Tuesday, December 13, 2011

We, robots

First we have robots that you take home after going to the hospital, and now we have robots before you leave the hospital to go home.  An excerpt:

[Brian] Jack and his colleague Timothy Bickmore of Northeastern University have enlisted “Louise,” an avatar, or virtual discharge advocate. She appears on a computer-like screen that is rolled up to patients’ hospital beds to walk them through the discharge process. 

Louise can spend 40 minutes or more with every departing patient. She is never distracted and can create well-targeted discharge summaries using information about each patient. Louise can communicate using synthetic speech and through a touch-screen display. And patients actually like her, says Clancy, “some . . . better than real, live nurses.” 
Oh, come on. Let's take some of the energy that went into this kind of programming and direct it to adopting Lean process improvement so that real, live nurses or case managers have the time and energy to carry out these functions.

Meanwhile, recall this scene from I, Robot.

Sonny (a robot): What does this action signify?
Sonny: As you walked in the room, when you looked at the other human. What does it mean?
Detective Del Spooner: It's a sign of trust. It's a human thing. You wouldn't understand.


Almond Butterscotch said...

How many nurses are there that have the time to actually hold a patient's hand and lead them through the discharge process? In this one instance, I'll take the programmed kindness over the aggravated close-to-assault real nurses.

Paul Levy said...

Ah, you fall into the trap. People become nurses because they CARE about other people. The system in which they do work does not always allow them to follow their instincts and live their values. The way work is done needs to be redesigned to allow them to be themselves.

Anonymous said...

Wow. Our profession has abdicated the last shreds of its humanity. While we're at it, I'm sure robots would dispense meds without error and not exhibit alarm fatigue, either. I wonder how good they are at chest compressions.

Where will it end, and to what end?

nonlocal MD

Anonymous said...

Brings to mind Lynne Truss's book,
Talk to the Hand: The Utter Bloody Rudeness of the World Today, or Six Good Reasons to Stay Home and Bolt the Door.
Especially the chapter on "Why am I the one doing this?" about self checkout, automated phone trees, and other so-called conveniences of modern commerce.

Chris Corio said...

I'm the CEO of Engineered Care and we make this product available commercially through a license. The funny thing about your post is that we actually haven't released the commercial version of the product yet (it comes out in the spring) because we've been focused solely on software that improves the discharge process. So, I guess we're on the same page. However, I think you'd find that this is an exciting patient education experience. Louise can describe various aspects of the patient's post discharge plan and then the nurse can see what the patient had questions about and directly address those issues. I'd be happy to have our team do a demo for you. Send me an email at chris.corio@engineeredcare.com

e-Patient Dave said...

Whoa whoa whoa, let's not jump too quickly.

NOTHING (in my non-trivial experience) will ever replace the genuine human care I received from nurses. (Most readers probably heard the announcement yesterday that Gallup's annual poll showed nurses to be the most trusted profession. When will robots get there?)

BUT - for specific tasks, there can be value. At Connected Health in Boston 2010, a researcher noted that for discharge instructions (and I think for similar patient education) patients did like the robot experience better - partly because they could stop and go back over something as many times as they want, without taking up someone's time. Considering how important readmissions are, that's nothing to sneeze at. (And yes, an avatar-y face on the screen was much different from just reading the info.)

The other thing they reported, which surprised me at first, was that the patient didn't feel like a person was going to think they were stupid for not understanding - so they DID ask to review things far more than with a busy human.

(Huh, I wrote this before seeing Chris Corio's comment, which I guess matches up with what I said.)

Anonymous said...

Dave, I see your comment as a further indictment of our profession - we are so abrupt and hurried that patients are worried about looking stupid and would rather talk to a robot! Good grief.

As I was trying to sarcastically indicate in my comment above, perhaps medical professionals should consider whether their jobs could be replaced by robots - since their humanity is the only thing differentiating them from one; certainly not their error rate.


Grace @ Sterilization Services said...

I completely understand e-Patient Dave's arguments concerning the efficiency, ease and effectiveness of a tool like Louise. What I question is whether an automated avatar can carrying out the emotional responsibilities of a nurse as well as the technical. I understand that not all nurses have the time or patience to hold the hands of overly inquisitive or anxious patients, but is this a reason to do away with the concept of "bedside manner" altogether?

e-Patient Dave said...

Grace, apologies for the delay - had computer problems. Here's what I drafted, which didn't post last night:

Grace, I agree - a robot is appropriate IMO solely to the extent that it gets the job done more reliably (eg some surgeries) or patients like it better.

Not to trivialize it but I think it's apt to point to email vs phones and ATMs vs tellers. Both are clear improvements for many things but neither suffices when you need or want human interaction.