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    Entries in health care (7)

    Wednesday
    Nov022011

    Never takes a day off, follows instructions, and is more empathetic?

    I've noticed at least two things since I have gone off on my recent 'robots are going to take away all our jobs' kick. One, oddly enough my blog traffic is way up, something like 33% or so, as I seem to be getting a fair number of hits from Google searches for the word 'robot'. Which is pretty cool. So if you've found your way here looking to actually learn something about robots - how they work, their manufacturing process, or you were seeking information about Robocop or the Robot from 'Lost in Space', all I can say is 'Welcome!' and 'I apologize for possibly wasting your time.'  The second thing that I have noticed is just how many of these robot stories are out there, it is getting a little ridiculous and I swear that I am not going to great lengths or scouring obscure sources to find them.Robot - 'So, what's on your mind?'

    The latest article on the growing, (and I think concerning) trend is from the MIT Technology Review, titled 'The Virtual Nurse Will See You Now', a review of a new virtual nurse and exercise coach technology program developed at Northeastern University. The virtual nurse interacts with patients, helps them to understand their diagnoses and aftercare programs, and by virtue of some additional programming, even can engage in rudimentary small talk about sports or the weather, a capability that helps to increase patient's comfort level interacting with the virtual nurses.

    According to the MIT Technology Review piece, the virtual nurses are proving effective, with patients that had interacted with the nurse more likely to know their diagnosis and to make a follow-up appointment with their primary-care doctor than patients who had not worked with the virtual nurse. The second set of trials with overweight, sedentary adults that were exposed to the virtual exercise coach, (named Karen), were also successful, with users reported to have "checked in with Karen three times a week, while she gave them recommendations and listened to their problems. Over 12 weeks, those who talked to the coach were significantly more active than those who simply had an accelerometer to record how much they walked."

    While it's not surprising anymore to read about how robots and other automation technologies like the virtual nurses are fast becoming so advanced, powerful, and capable to the extent that they can perform more and more traditional human jobs faster, more accurately, and cheaper than us mere mortals, some of the comments in the virtual nurse piece were striking for their assessment of the need and benefits of these new tools. Here's a sampling, (but you really should read the entire piece):

    Patients who interacted with a virtual nurse named Elizabeth said they preferred the computer simulation to an actual doctor or nurse because they didn't feel rushed or talked down to.

    Dang, that's not a ringing endorsement for patient care and bedside manner of our health care professionals. But once we get more people in the field I am sure the standard and quality of care will improve. After all, health care is one of the few consistently growing career fields.

    Not so fast though, check out this quote:

    Such technologies will become increasingly important with rising health-care costs and an aging population. "We already know we don't have enough health-care providers to go around, and it's only getting worse," says Kvedar. "About 60 percent of the cost of delivering health care comes from human resources, so even if you can train more people, it's not an ideal way to improve costs."

    That doesn't sound good. When even health care, one of the most hands-on, high touch, and needs the human element to be effective, kinds of fields is under pressure to cut costs via increased automation, well that does not seem to bode well for the long term employment prospects for a field most of us have come to see as safe, secure, and even in more demand as our population ages.

    But beyond the simple automation and efficiency play here, more alarming is the idea that the virtual nurses and coaches can be seen as more understanding, attentive, and even empathetic. How can a robot or a computer actually demonstrate empathy? It's probably a question for another day, but if the robots can start beating us on empathy, well, it's going to be tough to find something else we can still do better than them.

    Tuesday
    Mar232010

    Missing the Health Care debate

    Some folks that know me, or follow me on Twitter or Facebook know by now that my Dad has been in the hospital for what is now going on 13 days. 

    It started, as many of these kind of cases do I have learned, with what seemed to be a cold, then a bad cold, then a fall at home, then a call to 911, and finally a diagnosis of pneumonia (along with some other assorted issues that have popped up).

    As this process has unfolded, his condition has gone up and down, probably a bit more down, as additional issues and complications have arisen in the past few days. In the course of his care, the doctors (and there have been at least five, specialists for infectious diseases, neurology, endocrinology, cardiology, and  psychiatry), and nurses have been very professional and have done their best to help both my Dad and us stay informed of what is going on in what has proven to be a complex, challenging case.

    And as the number of doctors, nurses, clinicians, specialists, and other professionals has multiplied, so have the number and frequency of tests, procedures, and medications that have been involved in his care.  There have been really too many to count among the MRIs, CT scans, X-rays, blood tests, and more in the last 13 days. In truth, my Dad's case has been extremely complex, and at times they have not been completely sure what is going on, and as such, several of the tests have been perhaps a bit speculative.

    But as this process continues on, I can't help but wonder a few things:

    One - had my Dad not had health insurance coverage in the form of some combination of Medicare and insurance from his former employer, just exactly how would all of this played out?  Would any of the decisions and approaches to his treatment actually been any different? Does everyone in his situation get the same comprehensive, and I am sure incredibly expensive care?

    Two - Is it entirely normal and expected that the actual costs of treatment are really never discussed with the patient and family?  As each test, procedure, medication, etc. have been ordered, they have been discussed with us in detail.  The goals, steps, process, potential complications are all carefully described.  But not one time has the subject of cost ever been discussed.  Should the cost of care, of each additional test or procedure be a part of the decision making process?  I imagine that the Doctors or the hospital administrators take the costs into account, but to have what has amounted to zero discussion of cost between service provider and service recipient is certainly unusual (at least to me).

    Three - These last two weeks, as the US health care reform debate, compromise, and vote has played out on the news, in the blogs, and in social networking, most of the (limited) information that I saw was primarily focused on the macro level.  The many millions of uninsured people that would now get coverage, or depending on which cable news network you prefer, the billions of dollars that would be saved, or squandered as a result of these reforms.  Big picture discussion on percentage of GDP and national obesity rates.

    But to me, what is clear as a result of what my Dad and our family is going through, is that any talk of health care reform really starts and stops at the micro level. It is about what happens when Dad or Grandma gets sick and needs intensive, expensive care, (and rehab). It is about what happens if the new baby is born weeks and weeks early.  It is about making a decision, as many people do, to stick it out in a dead-end and soul crushing job in order to cling on to a marginally decent benefits plan, because your spouse has been sick for a long time, the kind of sick that insurance types like to call a 'pre-existing condition'.

    I have been really distracted the last two weeks, talking about ventilators, CT scans, catheters, spinal taps, and blood work.  So perhaps I simply have not had the time or attention to think about the big picture, and what these reforms mean to the country, the economy, the workforce, and the next generation. For me, at least right now, these concepts are too vague, elusive, and certainly contentious to fully grasp. 

    Right now, for me, the only thing in 'reform' that I care about, is whether reform will affect my Dad's ability (and you can insert your own loved one's here), to get the needed treatment, and walk out of the hospital one day soon.

    And I suppose any reform that makes that kind of positive outcome more likely for my Dad, and your Mom, Grandpa, daughter, husband, or friend, is the kind that we can all support. 

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