THE BLOG
09/03/2009 05:12 am ET | Updated Nov 17, 2011

MD's for Sale

With the stunning loss of Michael Jackson and the not so distant losses of Anna Nicole Smith and Las Vegas legend Danny Gans also under dubious circumstances, the roles of their personal physicians will come under greater public and possibly legal scrutiny. The lure of high profile, celebrity patients is a two-sided blade that can certainly cut a physician both ways.

Beyond the obvious direct financial reward which can be tremendous, the notoriety and publicity that comes from caring for high profile patients can be priceless promotion for your practice. Others will assume correctly or not that you must be an exceptional clinician if the celebrities are vying for your services. This assumption may appear reasonable on face value but many times fails under closer examination.

It's a simple fact that people promote doctors that they like. Patients many times cannot adequately assess ability or fund of knowledge but they are excellent judges of affability. People very rarely recommend their doctor because of their amazing intellect. "I've got the greatest doctor... She's so nice and listens" is a far more likely affirmation.

Celebrities recognize the very real monetary value of their active and passive endorsement. A celebrity promotes a doctor just by being seen leaving their office. 'If so and so uses that particular doctor they must be good' is a mentality shared by many people.

Once your celebrity clients have put you on the map as a 'doctor to the stars' the boundaries may become blurred. The intoxicating world of private A-list parties, hard to score 50-yard line tickets complete with all access credentials and swag lounges have enticed more than a few doctors to write prescriptions that are questionable to say the least.

Your new celebrity BFF's 'made' you and they can send you back to the world of an obscure, mundane suburban office practice in the blink of an eye at the first denial of a Percocet or Xanax prescription request.

During this Michael Jackson saga, the drug Diprivan continues to be mentioned. Diprivan (propofol) is a highly potent sedative that is routinely and safely used during the induction of anesthesia.

In my nearly 20 year of medical career, I have never (without exception) witnessed this medication administered outside of an operating room, intensive care unit, recovery room or emergency room and only to highly monitored patients (i.e. hooked up to several machines that monitor vital function). The mere idea that Diprivan could or would be administered in a private home to an unmonitored individual for any reason, much less poor sleep, is beyond absurd...but actually doing it is sheer lunacy.

How insane? Just imagine that you're a private pilot of your very own little single engine plane. You've been flying for years and feel pretty confident. So you decide that you're ready to step it up. Therefore on Monday morning, you waltz into JFK airport and decide that you are going to dismiss the pilot and crew of a 757 commercial flight bound for Paris (with 300 or so people aboard) and fly that baby yourself. And just to make it interesting, you turn off all of the computers and navigation system to truly test your skills. Now you're beginning to understand the scope of craziness involved in bedroom general anesthesia.

If a physician loses their mind (soon to be followed by their medical license and freedom) and chooses to perform bedroom general anesthesia, please, please remember one thing. Do not call me when the police and the Fed's are at your doorstep or you when you need an expert witness for your defense. I am a pretty fair spine surgeon... but criminal attorney? Not so much.

Hint -- as a physician, when a patient begins to request/demand prescription narcotics and sedatives by name and dose, you have a very real issue. When that patient is a celebrity you have a serious dilemma. When you foolishly write that shaky prescription for said celebrity..."Houston, we have a problem".

The world may never know the full story behind these tragic celebrity deaths but the physicians involved are destroyed regardless of the facts. As a physician, our reputation is everything. And right or wrong, perception helps to form reality.

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