VIPs and Lousy Healthcare: Poor Celebrity Care May Provide Lessons for Everyone

In the two weeks since Michael Jackson died, I've been asked many times whether I think he received proper medical care. I've punted the question because we don't have enough information and I hate to speculate. We're still awaiting the toxicology report and we have few details about his underlying health issues, medications, and the events leading up to his death. But I have offered the following thought: you would be amazed at the potential for VIPs to get lousy care.

While it's true that VIPs often get excellent medical care, with rapid access to top physicians and state of the art testing, they also are in danger of throwing doctors off their game. Derek Jeter of the New York Yankees goes through a ritual with every at bat. Change the ritual and he might be batting two hundred. Doctors go through a type of ritual too. We're trained to do an evaluation in a particular order: take a history, do a complete exam, think carefully about the clinical picture and then make recommendations. If a patient's status changes the way a doctor gathers information or thinks, the results can be deadly.

I understand that if you're one of the fifty million uninsured Americans, you may have little interest in the health care problems of VIPs. But you don't have to be rich and famous -- or even insured -- to get the same bad medical care that VIPs can get. You just have to have the wrong attitude and the wrong doctor. Here is my top five list of ways I've seen VIPs and doctors set themselves up for trouble:

1) There's no captain of the ship.

This is a fatal flaw. There has to be one person who knows the big picture and coordinates care. Wanting to remain in control and fearing the loss of privacy, a VIP may have multiple doctors who don't even know about each other. The physician is left trying to put together a puzzle without all the pieces. This is especially worrisome when medications are prescribed by doctors who are unaware of the patient's full medication list; drug interactions can be dangerous and even lethal.

2) The doctor is afraid to bother or upset the patient.

The doctor-patient relationship is a partnership that requires mutual respect and straightforward communication. It can be very tough to confront a patient with certain problems -- for example, drug or alcohol abuse. But you don't change the criteria for making a diagnosis because a patient is a VIP. And you never let a patient pressure you into prescribing an inappropriate medication, whether it's an antibiotic or a narcotic.

3) The doctor allows the patient to duck a crucial part of the evaluation.

I once had a patient with rectal bleeding try to talk me out of doing a rectal exam, to which I replied what I was taught in medical school, "There are only two reasons for not doing a rectal exam on a patient with gastrointestinal bleeding: no finger, no rectum." A test or a part of the physical exam may be uncomfortable for the patient but also lifesaving.

4) The patient's philosophy is "I can afford it. Let's do every test in the book."

There are downsides to excessive testing, including body scans that not only expose patients to radiation but can lead to unnecessary biopsies and other potentially dangerous procedures for what turn out to be benign findings (what doctors call "incidentalomas"). And patients may ask for or even demand new tests such as genetic profiling that we're not yet sure how to interpret. More is not always better.

5) The doctor or patient wants to operate in a vacuum.

Good thinking welcomes an audience. In a teaching institution, it may be the third year medical student who asks the crucial question that everybody else is too afraid to ask. A good doctor never shies away from asking a colleague for help.

For this week's episode of CBS Doc Dot Com, I interview an expert on the health care of celebrities. Dr. Barron Lerner, Professor of Medicine and Public Health at Columbia University Medical Center, is the author of When Illness Goes Public: Celebrity Patients and How We Look at Medicine.

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Comments

[healthmuse]

Self-care is the best answer! healthmuse­dotwordpre­ssdotcom

[Pearlswan]

If we had a national healthcare system, celebrities would be treated like everyone else. The problem with our current healthcare system is that it exists as a conglomeration of businesses and corporations whose sole existence is for profit--they exist to deliver profitable healthcare rather than excellent healthcare. If excellence brings a profit, its included but, if not, its excluded. One celebrity patient is worth hundreds of regular patients on the accounting books so they become valuable profit centers and rules are bent to keep them as patients for as long as possible or until it gets too risky. This preferential treatment even occurs for patients with top-notch medical insurance plans too.

Take the profit out of healthcare and there will no longer be any incentive to prescribe drugs for every symptom under the sun, regardless of the risks or the precedent it sets when celebrities request and use them. The rich and famous are no different than the down and out when it comes to healthcare delivery in this country: money can't buy the right care for the right condition--we are all at risk unless we are neither an asset or a liability to the medical accountant. We all need the same non-profit healthcare so we can trust the system rather than be gamed by the system. MJ proved that even money can't buy you good health or trust in your doctor in our current healthcare system. Greed is good.

[TXfemmom]

Every time we had a celebrity at our hospital, everyone would get all out of shape, and the result was usually that something went wrong in their care.

I took on the policy that everyone got the best care and no one needed to be treated any differently from every other patient.

[Melissa]

Do you really think for one minute that if a healthcare plan is passed that everyone is going to get the same treatment? If you can pay for it, you will get what you want.

[sunnybunny]

Obviously, throwing money at this problem won't solve it. That is as clear as the nose on Michael Jackson's face.

[PresidentRobertBooth]

Great article.


Seems that isolation is the big problem.

[quidam56]

As a former health care giver, I am shocked to see what is called quality health care now in Tennessee and Virginia. http://www.wisecountyissues.com/?p=62 Clearly profit care is more important than patient care. How many more innocent people have to die because of greed ?

[TXfemmom]

I was an RN, Advanced Nurse Practitioner and Certified Registered Nurse Anesthetist for nearly 25 years but became disabled in the mid 90's. Since that time, I have seen care deteriorate so badly and from the patients' view to the point where it frightens me.

[Gnrshrtd]

The final sentence: "A good doctor never shies away from asking a colleague for help" is one of the most significant. In my thirty year career in healthcare, the practitioners who made the best decisions were those practicing in groups who routinely, almost unconciously, stepped around the corner to show a film to a colleague or make a phone call. Their outcomes were measurably better.

[littlepeople]

I think that is good advice in every walk of life.