The average Canadian may not have much in common with astronauts orbiting Earth, except for the decent chance they both lack access to a family doctor.
It is a parallel that at least one federal agency, one tech startup and one regional health authority in Quebec have noticed. And on Monday, they unveiled the fruits of that observation: a machine originally designed to monitor the health of astronauts in outer space that has now been installed in a clinic on the outskirts of Montreal. The Baüne Autonomous Care Unit is the first of its kind in Canada.
Some of the thousands of orphan patients in Montreal’s West Island will eventually be eligible for checkups from the device, named after the Edmonton-based company that developed it, in lieu of seeing a physician. Their experiences and health data will then help determine if the module is fit for space travel.
“We were developing this for our own needs for space, they were looking for a way to cut into their waiting lists,” said David Saint-Jacques, the renowned astronaut with the Canadian Space Agency who completed a mission to the International Space Station from December, 2018, to June, 2019.
“What we want is what they want,” added Dr. Saint-Jacques, who was present at the unveiling of the autonomous care unit in Montreal.
Approximately six million Canadians don’t have a family doctor, and the situation is especially bad in Quebec, where more than a quarter of residents are without one. The provincial government has threatened action, including forcing medical school graduates to practise in-province, to curb the primary-care crisis.
The autonomous care unit’s backers say the pilot project will get people the care they need faster without a family doctor. But some health care experts wonder if it simply forces patients who’ve waited years for a human doctor to settle for a high-tech check of their vital signs instead.
“We already have blood-pressure cuffs in pharmacies,” said Lauren Lapointe-Shaw, an internal medicine physician and researcher at the University of Toronto who studies virtual care.
“What worries me is that this is being sold as some kind of alternative to a family physician. It’s a very dramatic misunderstanding, I think, of what physicians can do for you, which is far beyond what a vital-signs check can do for you.”
The autonomous care unit, located at the Pierrefonds CLSC, or community health clinic, resembles an automatic customs scanner at the airport. Patients fill out a digital questionnaire ahead of time – with prompts such as, “Are you a smoker?” – then stand on a scale that also measures height, yielding their body mass index. The machine takes blood pressure and other vital signs.
A camera even scans the person’s facial expressions, which a computer algorithm assesses for signs of mental distress. A nurse will be in the next room and ready to intervene or escalate the case to a doctor if the data presents any warning signs.
Dan Gabay, president and chief executive officer of the CIUSSS de l’Ouest-de-l’Île-de-Montréal, the regional health authority responsible for the project, is aware the optics of filling a doctor shortage with a robot are not ideal, but argued it was an effective way to make a dent in his region’s groaning waitlist. He would eventually like to see the machines installed in pharmacies to make them even more accessible.
“I know people will say it’s a gimmick but I see it as a positive. You’re doing something that’s first, that’s different,” Mr. Gabay said. “The system is a little bit under duress … This is a way for us to cut into the curve.“
Innovations such as the autonomous care unit could help take the edge off Canada’s health human resources crisis, said Brian Hodges, chief medical officer at Toronto’s University Health Network – so long as they don’t replace the human connection essential to good medicine.
“I think this is a moment when we can see that the technology could really help us,” said Dr. Hodges, who is also president of the Royal College of Physicians and Surgeons of Canada. “But there are also ways in which technology could be really isolating.”
For example, he said, video counselling has proven beneficial for people in mental distress, but an artificially intelligent chatbot that tried to offer similar care without a human presence in the background could leave patients feeling more alone.
In Montreal’s Pierrefonds neighbourhood, the health authority is still determining how to select the patients who will be given access to the autonomous care unit, but Mr. Gabay said variety will be important in choosing the first users so that the machine’s performance can be judged across the spectrum of patients’ needs.
The device is not a doctor, of course, but its goal is to determine which patients need the attention of a human medical professional. Dr. Saint-Jacques, the astronaut and physician, said that such triaging is the first step of any doctor’s appointment, anyway.
“I was a family doctor myself, and your first job is to determine, sick or not sick,” he said.
The autonomous unit introduced Monday only gathers a handful of vital signs, but Andrea Galindo, chief operating officer and co-founder of Baüne, said there is a version at the Canadian Space Agency in Longueuil, Que., that is capable of gathering 40 health data points. It is much more expensive and unwieldy, but its capabilities could eventually be rolled out on the public machines.
But Dr. Lapointe-Shaw doubts that would make much of a difference to the primary-care crisis.
“I think there’s a little bit of magical thinking that goes on – that somehow technology will make two plus one equal to six,” she said. “When, in fact, you really just do need people like physicians, nurses to be able to properly assess someone.”
