Robodoc

WASHINGTON - Ries Daniel was waiting in his hospital room the morning after bladder surgery when the door finally swung open. But it wasn't his doctor. Instead, a robot rolled in, wheeled over and pivoted its 15-inch video-screen "head" toward the 80-year-old lying in his bed at Baltimore's Johns Hopkins Hospital.

"Good morning," said a voice from the robot's speaker. It was Louis Kavoussi, Daniel's urologist. His face peered down from the screen atop the 51Ú2-foot-tall device dubbed Dr. Robot. "So, how was your evening? No problems?"

Studying his patient through an image beamed back to his office by Dr. Robot's video camera, Kavoussi was concerned because Daniel had run a fever overnight and developed a cough. "You're not looking as good as yesterday," said Kavoussi, zooming in the camera for a closer look after having focused on Daniel's chart moments before.

"I didn't have my martini," said Daniel, managing a smile.

"Well, let's see how you are feeling later on today," Kavoussi said. "If you're feeling better, we'll send you home, all right?"

Later Kavoussi, who is on the robot manufacturer's scientific advisory board and a stockholder, tweaked a joystick to maneuver the robot back to the hallway.

Such robot-assisted exchanges are being repeated in dozens of hospitals across the country by doctors who use the machines to make their rounds, monitor intensive-care units, respond to emergency calls and consult with other physicians.

Proponents say this and other new "telemedicine" technologies are allowing doctors to use their time more efficiently and serve more patients, often at odd hours or in remote places where the sick would otherwise have a hard time seeing a doctor.

"There's a tremendous amount of medical care being provided from a distance today through technology like this," said Jonathan Linkous, executive director of the American Telemedicine Association.

Skeptics, however, fear that the technology is further depersonalizing health care, accelerating the trend of doctors spending less and less time with their patients, and eroding what remains of the doctor-patient relationship.

"This is a triumph of the model of medicine that has abandoned the idea of personal interaction and providing comfort in favor of a model of the patient-physician interaction as essentially an exchange of information," said David Magnus, a Stanford University bioethicist. "You can see a face, but there's no touch, no laying on of hands, no personal contact. We're increasingly isolating people in a sea of technology."

Robots are turning up in more medical roles. Some help surgeons perform procedures, especially those requiring extreme precision. Others ferry supplies and equipment around hospitals and even dispense medication. Pittsburgh researchers are testing the Nursebot to lead nursing home residents to physical therapy sessions and remind them to take their medicine. GeckoSystems Inc., of Conyers, Ga., plans to soon begin marketing its CareBot to help nurses, doctors and relatives monitor and care for the elderly at home.

Face-to-face encounters between doctors and patients are increasingly giving way to technology in other ways, with the goal of avoiding frustrating telephone tag, long drives to the office and time wasted sitting in waiting rooms.

Physicians are turning to e-mail to reach and respond to patients. Hospitals, clinics and doctors groups are setting up secure Internet portals allowing patients and doctors to consult electronically.

In almost every state, patients also are "meeting" with their doctors from afar through dedicated telemedicine networks. They directly link major medical centers, such as the University of Virginia Medical Center in Charlottesville, the University of Maryland Medical Center in Baltimore and Children's National Medical Center in Washington, with distant sites.

The networks provide care to patients who do not have easy access to physicians, such as people who live in poor inner-city areas or in remote rural regions where specialists are rare. Prisoners are another group that may benefit.

Psychiatrists conduct regular therapy sessions using video teleconferencing. Surgeons examine patients' incisions via video hookups after they return home. Dermatologists diagnose rashes or lesions from images snapped with picture phones or transmitted live by video cameras.

"We've saved a lot of lives," said Joseph Kvedar, director of telemedicine at Partners HealthCare in Boston, who runs a weekly long-distance dermatology clinic for residents of Nantucket Island. "We've picked up a lot of skin cancers."

The need, proponents say, is increasing as the population ages and further strains a system already experiencing a shortage of doctors and nurses.