The Electronic Patient: Medicine and the Challenge of New Media 電子病人：醫學與新媒介帶來的挑戰 Speaker: Dr. Jeremy Greene
While the COVID-19 pandemic has thrust telepresence into the mainstream for most clinical (and many nonclinical) interactions, the suite of social and technical operations that make up telehealth have been at place for at least a half-century. This talk revisits the history of early telemedical encounters in the 1960s and 1970s, as framed by records of physicians, nurses, policymakers, engineers, and sociologists, to reveal an earlier reckoning with the forms and meanings of clinical care through electronic media. The invention of the telegraph in the mid 19th century, celebrated a bit fancifully perhaps as “the Victorian internet”, nonetheless brought a new experience of being “together apart” such that telegraph operators could claim to recognize the distinctive “touch” or telegraph style of their remote interlocutors. The telephone added the simultaneity of voice to remote presence, the radio the possibility of mobility, the television the multimedia component of sound and vision together. Yet for physicians and patients, each new electronic medium of telepresence, in filling part of the void left by its predecessors, highlighted those forms of absence that continued. When the Boston physician Kenneth Bird has been credited with inventing the term “telemedicine” in his newly-minted telediagnostic clinic at the Massachusetts General Hospital, allowing him to see a patient through a series of different camera lenses beamed by microwave link, some things—like the color of dermatological lesions, or the smell of a patient’s urine—could not properly be conveyed. Telepresence would never, he admitted, truly replicate the “touch” of the physician. Yet Bird and those who followed his lead to create telehealth platforms nonetheless wondered: if at a certain point we accept a telephone call as a conversation, at what point does telepresence simply become presence? Does it require adding the sense of touch, or perhaps also the olfactory, the gustatory, three dimensional immersion, proprioception? Or is presence a more contingent thing than that? Are there forms of presence which might even become heightened with distance? This talk positions telepresence in medicine as an open-ended form, with potential to both support and subvert existing structures of the doctor/patient relationship.
Medical Humanities in the Digital Era 數位時代中的醫學人文 Speaker: Dr. Ying-Wei Wang 王英偉署長
The fundamental values of medicine is committed to improving the health of the patient by finding the right answer and doing the right thing. Patients provide a rare privilege for health professionals to have a glimpse in their most private and intimate moments, known as the “human touch”. It is important to continuing building the relationship between patient-providers by nurturing the human side of medical care that can be quickly overlooked due to the tremendous stressors that health systems face today. Healthcare is shifting to a digital era and entirely new forms of interaction such as telehealth are evolving; providing a new opportunity for medical humanities. There are many variations of technology that can be applied to teaching, communicating and treating individuals and health professionals. Virtual worlds provide online communities that engage users in purposeful and focused communications in a highly engaged environment. Avatar-based role-playing programs can also profile different human conditions of illness and suffering; developing health professional students’ skills for interpreting, analyzing, evaluating, synthesizing and solving complex problems. The patient landscape is changing and the healthcare sector needs to evolve with the new needs. Technology is hardwired to be efficient; and traditional approaches of interacting with patients should not be limited to sitting in front of a screen, googling for answers. Organic digital opportunities are growing to be experimental and innovative- they provide a new, endless opportunities for users to explore the meanings attached to health, illness, life and death. The content is more relevant to the learners and fill gaps in the current clinical learning and patient environment. Embracing digital technologies in the health system can expand the creative and physical space, ensuring health for all.
In the Name of AI – Love in Health Care: A Reflection from STS Perspective AI醫療 •「愛」醫療：STS的提問 Speaker: Dr. Wen-Hua Kuo 郭文華教授
This brief presentation aims to offer some reflections on the trends in prospecting future health care that features artificial intelligence (AI). Contrasting to traditional health service that emphasizes on patient-physician relationship both intimate and professional, the AI-facilitated medicine, as generally perceived, is clod, rigid, and without compassion (or “ai” as pronounced in mandarin). With perspectives from science and technologies studies (STS), I do not intend to comment much on the “invasion” of AI technologies that would be applied to almost every aspect of health care, nor how to preserve the compassionate essence in the doctor-patient relationship under the increasing financial pressure in health sector. Instead, by closely following how Taiwan’s national health insurance scheme has changed the conception and practice of care, I will invite the audience to think together how to confront AI discourses/initiatives in health care; the opportunities and pitfalls they can bring to the changing landscape of care that consists not only medical professionals and those who passively need helps for better health but also health technologies and information. Only with this understanding can we circumvent futile debates over the introduction of AI in health care. More attention, as I will argue, should be put on how care is actually delivered and what changes we can make to achieve constructive healing interactions both medical professionals and patients deserve.
Responsible Care for Older Adults through Robotic Media 透過機器人媒介對年長者的責任照護 Speaker: Dr. Ryuji Yamazaki-Skov
As populations continue to age, there is a growing need for new technologies to assist older adults in daily living, especially during a pandemic. Their social isolation is one of the leading issues in healthcare promotion and designing communication aids is crucial. Computer-based intervention has been investigated for improving communication among people with dementia, healthcare personnel, family members, and volunteers, and telecommunication support is expected to be provided by robotic media technology and facilitate social interaction both verbal and nonverbal. Problem-solving through new technologies is an opportunity not only to research how social isolation can be mitigated, but also how new relationships can be fostered.
In this talk, I will present my research projects and discuss how telecommunication with dementia patients can be realized and improved by robotic media and its potential for improving the operator’s communication skill, including related ethical issues, e.g., regarding utilization of personal information. Healthcare professionals will be required to provide care by making use of new technologies such as social robots both in local and remote care settings. By showing and reflecting on my robotic mediation project, I will propose research topics for people involved in care for older adults, especially for healthcare professionals as ‘robotic mediators,’ and discuss their challenges with ethical as well as educational implications.
With respect to medical education, I propose to employ a teleoperated robot as a training tool for communication with dementia patients. While this robot can promote the patient’s conversation, a limited functionality of the robot may lead the operator to pay more attention to their dialogue itself rather than gestures as in person. At the same time, conversational data storage and analysis may allow knowledge sharing among the robot/operators and people involved in care for older adults. This kind of communication style has potential for helping healthcare professionals, especially at early carreer stages, evelop their communication skill. Furthermore, for example, in a case where family members of the patients are willing to teleoperate the robot, healthcare professionals may need to instruct them in effective ways of communication and how to utilize the robotic Embodied Comunication Technology (ECT), resulting in a call for a new type of education and teaching together with a view into ethical aspects of robotic care.
Health Care and the Lived Reality of Patients 醫療照護與病人經歷的現實 Speaker: Dr. Annemarie Mol
The dominant self-understanding of Western medicine is that diverse diagnostic techniques all cast a different perspective on the condition of a patient. However, in the practices that I studied in hospitals in the Netherlands, I learned that there are often tensions between what different diagnostic techniques demand, do and conclude. For instance: is atherosclerosis of the leg vessels best characterised as the pain upon walking that a patient grapples with, or as the loss of lumen visible on an angiographic picture? These versions of the disease do not fully align. Notably, walking therapy will help to increase the distance people are able to walk, even though their lumen loss stays the same. This raises the question which reality to prioritise: that of walking patients or that of techno-images.
And if the object of medicine is diverse, so, too, is its process. The dominant ways to imagine the health care process is as a decision tree, with one bifurcation point after the other. However, the practices that I witnessed were rarely linear. Take the treatment of type 1 diabetes. This is not a step by step affair, but a matter of persistent tinkering. And while patients are encouraged to self-measure their blood sugar levels in the hope of postponing complications, they have to avoid their fingertips, to maintain optimum sensitivity. In this way, a future in which blindness is a possibility is included in a present meant to avoid it.
In Western medicine, then, different logics are at work at the same time. Rationalist ones, that tend to get built into machines; and clinical ones, that foreground the lived realities of patients. Here is my question: how do these two logics travel? How do they interfere with structural health care conditions across the globe, and more particularly in Taiwan?
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