My brother and I like to exchange stories about our medical encounters.
“This is a terrible show,” he tells me from his home on Martha’s Vineyard. “There’s no one left on this island. Those doctors who do either stop seeing new patients or have incredibly long waiting lists.” I am forced to go to a medical center.
But it’s not the shortage of doctors that bothers him. Add to that the impersonal manner in which health care is delivered, and the fact that telemedicine is not a panacea.
“Now it’s my turn to complain,” I tell him. I told him I was logged on to the patient portal to send a message to my PCP, but before my message was delivered, a pop-up screen appeared.
- In case of emergency, please call 911.
- Please allow up to 2 business days for medical questions to be answered.
- For new issues involving skin conditions, please use the symptom checker or schedule an appointment before sending a message (both “Symptom Checker” and “Schedule an Appointment” are hyperlinked).
- Messages to providers are part of the medical record.
I wanted to know about Symptom Checker so I clicked on the hyperlink and it first took me to “Terms and Conditions”. I pretended to understand legalization and then was introduced to a symptom checker.
Here’s what the bot provided:
“Welcome to Symptom Checker! Let us know how you’re feeling and we’ll help you get the right care, including:
If your symptoms are mild, you may be able to complete your eVisit immediately. Just answer a few questions about your symptoms and your healthcare provider will send a diagnosis and treatment plan to your inbox.
first aid video visit
Some mild conditions do not require face-to-face care, but do require face-to-face conversations with a provider. I can.
urgent care or clinic
If your symptoms are mild but you need in-person treatment, we can help you find emergency care near you or book an appointment with your doctor.
“If your symptoms are life-threatening, call 911 or get emergency medical attention right away.”
There are a few things about the message that I find amusing and tragic at the same time. First, the healthcare system doesn’t want me to see her PCP. Instead, I prefer to protect him with a chatbot that acts like a downfield line blocker.
Second, the health care system holds me accountable, with minimal advice, to determine if my condition warrants an in-person visit. As long as triage is suggested before, the proverbial cart is before the horse.
Third, dummy understands to call 911 in the event of a life-threatening emergency. i’m not a dummy
Finally, all I needed from my PCP was refills.
Still, I clicked on the symptom checker to explore the application. I was asked to choose the symptom or condition that most closely resembled what I was experiencing.The program, which has no artificial intelligence, actually generated over 20 conditions to self-treat or self-treat with OTC medications. Did. Conditions ranged from sunburns to rashes, athlete’s foot, sting, constipation and even COVID-19. Again, the goal was for the healthcare system to avoid unnecessary PCP visits.
At this point, I thought I might need a psychiatrist, so I clicked “mental health.” I was advised to call the Suicide & Crisis Lifeline (988) if I was in a crisis.
I was then asked to enter my phone number and asked if I was thinking of hurting myself or anyone else. I was asked if I was happy, excited, or hyper. However, by endorsing manic-like symptoms (happy, agitated, hyper), he was instead ordered to make an appointment with a PCP.
Now I wanted to hurt someone. This algorithm was clinically flawed. I did not recognize hypomania or mania as a psychiatric emergency. Additionally, if they endorsed ‘sad’ or ‘anxious and worried’, they had to take the PHQ-9 and GAD-7 screening devices for depression and anxiety, respectively. Commonly used in primary care settings, these screens are far from perfect. Interpreting the results at face value without the benefit of clinical evaluation may result in adverse patient outcomes.
I agree and agree with severe depressive symptoms on PHQ-9. I was advised to contact my primary care physician. Ironically, Symptom his Dr. Checker puts further strain on PCPs by placing them in their proper place in patients’ mental health problems. This is especially egregious given that the medical system my PCP practices has a separate psychiatric department. Mental health care should be integrated with primary care as much as possible.
Overreliance and uncertainty on artificial intelligence is one of the myriad problems plaguing healthcare delivery systems. Added to these issues is the recipe for depersonalization and dehumanization of the medical experience…well, as my brother put it, the “shit show.” And we must not forget the increasingly intolerable conditions that doctors have to put into practice. Toxic workplaces, EHR disasters, constant third-party tracking, to name a few.
Medical practice has become a joke, staffed by run-of-the-mill healthcare providers who are probably not even human. But doctors who remain true to the cause of serving the suffering are not laughing. Although they are burning out in record time, dealing with the moral injury inflicted by a deceptive healthcare system that dangles lucrative employment contracts that promise to respect the beliefs and values of doctors. , they were found to be sold false gift certificates. Doctors clearly feel a moral imperative to spend time forming important relationships, but the transactions inherent in the health care system demands undermine these ideals.
There is no joy in practicing medicine in Mudville, USA. Mighty Casey strikes out and happiness may never spread again.
Arthur Lazarus is a psychiatrist.