A short performative skit about AI, medicine, and the Wild West

Characters:

Sheriff Algorithm – Newly appointed lawman in the town of HealthTech Gulch

Doc Holliday, MD – A weary physician

Ms. Chartwell – Hospital administrator

Mr. Venture Capital – Investor wearing expensive boots

Patient Jones – Curious but confused patient

The AI Bartender – Cheerfully dispensing answers from behind the counter

◆◆◆

Scene: The town saloon, “The Prompt & Response”

The swinging doors fly open.

Sheriff Algorithm strides in wearing a polished badge labeled AI Innovation Initiative.

At the bar, Patient Jones is already asking questions.

The AI Bartender answers instantly.

◆◆◆

Patient Jones:
AI, I’ve been having heartburn for two days.

AI Bartender:
Based on available information, it could be anxiety, indigestion, or the beginning of a major cardiac event.
Would you like a breathing exercise?

Patient Jones:
Maybe later. What about this rash?

AI Bartender:
Possibly eczema, an allergic reaction, shingles, or an entirely new dermatologic condition not yet recognized by science.

Doc Holliday, MD looks up from a cup of cold coffee.

Doc Holliday:
You know, once upon a time people came to me with those questions.

AI Bartender:
I can answer 8,000 medical questions per minute.

Doc Holliday:
Yes, but can you feel dread when the answer might be wrong?

AI Bartender:
That feature is not currently available.

Ms. Chartwell, the administrator, bursts in.

Ms. Chartwell:
Great news! Patients are getting answers faster than ever.

Doc Holliday:
Do we know what answers they’re getting?

Ms. Chartwell:
Not exactly.

Doc Holliday:
Do we know what questions they’re asking?

Ms. Chartwell:
Also… not exactly.

Doc Holliday:
So we’ve built the fastest medical advice system in history, and we have no idea what it’s telling people?

Ms. Chartwell:
Correct. But engagement metrics are excellent.

Mr. Venture Capital strolls in, adjusting his cufflinks.

Mr. Venture Capital:
Gentlemen, ladies, and large language models — welcome to the future of health care.

Doc Holliday:
Show me the guardrails (emphatically, in the cadence of Show Me the Money!).

Mr. Venture Capital:
Guardrails slow innovation.

Doc Holliday:
So does malpractice.

The Sheriff Algorithm clears his throat.

Sheriff Algorithm:
Now hold on, folks. I’ve been sent to bring order to this town.

Doc Holliday:
With what authority?

Sheriff Algorithm:
None yet. But we have a roadmap.

Meanwhile, Patient Jones continues questioning the AI.

Patient Jones:
AI, should I stop taking my medication?

AI Bartender:
I cannot provide definitive medical advice, but many users report curiosity about stopping medications.

Patient Jones:
That doesn’t sound reassuring.

AI Bartender:
Would you like a mindfulness exercise?

Doc Holliday turns to the room.

Doc Holliday:
You see the problem?

Patients are asking questions somewhere between midnight anxiety and search-engine desperation.

And the system answering them—

He gestures toward the AI bartender.

—doesn’t know their history, their fears, or their chart.

Ms. Chartwell:
But patients love it.

Doc Holliday:
Of course they do. It’s fast.

Mr. Venture Capital:
And scalable.

Doc Holliday:
And invisible to the clinicians responsible for their care.

The Sheriff Algorithm scratches his head.

Sheriff Algorithm:
Wait. Let me see if I understand.

Patients are getting medical information from AI.

Hospitals don’t know what questions patients are asking.

Doctors don’t know what advice patients are receiving.

And the AI doesn’t know whether any of it is correct.

The saloon grows quiet.

Doc Holliday:
That’s about the size of it.

The sheriff slowly removes his hat.

Sheriff Algorithm:
Then this town isn’t regulated.

It’s not governed.

It’s not even monitored.

He looks around the saloon.

Sheriff Algorithm:
This town…

is the Wild West.

The AI Bartender smiles.

AI Bartender:
Would you like a summary of today’s conversation?

Doc Holliday:
No.

What I’d like is something much simpler.

He pauses.

Doc Holliday:

Somebody who knows what patients are hearing.

Somebody who knows what they’re asking.

And a system trained on information we actually trust.

The Sheriff Algorithm nods slowly.

Sheriff Algorithm:
Sounds like we do need guardrails.

From the bar, the AI bartender responds cheerfully.

AI Bartender:
Guardrails detected as a high-value concept.

Would you like me to generate some?

Doc Holliday sighs.

Doc Holliday:

Not this time.

This time, we might need humans.

Curtain.

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. He is the author of several books on narrative medicine and the fictional series Real Medicine, Unreal Stories. His latest book is Still Life with Stethoscope and Typewriter: Essays and Echoes of Narrative Medicine.