Column

Bad news should be delivered in person, not via a machine


Evelyn Lewin


13/03/2019 2:13:19 PM

When a man in the US was told he was terminal via video – delivered by a robot – it highlighted inappropriate use of tech in healthcare.

Man in doctor’s office
Dr Evelyn Lewin was never specifically instructed to deliver bad news in person because ‘such advice seems so obvious that it doesn’t need to be said’.

As a medical student and general practice registrar, I learned a lot about how to break bad news.
 
Firstly, I was taught it is important to allocate plenty of time with the patient, so they can start to process the news, ask questions and not feel rushed.
 
I was also told it is important to break the bad news in the right location. Rather than speaking to a patient in the middle of a busy emergency department, for instance, it is best to find a quiet enclosed space to talk.
 
Tissues should also be on hand and, if possible, loved ones should be present.
 
But one factor I was never taught was that bad news needs to be delivered face-to-face.
 
And, to be honest, such advice seems so obvious that it doesn’t need to be said.
 
At least, that’s what I thought before I heard the story of American man Ernest Quintana, who was told the news that he was imminently terminal via video call – through a screen attached to a robot.
 
Mr Quintana, 78, knew he was dying of chronic lung disease when he was taken by ambulance to the hospital, unable to breathe.
 
His granddaughter, Annalisia Wilharm, 33, was alone with him when a nurse popped in to say a doctor would soon be making his rounds.
 
A video screen on wheels then rolled in, a doctor appearing on the screen. Ms Wilharm initially thought the visit was routine, but was soon astonished by what the doctor started saying.
 
‘This guy [my grandfather] cannot breathe, and he’s got this robot trying to talk to him,’ she said.
 
‘Meanwhile, this guy is telling him, “So we’ve got your results back, and there’s no lung left. There’s no lung to work with”.’
 

When Ernest Quintana was told he was dying via video call , his daughter said such news should be delivered by a ‘human being and not a machine’. (Image: Facebook, Julianne Spangler)

While having a doctor on a video screen deliver such news was distressing, the situation was made even more upsetting by the fact Mr Quintana was hard of hearing in his right ear and the machine couldn’t get to the other side of the bed.
 
This meant Ms Wilharm had to repeat what the doctor was saying to her grandfather.
 
‘So he’s saying that maybe your next step is going to hospice at home,’ Ms Wilharm is heard saying in a video she recorded of the visit. ‘Right?’

‘You know, I don't know if he’s going to get home,’ the doctor said.
 
The patient’s daughter, Catherine Quintana, was shocked by the callous nature of the news.
 
‘If you’re coming to tell us normal news, that's fine. But if you’re coming to tell us there's no lung left and we want to put you on a morphine drip until you die, it should be done by a human being and not a machine,’ she said.
 
Mr Quintana died two days after being taken to the emergency department. A hospital spokesperson has since apologised and said it will review its use of the video technology.
 
When I read this story, I was appalled.
 
While I thankfully haven’t heard of similar stories occurring in Australia, it worries me that this can happen in the first place.
 
The world is ever-evolving and telehealth certainly provides a vital role in the future of medicine, especially for people who live in rural and remote regions and otherwise might not have access to medical care.
 
But the way Mr Quintana had to find out his death was imminent, and the reliance of his granddaughter in relaying that information, shows how easily the world of medicine and technology can collide in devastating ways if not handled with care.
 
Mr Quintana was not in a remote location. He was in a hospital where other health professionals were present. Why someone made the decision to deliver this news via video call is beyond me.
 
The saddest part of this story, for me, is the lack of humanity afforded to this man and his family.
 
As doctors we are taught to first, do no harm. That doesn’t mean we can always provide life-saving care, but it does mean that we can treat our patients with dignity and compassion.
 
As Emma Warnecke wrote in an article for Australian Family Physician, ‘Despite all the technological advances of recent decades, caring, compassionate, healing doctors remain the best therapeutic tool in medicine. The ability of a doctor to provide comfort through their presence and their words is a fundamental component of good medical care’.
 
Instead of receiving such comfort, Ms Wilharm says she is now ‘scarred forever’ by the experience.
 
Breaking bad news is one of the hardest parts of being a doctor, but we must remember the impact on patients and their loved ones.
 
That’s why it’s so important that we put thought into how we deliver such news, and why it should be seen as absolutely essential that such news is delivered face-to-face whenever possible.
 
As Hippocrates said, ‘Cure sometimes, treat often and comfort always’.
 
Sadly, the day a video screen was rolled in to tell Ernest Quintana and his family that the elderly man was dying, that comfort was sorely missing.



bad news telehealth video call



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Dr Deborah Uwa Sambo   14/03/2019 11:06:47 PM

I have a few patients unfortunately who were called while driving by the " all knowing Dr- often specialist; to be told they had some bad diagnoses!.

That immediately sours the relationship going forward.
I don't have any EMB or scientific evidence, but I know that most of those patients do not fare well and they are often prone to talk about seeing the Dr- Hopefully, I have tried to dissuade a few from seeing a colleague.


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