Telemedicine can’t replace the ‘laying on of hands’ and personal relationships that help patients discuss problems and can improve their health.
The patient appeared to be dying. She had chronic lung disease, and she had been told she had little reserve left and had barely survived on home oxygen for the past few years. Each time she picked up a lung infection, the buzzards circled closer. Now she had tripped, fallen, broken a bone, had surgery, and her subsequent infection seemed to have pushed her past the point of no return. Still, I held off the palliative care/comfort care team for as long as I could, and she rallied. Everyone saw how tough she was and a fighter and praised my intervention, but it just wasn’t enough in the end and she died.
I was reminded of the role I had played with that end-stage lung patient recently when a mechanical device wielding a video screen was rolled into an intensive care unit of a Kaiser Permanente hospital in California so that a doctor could remotely tell his patient that the lung scan showed no lung reserve left and he was a goner.
I am not questioning the poor prognosis, though I can tell you that the practice of medicine is often not that well defined. Sometimes, patients you have given up on actually do defy the odds and survive. But more to the point, the process of delivering bad news or potential bad news necessitates an in-person give and take. The 78-year-old patient’s granddaughter, who was in the ICU at the time, had every right to be distraught over the method of communication.
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This insensitivity in the medical world points to a larger problem. Too often, we physicians are being marginalized. As a society, we need to find a way to once again offer incentives for a doctor’s bedside manner and central role as a communicator and healer. Physicians must be rewarded for being present at all difficult and turning-point situations involving a patient’s illness. Otherwise, we are relying blindly on a doctor’s good judgment and sense of decency to do the right thing.
We doctors are swamped with computer documenting and regulatory hurdle-jumping that dramatically shortens the face time we have available for our patients. Medical teams have been assembled to fill the gaps, and there is certainly no reason that a well-trained nurse practitioner or physician’s assistant or even a medical assistant can’t sometimes inform patients about routine results. But when medical situations are dire or life-threatening, a doctor’s extensive training and experience becomes more crucial.
Doctors need to take time with patients
At the same time, medical technology is surging to the point where artificial intelligence is beginning to replace functions traditionally assigned to physicians. This can be a good thing, as long as it is carefully controlled. Artificial intelligence and expanded interactive computer tools can help to inform me, to guide me or a doctor like me toward better and quicker decisions. But they cannot take my place.
Patients crave and rely on human judgment. Telemedicine is a valuable tool, but it lacks the therapeutic value of the “laying on of hands,” part of a doctor’s essential repertoire. Studies have shown that a doctor’s bedside manner and a strong doctor-patient relationship can affect a patient’s health and chronic disease outcome.
It is difficult to prove the exact impact of healing and intuition on a case-by-case basis. But I have experienced many office or hospital visits when spending an extra few minutes with a patient causes him or her to relax enough to reveal a burden they were holding back (chest pain, palpitations, severe depression, genital sores are all examples). Full disclosure helps me to treat and heal my patients, but it does not come easy. It is something that a robot-carried video engagement would routinely miss. The essential chemistry between patient and doctor is part of the art of medicine.
Marc Siegel, a member of USA TODAY’s Board of Contributors and a Fox News medical correspondent, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. Follow him on Twitter: @DrMarcSiegel
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