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Comment by nkoren | Hacker News Reader

For anybody who is confused about why this is an issue:

There's a right way and a wrong way to talk to someone about their death. The right way involves making eye contact, making sure that they can hear you, and if they are comfortable with it, holding their hand.

The wrong way involves doing none of those things, because you are talking to them via a shitty Skype connection on wheels.

Technology has a huge role to play in healthcare. It's invaluable in diagnosis and treatment. In the long run it'll probably put a lot of people who do those kind of things out of work. But it should not be used to replace the empathic, emotional aspects of healthcare. If anything, the labour efficiencies generated by technology ought to increase the resources put into empathy -- not be used to eliminate it.

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I’m curious - What would it look like if you were accustomed to remote communication with your doctor(s) and handled most follow ups that way and then suddenly your doctor says, “You should come chat in person” if you know you have some results pending that could lead to a serious diagnosis? My first thought would be that it’s terrible news, and if that were the case I’d rather rip the band-aid off and just hear it via Skype instead of waiting a week to see the doctor in person. Maybe it’s less personal, but for me it would be less anxiety-inducing and give me a chance to start processing immediately.

That being said - I agree that the empathetic and emotional aspects are lost when communicating remotely. Heck, I already feel that even in a work setting. It’s hard to imagine what it would be like when handling a crisis.

That already happens. My mom had cancer a few years back, and it is immediately obvious after a follow-up test whether something is serious or not based purely on how quickly you hear about it. Doctor calls the same day, then something is bad. Takes a few days to get back to you with results, then there's nothing to worry about.

I think if it were the case that you and the doctor were already apart -- e.g. you were at home -- then you would be fine with a remote discussion because you implicitly know that the doctor is not actually in your home.

The OP article describes a situation where the patient is waiting in the intensive care unit.

Respectfully disagree. "You might not make it home", he said.

If my time on this earth is now measured in hours or days instead of years, every minute is precious. I don't want to wait for the doctor to drive in to the hospital. And I don't want to hear from a stand-in doctor who isn't familiar with my case. I have questions, and I need to compress both 1) acclimating to this new reality and 2) enjoying what remains of my life into a painfully short period.

Email is insufficiently interactive, but Skype is fine. I have family for emotional support, let me spend as much time as possible with them instead of waiting for test results.

If the questions and discussion you have are hampered by what the parent commenter (and family in the article) describes as a shitty Skype connection, that may more than make up for the time purportedly saved by doing the talk remotely.

It's possible/likely that better technology will make this kind of remote interaction much more palatable and useful. But it's obvious that that better technology is not quite here, and yet the hospital seems to have OKed it, as if they were doing internal beta testing an experimental feature.

I went through this recently with a family member, there were robots allowing specialists to review chart. There is always a hospitalist (doctor) on staff. The most appropriate way for the hospital to approach this topic is for the robot to consult with the hospitalist outside the room, and then have the hospitalist with end of care professionals have that discussion.

Very well put. As technology replaces more of the medicinal busywork and ostensibly even diagnosis, more emphasis should be placed on the doctor being the human element. In the end, that's what humans are good at. While I'm sure it was well intentioned, this technology tries to replace the one thing that machines cannot (yet, maybe ever?) provide: authentic human interaction and empathy.

I find it comical actually, in a grotesque way. It's a situation I would expect in the Simpsons: family huddled around a very ill relative, when the door opens and a tragic robot vaguely reminiscent of a Dyson vacuum cleaner rolls in and announces that the patient is going to die in short order.

The entire scene could be more bizarre only if upon this announcement, a small tray popped open with a tranquilizer pill that expedites the demise of the suffering person and prints a receipt for the "care" rendered.

The scene from Elysium really did this well... having him attempt to sign a receipt for the five days of terminal care painkillers. Very evocative.

I liked the part in Elysium where they had a magical science machine on another planet that they could use to heal anything, but they only used it for rich white people because they're evil.

I also liked that the machine must have run on sunshine and gumdrops and cost $0 to use because of course that is how health care works, we definitely have the means to heal every person on the planet, the only thing preventing us from doing so is evil white people.

Note that rich white people witholding medical care =/= white people. It is a huge distinction, and seemingly refers to how more and more treatments and cures are being priced to extract the most money possible, heavily restricting who has access.

Hepatitis C is curable, but it is purposefully priced out of reach for much of the affected population, hoping that the local government will pick up the tab. Epi Pens have skyrocketed in price over the past few years, and the manufacturer that makes them has claimed that there is a shortage of the generic version, while plentiful supplies of the on brand version.

This is Late Stage Capitalism.

Purposefully priced?

Gilead did pay $11 billion to acquire Pharmasset and at one point was facing a $2.5 billion patent infringement ruling (later overturned) for that same drug.

AbbVie’s a new entrant which can treat certain strains at at about a third the cost.

Damn that Late Stage Capitalism developing a miracle cure for Hep C which is painless and effective.

This is the same AbbVie who’s treatment costs $26,000 right? I think it’s fair to say that’s priced well out of reach for most people, whatever the cost relative to Gilead’s product, which the CEO apologized for. The same AbbVie that sued the NHS? https://outline.com/brsHyA Incidentally Gilead made $5.8 billion in a single quarter so I think we can safely assume they managed to defray the cost of acquiring Pharmasset, don’t you think?

Companies making tens of billions a year while poor people suffer and die does seem to be a fairly negative situation, however you care to label it.

I simply refuse to believe that treatments that cost the same as a brand new luxury car are down to labour + materials cost of some pills.

There are absurdly massive inefficiencies if as you say they aren't making profits.

A major purpose of science fiction is to examine the present through the exaggerated lens of a possible future. Can you really think of no present-day examples of high-capital-expense, low-marginal-cost, highly-effective medical care being priced away from a large chunk of the population?

If you can't, I'll do you one better - worldwide, infant diarrhoea is the second leading cause of death in children under five years old. It can be treated with pennies worth of clean water, sugar, and salt. It can be prevented just by providing access to clean water. We absolutely have the resources to heal every child on the planet of this disease, if we cared.

Well said. This kind of tech seems fine for less severe diagnoses, and the time saved could be used to make human doctors more available for the severe cases. It's not even an argument about whether terminal diagnoses "deserve" a personal touch. Patients and their families may press the doctor about Hail Mary options -- having this argument over videoscreen-on-wheels might exacerbate the conditions in which the family/patient goes for the unreasonable option.

Tangentially, this is a sub plot of the movie 2009s 'Up in the Air' but with being laid off. Not the same as being told you are going to die, but in 2009 just as the recession was really hitting hard it's similar in many ways.

[1] https://www.imdb.com/title/tt1193138/

You’d think with all the money people pay that hospital they can afford the cost of the doctor walking over to the room...

It doesn't cost the hospital a nickel to have that doctor walk into the patients room. You will get a bill for that from the doctor's practice, not from the hospital.

"The wrong way involves doing none of those things, because you are talking to them via a shitty Skype connection on wheels."

What if the doctor couldn't get back to the hospital in time and this was the only way to tell them?

If it's over Skype or nothing. I choose Skype.

"But it should not be used to replace the empathic, emotional aspects of healthcare"

I've been to hospitals different parts of the world and this is pretty much the norm (low empathy). Most Doctors are very busy/overloaded with patients, they don't have any time to sugar-coat results or make you feel better.

This is one aspect of government-run healthcare that I'm not sure many people are willing to accept.

> What if the doctor couldn't get back to the hospital in time and this was the only way to tell them?

Well, that's not what's happened in this particular instance, nor will it be anywhere near the common case.

And if the doctor actually can't be there, then at least have the attending nurse break the news. As long as it's a warm body with good bedside manner.

We're big, squishy monkeys hardcoded to have contact with each other. We're particularly bad at making connections with people through a low-quality screen. It actually makes a difference when the person is there and present with you.

Why do we bother going all that way to go and see therapists in person when we could just send them a text message?

What if the doctor couldn't get back to the hospital in time and this was the only way to tell them?

Maybe he or she can, umm... send someone else?

Huh, that's funny. I legitimately would prefer the "wrong" way. Does that make me dysfunctional in some way?

Enough people on this thread disagree with you that I think it's safe to say that there is no "right" method, just one that most (but not all) prefer. What's wrong with actually giving people a choice?

"Would you like critical medical news delivered to you

[x] Through teleconference (faster) [ ] In-person (depends on doctor's availability)"

Is there? I think this is fine for me. In fact a email or sms or whatsapp message might be even better.

Why is eye contact and holding hand the right way? For instance I would prefer an email.

Honesty is better than empathy as a job.

Ah, the classic "why is this email a meeting"?

Subject: You're dying. Message: 2-3 weeks. Cancer. Please see attached invoice.

Literature is more complex than that supposedly comic sketch. People is expressing all kind of really complex feelings since a lot of time with written language so that wouldn't need to be a problem. Is not a fair comparison.

Some people would prefer a theater of acting sad, holding your hand and pretending to be an old friend in a strange environment, other would prefer to receive the hit at their home and cry in private. Each people is different.

As the physician doesn't get to know the ins and outs (emotionally, not physically) of a person, they have to adopt the approach that they hope helps the most people.

Yes, but sometimes things are more complex. I know physicians that were assaulted with a knife in their workplaces. A bagcase raised in the last second stopped the hit, aimed towards her heart. Some people could have solid reasons for acting like that.

I'm confused as to your argument. Are you saying that because someone was attacked that means they SHOULD be emailing this news? I'd bet that most people , being social animals, would rather be told in person, face to face. One outlier doesn't change standard operating procedure.

I am saying that the physician could have logical reasons also to act like that, and that we could be missing some context.

After begin attacked by an enraged patient (or their relatives) I can understand how the physician could develop a phobia to put him/herself in a similar situation again. Just being forced to return to the same workplace day after day can be emotionally draining and very difficult for the physician.

The biggest problem of using e-mail in this case is keeping the privacy of the patient.

You're building a narrative that doesn't exist in the article - there was no mention of a previous violent incident leading to this.

This was just them pulling a stupid, and the hospital apologizing for it.

Not only is email not able to be kept private, you also can't guarantee the patient is going to get it in any sort of timely manner, or in fact, at all. It's also ensuring that no follow up questions can be asked in a timely manner.

There is great irony in your comment, given the topic. You are literally advocating for an approach based on not actually knowing the patient and going off of generalities. You aren't wrong, but it is...weird.

I think it's realistic - the physician doesn't know you as a person. They care about you as another human being but not on a personal level, and don't have the time or the emotional energy to get to know you. Really, I'm just advocating for a return to the conventional approach which the article is saying they should have followed. I'd say the "wheel a box into a room to tell people that someone is dead" approach is a bad one.

I get it - but I still believe that mimicry of concern is less desirable than actually HAVING concern. I'd much rather get bad news from someone remote that has concern than from someone in-person that doesn't. And I certainly wouldn't want to have to wait for an in-person meeting with a diagnosis hanging over my head if I can find out sooner.

You're on to something, but have it slightly backwards.

"First, do no harm."

Physicians, at least in Western medicine, are bound to the principle of non-maleficence. Their obligation is to take the approach (by action or inaction) that does the least harm to most people, NOT what helps the most people. This is an important, but subtle distinction.

This principle prevents, e.g. administration of a treatment that would cure 51 of 100 patients of a chronic but not debilitating condition while killing the other 49.

It's hard to imagine the quantifiable positive ill of telling someone something in person that they'd rather receive in email. But the underlying principle here is not in helping as many as possible but, overall, hurting as few.

Imagine if this got snagged into the Spam folder.

It'd be prime material for a Tom Lehrer song involving lawyers, malpractice law, ISPs, IT professionals, email protocols, and similar related ilk. Just this simple "proposal" is blowing my mind.

I know ads are already kind of doing this, but I look forward to google definitively knowing you have chlamydia before you do, or the first "Experiencing Heart Failure? This stay at home mom beat it in these 3 simple steps" banner ads.

Honesty doesn't seem to be at issue here. Empathy definitely is. And while I take your point that you'd prefer an email, and I guess a degree of privacy with your own emotions on the topic, I can imagine that many people feel otherwise. I think I find myself in their camp, not yours.

@polly "bad news by email?" "hell no" "just post it on twitter"

It may not be the right way. We use it because some people need to hear it from a human. Given it's a fairly difficult thing to elect the method, we seem to have defaulted to humans being the best tool for telling other humans they are going to die.

Email is wrong because the culture has decided it so, and doctors are judged based on how they exist within the culture.

As are we all.

When my friends parents had to get the unfortunate news that their sons body was found, the police drove to their home to give them the bad news in person.

The news was going to hurt one way or another, but they appreciated that other humans empathized with their situation, taking a completely less efficient means of giving them the information directly.

Granted, it's different than hearing you have a terminal disease, but both are jaw-dropping, numbing realizations few people could be mentally prepared for, especially with the swelling of emotions.

Perhaps there is no 'right' way, but IMO there is a humane way.

As someone who made the professional healthcare to tech career crossover, I feel exactly the same way. Email me.

The world has changed. People are tried and sent to prison over video chat, surgeons remotely control surgery.

Telemedicine improves the quality of life for millions of people, allowing them access that they wouldn't have had in the past. It provides decreased morbidity and mortality as a whole.

Quick reminder: everyone is dying. everyone.

Dear [TEMPLATE_NAME], We're sorry to inform you that you have advanced stage cancer and will die in the next [TEMPLATE_TIME_RANGE]. Good news however. We have partnered with FinalResting! Be sure to click on the following link to save up to 25% off your funeral services.

Yes that works

Is this a joke? It's terrible.

This is not a joke at all, and was not an attempt to offend people's feelings, though it appears i did.

I truly do not understand why people want doctors to be required to hold hands and make eye contact, when telling there's no cure. I'd prefer doctors to be chosen based on their ability to cure illness, instead of the ability to demonstrate empathy to thousands of patients that will die during their career.

And i wonder how many of the people who are outraged by lack of the empathy from a doctor, also think that extending human lifespan to several centuries is a bad thing

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