Home Commentary The view from inside the robot

The view from inside the robot

February 2015

Published in the February 2015 issue of Today’s Hospitalist

THE CORE OF MY INTERNAL MEDICINE TRAINING was learning how to talk and listen to patients, hone my physical exam skills, and develop a bedside manner to establish rapport and gain patients’ trust. I was taught to get close to my patients to listen to their heart and lungs, touch their areas of pain, and smell their wounds. It never occurred to me that I’d have the option of “seeing” my patients through a video screen in the head of a robot.

I was introduced to telemedicine in 2009, smack in the middle of my first year as an attending. I was living in Paris, flying back to the U.S. every month to spend between 10 and 12 days a month, sometimes working 24-hour shifts. My locum tenens contract was up for renewal.

I was torn between staying in France and finding a local job or continuing to divide my life in half. I figured that practicing medicine in a foreign country where I hardly spoke the language might be tough, but I was determined to stay in the City of Lights.

When I ultimately told my boss “I worked for Eagle Hospital Physicians, based in Dallas “that I was staying in Paris, like it or not, he surprisingly had no problem with that decision. In fact, he offered me a position as the first physician in the company’s new telehospitalist program.

At first, I had to repeat the word “telehospitalist” because I had no idea what he was talking about. As a telehospitalist, I would work as a nocturnist and see patients in a hospital in Kentucky via a sophisticated robot. That robot is capable of many things, including transmitting sound to me through a stethoscope. I’d be steering the robot into patients’ rooms accompanied by a nurse who’d help me with touch and smell.

In the beginning, I’d continue to fly back to the States to do 10 shifts a month onsite, then work one week a month from my office in Paris. For me, it was the perfect solution, but I soon realized that with any change comes with challenges.

The robot disappears
When I began the program and described my work to colleagues, they’d often ask me if I’d like to be examined and taken care of by a robot. After all, speaking to a face on a screen isn’t the same as talking to someone standing next to you, and the idea of being so impersonal as a physician really didn’t make sense. While I wanted the program to work out, I had many doubts in the beginning and didn’t know what to expect.

But then I started interviewing my first patient, delving into his history just like I did with patients I treated in-person. The robot seemed to disappear and we were talking to each other as if I was right next to him. I never thought that his story might have been any different if I was onsite or that he was hesitating to tell me more because I was not there in person.

Using telemedicine has taught me that patients yearn for their doctor’s full attention, and they look to our expertise for solutions. The robot is just a tool that mediates that communication, and I don’t feel that my treatment decisions are limited because I am not physically in the hospital.

Plus, the ubiquitous use of electronic medical records with access to labs, imaging, notes and computerized order entry makes it even easier to practice anywhere, anytime. Some patients “and I’ve treated people as young as 18 and as old at 100 “feel special to be a part of this new technology. They’ve embraced looking into the screen and telling me the story of their sickness.

Resistance from (a few) colleagues
I have run into only one or two patients (out of literally thousands) who didn’t want to be seen via a robot. At the time, I chalked that up to their being frustrated about being in the hospital and dealing with long ED stays.

I have, however, met some resistance from consultants and even fellow hospitalists. A few have had a hard time dealing with a telephysician, mainly because they don’t believe in the technology or they don’t think it is reliable.

At the same time, telemedicine is winning more converts, particularly within urgent care. Neurologists have found telemedicine to be especially useful to examine and provide life-saving treatment to patients exhibiting early signs of stroke. And there have been many situations where I was needed in a code; I was able to beam onto the robot and assist immediately.

Full-time telemedicine
In 2013, when I became pregnant with my daughter, I stopped commuting back to the U.S. for some shifts and began working full time as a telehospitalist. In my program, there are now at least 10 of us. One lives in Israel, while the rest live in the U.S. and telecommute to their hospitalist practices. All of us are still working night shifts only “a solution that certainly works for our fellow hospitalists who live locally.

Telemedicine won’t be for everyone. To be successful, physicians must have a wonderful bedside manner and come across as being very compassionate to help patients deal with only a virtual interaction.

And I miss working physically in the hospital and interacting not only with patients, but colleagues. All my consults and signouts are done via telephone, and while I can always pick up the phone or send a text message to another physician, our communication remains virtual.

While I stay in touch with the other daytime hospitalists in my program, I often feel lonely working from home. But it is wonderful to be surrounded by my family “and to be able to head to my favorite boulangerie here in Paris when my shift is over.

Jayne Lee, MD, has worked from Paris for several years as a telehospitalist for Eagle Hospital Physicians.