-ray, that weren't detected by the human radiologist until a (more expensive) CAT scan was performed.

sheesh, you're right that most diagnosticians have little or no patient contact. But there will always be in-person radiologists and pathologists at medical schools and research facilities (both those affiliated with hospitals/schools and those in the private sector). What kind and size of a hospital does your son in law work with? Is it in a populated metro area?

Remote radiology is becoming more common in the veterinary world. One reason is that boarded veterinary radiologists are not that numerous and only the very largest practices have enough work to keep them busy full time. Before detailed imaging was so easy to handle over the internet, veterinary radiologists even in populated areas needed to travel, to split their time between practices, to have full time work.

Human medicine is different, of course, but the remote access that so many practice almost begs the question - why do I need you when someone else is cheaper? It doesn't need to be India, I'm sure costs are cheaper in Europe too and the standards of training aren't that different if at all.

Regarding the OP, and Elmer's follow up, I think calling would have been just as bad as delivering the bad news via robot.

A few years ago I complained that a doctor scheduled an appointment with me to present the results of tests that were performed. I drove across town, waited, and the doctor came in and announced the tests were fine, you don't have cancer. I grumbled privately that I had to drive across town, and pay the out-of-pocket portion of an office visit, just to hear a few sentences that could have been relayed over the phone. Although I supposed if the policy were "We will give good news over the phone, but you have to come in person for us to deliver bad news" then as soon as they tell you "you have to come in to hear the tests results" you'd know it is bad news.

Yes, Elmer, there will always be diagnosticians on campus, but only one or two from each practice instead of the dozens there now. Son-in-law works in a major metro hospital.

I had kidney cancer and never saw a single path or radiologist, and have never seen whoever reads my mammograms, but they are in the building for now. Paths also do bone marrow transplants so those specialists will always be there, because people want to see their doctors and have a relationship with them, something patients don't really need with diagnosticians. Their personal physicians can handle that, and probably have much better bedside manners than the usually much more nerdy paths and radiologists. Even s-i-l realizes that.

Bob, what you said about the phone call is so true. I for one would be willing to have the news delivered by appointment over the phone, as I could arrange to have a support system in place, my husband or one of my kids. I know that's not for everyone.

I have a neighbor up the street from me who is a radiologist at a major hospital in my area (largest city in the state). But he works from his home as an "independent contractor". This is done more and more these days. It is more cost efficient for most hospitals, and apparently the radiologist love being able to work in their PJ bottoms and a t-shirt at home. I think this is going to happen more and more. Already, much lab work goes to outside, independent labs that do work for hundreds of hospitals.

Anglo, my s-i-l has a sophisticated set up in his home which he uses when the docs on duty want a larger consultation, which is not often, but he is also on call every third weekend and sometimes needs it then. Otherwise he goes in to work every day, all day.

It appears that the gentleman was not given some morphine in his IV. Yes, it does depress respiration, but at the very end of end stage COPD, the patient isn’t constantly gasping for air — that is a horrible way to succumb. It would have been most decent and merciful to have eased his panic and gasping by giving him enough morphine for comfort. The daughter/son should have been spoken to privately and this measure would have been available. We’re speaking about a man approaching his final hours. RIP, sir, and comfort for his loved ones.

petalique the patient or wife may never given the doctor permission to speak to the daughter/son. This is hard for a family member who does have the patients medical POA or whatever it is called in your state to remember to tell staff who can be told things and who could not. If they were in the room they may have overheard about the morphine but even then in some states if permission has not been granted for them to direct medical care other than "fluffing pillows" they can not direct things. Some doctors and hospitals disregard this but others are by the book. Which is something that everyone should be aware of and if they go to the charge nurse and are told that the doctor will be called is probably what is happening if no instructions are in the file.

Having been diagnosed about twenty years ago with mild COPD. Asthma, and some unknown lung problem dying of other problems is my wish. It is very difficult both for the person and for those watching.

maifleur01, ^^^^^ you are absolutely correct. I had not remembered and considered that. In a thread last year forum members were discussing this sort of legal bind. I want to educate myself about it. I spent a lot of days and nights caring for a similarly ill parent Who was also developing some memory and cognitive issues.

I’m sorry to hear of your medical situation and hope you’re feeling well. I hope I’ll people and their caretakers get the latitude they need to make the best and the most meaningful decisions. It gets complicated.

I believe you're right in saying that some patients hang on while their loved ones are in the room.

When I was with my dear hubby, I left in the morning to come home and feed the cats. I told him when he saw the bright light to go towards it, not to turn away. That it was okay.

I got the call later that morning.

As our health-care is government funded, we have to go in to physically see the doctors even to be given news on tests. Sometimes they will call. Even to have prescriptions renewed, it's a doctor visit. If they call the pharmacy to renew, we get billed for that service. Once we cross the threshold, they get paid by the province.

I remember our radiologist joking with us about it. We were in to see the oncologist, and the radiologist walked by the room. We really, really like him and shouted out to him. He came back and said that he couldn't come 'into' the room or he'd have to bill OHIP. We all laughed and he came in and shook our hands etc and asked how we were doing.