My brother and I like to swap stories about our medical encounters. I suppose our ages – 69 for me and 74 for him – lead to varied encounters and tales.

“It’s a sh*t-show,” he tells me from his home on Martha’s Vineyard. “No one’s left here on the island. The doctors who remain have stopped seeing new patients or have incredibly long waiting lists.” My brother is forced to go to medical centers in Boston to see doctors.

It’s not the shortage of physicians that irks him, however. It’s the impersonal way health care is delivered plus the fact that telemedicine isn’t the panacea it’s cranked up to be, certainly not when physical and neurological exams are required to evaluate his fused lumbar spine and painful and progressive neuropathy.

“Now it’s my turn to complain,” I tell him. I relate that I logged on to my patient portal to send my PCP a message, but before the message could be delivered, I received a pop-up screen:

• Call 911 if you have an emergency.
• Allow up to two business days for a medical question response.
• For new problems, including skin conditions, use Symptom Checker or schedule an appointment before sending a message (both “Symptom checker” and “Schedule an appointment” were hyperlinked).
• Messages to your provider are part of your medical record.

I was curious to learn about Symptom Checker, so I clicked on the hyperlink, which first directed me to the “Terms and Use.” I pretended to understand legalise and then I was introduced to Symptom Checker.

Here is what the bot offered:

“Welcome to Symptom Checker! Tell us how you’re feeling, and we’ll help you get the right care, including:

eVisit

If your symptoms are minor, you might be able to complete an eVisit right away. You’ll just have to answer a few questions about your symptoms, and a health care provider will send a diagnosis and treatment plan to your inbox.

Urgent care video visit

Some minor conditions don’t require in-person care, but do require a face-to-face conversation with a provider. In those cases, we’ll help you start a video visit and get the care you need from the comfort of home.

Urgent care or doctor’s office

If your condition is minor but requires in-person care, we’ll help you find an urgent care near you or schedule a visit with your doctor.

Emergency room

“If your symptoms are life-threatening, call 911 or seek emergency care right away.”

A few things strike me as both funny and tragic about the messaging. First, the health care system doesn’t want me to see my PCP. It prefers instead to shield him with a chatbot acting like a downfield line blocker.

Second, the health system puts the onus squarely on me, aided by minimal advice, to figure out if my condition requires an in-person visit. The proverbial cart is before the horse insofar as triage is suggested before a diagnosis is made.

Third, a dummy understands to call 911 if they are experiencing a life-threatening emergency. I am not a dummy.

Lastly, all I needed from my PCP was a refill of medication.

Nevertheless, I clicked on the Symptom Checker to explore the application. I was asked to pick the symptom or condition that most closely matched what I had been experiencing. The artificially unintelligent program actually generated over two dozen conditions to self-treat or self-medicate with OTC drugs. The conditions ranged from sunburn to rash to athlete’s foot to jock itch to constipation and even COVID-19. Once again, the goal was to spare the health system an unnecessary PCP visit.

I clicked on “mental health” because at this point, I thought I might need a psychiatrist. I was advised to call the Suicide & Crisis Lifeline (988) if I am in crisis.

Next, I was asked to enter my phone number and questioned whether I was thinking about hurting myself or someone else. Responding in the negative, I was asked if I am either sad, anxious or worried, or unusually happy, excited, or hyper. Choosing none of these options, I was offered an urgent video call. However, endorsing manic-like symptoms (happy, excited, hyper) ordered me instead to make an appointment with my PCP.

Now I felt like hurting someone. The algorithm was clinically flawed. It didn’t recognize hypomania or mania as a psychiatric emergency. Furthermore, when I endorsed “sad” or “anxious and worried,” I was required to take the PHQ-9 and GAD-7 screening instruments for depression and anxiety, respectively. Although commonly used in primary care settings, these screens are far from perfect. Interpreting their results at face value without the benefit of a clinical evaluation can have detrimental consequences for patients.

I played along and endorsed severe depressive symptoms on the PHQ-9. I was advised to contact my PCP. Ironically, Dr. Symptom Checker further burdens PCPs by designating them to be on point for patients’ mental health problems. This is especially egregious considering that the health system where my PCP practices has a separate department of psychiatry. Mental health care should be integrated with primary care whenever possible.

The over-reliance on and uncertainty of artificial intelligence is one of myriad problems plaguing health delivery systems. Add to those problems the depersonalization and dehumanization of the medical experience, and you have a recipe for … well, as my brother put it: “a sh*t show.” And let’s not forget about the increasingly intolerable conditions under which physicians must practice: toxic workplaces, EHR calamities, and incessant hounding by third parties, to name a few.

Medical practice has become a joke, staffed by threadbare providers, possibly not even human. Physicians who remain loyal to the cause – to serve the suffering – are not laughing, however. They are burning out at record rates and dealing with moral injury inflicted by deceptive health systems that dangled lucrative employment contracts promising to honor physicians’ beliefs and values, only to find they were sold a false bill of goods. Although physicians clearly feel a moral imperative to spend time forming important human connections, inherent transactional demands of health systems undermine these ideals.

There is no joy in practicing medicine in Mudville, USA. Mighty Casey has struck out, and happiness may never prevail again.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.