Takeaway
In critical care, physical presence at the bedside is required to recognize subtle changes in the patient’s condition. A doctor in the room must remain the gold standard for clinical excellence.
Passion in the medical profession | May 21, 2026 | 3 min read
By Souvik Chatterjee, MD, Johns Hopkins Medicine
NPR’s 1A recently ran a segment on tele-ICUs. At the center of the story was the death of Conor Hylton, a 26-year-old who walked into Bridgeport Hospital in Connecticut and died overnight after being transferred to critical care. His family only learned after he’d passed that the doctor managing his care that night wasn’t in the building. Surprisingly, up to a third of ICU beds in the U.S. are now touched by remote care.
The human cost of remote critical care
I keep coming back to one fact from this story—no one called the family to tell them Conor was getting worse, or that he was being admitted to the ICU. The first call home didn’t happen until after he had a cardiac arrest. That’s not an oversight that can be blamed on a single missed page or message. It’s the predictable consequence of practicing critical care from a screen. When you’re in the room—when you actually walk in and watch a chest rise and fall—you quickly understand that this is a person, that his mother should know what’s happening, that someone needs to pick up the phone and call the family. A trendline on a flowsheet, or number with two red arrows next to it, doesn’t make that phone call. A human in the room does.
Presence powers excellence in critical care
This is the argument I want to make plainly—you can’t be clinically excellent at a distance. Excellence in critical care lives at the bedside. It always has. Almost everything we value about our specialty—recognizing the patient who looks worse than the numbers, noticing the family member who hasn’t slept in three days, hearing the asynchrony the ventilator alarm won’t catch for another half hour, sitting down in a chair so a goals-of-care conversation can actually breathe—happens because a trained person is physically there.
I’m not against AI or data. Trend analysis on vitals and labs, early-warning models, remote second eyes overnight—there’s likely real value there. But it’s all of secondary importance. The primary good in critical care is presence. The primary good in being a physician is presence. Data informs presence—it can’t replace it. The moment a hospital decides the algorithm and the video screen are enough, we’ve quietly redefined what we owe patients, and we’ve redefined it downward.
Be at the bedside
This’s why our group has worked so hard on SWIFT: Streamlined Workflow for ICU Fast Transfers. We bring expert ICU nurses and doctors to the critically ill in the ED, so the sickest patients have a trained pair of eyes on them before the elevator ride upstairs. The reason is that presence, early, changes outcomes in ways no remote signal can replicate. You see things. You ask the family questions no one has asked yet. You diagnose, identify suffering, and most importantly, communicate.
Presence preserves humanity
The other thing presence does—and this is the part of the Conor Hylton story that bothers me most—is it reminds you that the patient is a human, and that you are a human too. When you see a 26-year-old who’s very sick, something in you knows to call his parents. You don’t need a workflow to tell you that. You do it because you’re a person standing next to another person. Take the person out of the room and you take that instinct out of the room.
I’ll say what the intensivists on the NPR panel didn’t quite say: tele-ICU, compared with a trained critical care clinician at the bedside, is substandard care. I understand the constraints. Workforce shortages are real. Lack of rural access is real. There are nights and places where remote support is better than nothing, and I’m grateful for the colleagues who do that work. But “better than nothing” shouldn’t be our ceiling. The aspiration of our field has to remain a trained person in the room. If we forget that, we’ll keep finding out, the way Conor Hylton’s family did—after it’s too late.
Excellence isn’t a dashboard. It’s a clinician in the room.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.