The day after the operation, she was sitting quietly by her bed, reading a magazine, when with a whine, a whirr and a flutter of tire tread, up trundled a Dalek or at least something like it. The body resembled a self-propelled heavy duty vacuum cleaner and was topped by an adjustable, flat-screen television monitor with the consultants concerned face on it.
The machine came to a quiet halt in front of Marjorie. She hadn’t noticed. She carried on turning the pages of her magazine. ‘Good morning, Marjorie, it said, how are you feeling today?’
She looked up, stared, seem to give a start, then recognised her consultants face. She relaxed, smiled knowingly, and replied a little self consciously, ‘I feel better, thank you.’.
The face on the monitor then proceeded to ask her specific questions about how much she was eating, her bowels, any soreness. The machine then focussed in on the results of today’s tests, seemed satisfied, ‘That’s fine, Marjorie, I’ll see you tomorrow.’ and swivelled round with a whirr and motored on down the ward.
Asked what she thought of addressing a robot, she smiled and said, ‘Oh it’s just like talking to my husband. He’s deaf, you know.’
Oh, so not much communication there then!
But the consultant on the monitor was none other but Lord Darzi of Denham, KBE, perhaps the most eminent doctor in the country, the author of the government’s latest review on the health service and the advocate of a new constitution for the NHS, one that respects and empowers the patient.
Yet, this same man conducts ward rounds using a Dalek!
In the introduction to his review, Darzi writes, ‘I have continued my clinical practice while leading the review nationally. I have seen and treated patients every week. Maintaining that personal connection with patients has helped me to understand the changes we still need to make.’
Personal connection? With a robot?
The report continues with high sounding rhetoric. Patients should have control and influence on their own health care. They should be able to choose which GP practice they attend, they should have access to the best drugs, and those with a chronic illness should have a personalised care plan.
I suppose patients could also have a say on which colour robot they wanted – something to match their dressing gown, maybe!
‘All patients want care that is personal to them.’
Personal care? With a robot? How does C3PO palpate the patient’s abdomen – conduct a rectal examination. No milord, care by a robot, is hardly personal. Perish the thought that it even might be!
‘High quality care should be as safe and effective as possible, with patients treated with compassion, dignity and respect.’
Compassion is something that can only be conveyed by personal contact. The patient has to be sure that their doctor really cares. Sending a robot along really doesn’t do it.
Dignity? How could you tell a Dalek about your most intimate symptoms, your deepest worries? Who else might be listening? Sending along a robot reduces the status of the patient to that of a machine.
Respect? I’m afraid that the use of robots to conduct ward visits conveys the message that their consultant is far too important and busy to see them. This is hardly respectful.
Darzi’s robot featured on the television programme, Superdoctors, which was broadcast on Thursday night. So, to be fair, we don’t know whether the good Time-Lord uses his C3PO routinely or whether this was just for the programme. Darzi commented that a robot would enable him to maintain continuity of care wherever he was – even from America. That is true, up to a point. C3PO might allow Darzi to keep control of his patients, but does it really allow him to administer care?
Caring is a very human relationship, like loving. Indeed, it is important that doctors love their patients – not in any romantic sense – but in a compassionate, human sense. But some patients are difficult to love. I remember one of my teachers, a very wise professor, telling me how he once had to look after a tramp. ‘He was filthy dirty, drunk, abusive and he smelt like a latrine that hadn’t been cleaned for a month. He only had one tooth in his jaw, but that tooth seemed to sum up the tragedy of his life, yet at the same time, his determination to live. I focussed on that tooth and I began to love it and the more I loved the tooth the more I found I could feel a love for him that overcame my natural revulsion – the more I saw him as a vulnerable person in need of care.’
Caring is an essential component of healing, though sadly it seems that medical students are not encouraged to develop either of these essential arts. The emphasis is on efficiency; diagnostic algorithms, personal care plans and evidence based management. This has been a developing trend since the nineteen sixties – for as long as I have been in medicine.
I once remember writing a piece for Northwing, the Sheffield medical student’s magazine, entitled ‘The White Coat Game’. In it I observed how white coats were originally worn by doctors to protect their suits from the bodily fluids of the patients under their care, but spotless and buttoned up, they seemed to serve another purpose: to defend the doctor from contamination from the messy emotions of their patients, who were depersonalised in hospital pyjamas and gowns. The message, ‘Don’t get too close!’ And what did the doctor do when he needed to carry out some messy procedure such as sigmoidoscopy? He took the white coat off and inspected the rectum in his shirt sleeves!
Darzi’s robot made me wonder how much of the new NHS constitution is political – offering lip service to an increasingly powerful patient lobby. Does the strapped-for-time lord not have a public relations assistant? If he does, they deserve to be fired. C3PO is appalling PR!
Healing a patient is like bringing up a child. It requires intimate personal contact and absolute trust. 95% of human interactions are non verbal. Touch, eye contact, the flushing or blanching of the skin, involuntary body movements, smell – all of these are important. They all help to create trust.
How can you trust a robot? It may be programmed for a kind of compassion. The face on the monitor may say reassuring words. But it is still a robot. Like television, it is not real!
And robots are fallible. What would happen if somebody left a cloth on the floor in front of C3PO, or like ‘Q’s robot in those last few intimate sequences of ‘Live and Let Die’, somebody threw a towel over its head? What would happen if it took a wrong turning and trundled off down the stairs? Computers may be great at shopping on line, managing finances, buying theatre tickets, arranging travel, but they are just not reliable enough to deliver health care.
And one dreads to think what might happen if the treatments didn’t work and there was no hope.