Treating celebrity patients not all glitz and glamour

In the wake of Michael Jackson's sudden death, doctors to the stars urge physicians to establish appropriate boundaries with famous patients.

By — Posted July 13, 2009

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The controversy surrounding the medical care pop star Michael Jackson received before he died at age 50 in late June has drawn attention to the difficulties doctors face when caring for high-profile patients.

There is little ethical or clinical guidance for physicians that specifically addresses celebrity patients and how to ensure that their fame does not interfere with delivering the right medical care.

The guiding principle is that celebrity patients ought to receive the same quality of care as other patients, regardless of their notoriety. In terms of privacy, celebrities are covered by the same laws and regulations that apply to any patient. Doctors commonly take confidentiality measures, such as allowing famous patients to fill out paperwork in an exam room instead of in the waiting room.

But other questions arise when caring for the rich, powerful and notable.

How do physicians prevent special privacy accommodations for famous patients from bleeding over into clinical care? Could the acceptance of gifts from celebrity patients -- anything from glossy head shots to tickets to red-carpet movie premieres or public endorsements -- influence a physician's objective judgment about the patients' medical care? How does the star patient's fame affect the doctor-patient relationship?

Physicians can get starstruck too, and may unconsciously try to please these special patients in ways that are medically inappropriate.

Drew Pinsky, MD, said doctors should check themselves before taking on famous patients. He is medical director of chemical dependency services at Las Encinas Hospital in California -- a stop on many a Hollywood star's passage through drug addiction and recovery -- and is well-known as a radio talk-show host and star of VH1's "Celebrity Rehab with Dr. Drew."

"You really have to assess your own liability," Dr. Pinsky said. "Are you seduced by the opportunity to bask in the glow of celebrity? Is it particularly appealing to you to have a powerful person say you did a good job? Will you be able to sustain that same person saying, 'I can't believe you won't give me what I want'? You had better be prepared, because that is exactly what you'll get. You have to do what's best for the patient and not be seduced by the fame."

The doctor-patient relationship can become "adulterated" by the elephant in the exam room -- the patient's fame, Dr. Pinsky said. He co-authored a 2006 study in the Journal of Research in Personality that found celebrities are on average 17% more narcissistic than the general public.

"There is not a separate diagnostic manual for celebrities. These are just people. They are just patients," Dr. Pinsky said. "And if you feel yourself overlooking things or making exceptions, these are huge mistakes. You have to realize that the standard of care is the standard because it's the best, and if you start offering special care you are probably going to do substandard care."

Gary Brazina, MD, is an orthopedic surgeon in Marina del Rey, Calif., who specializes in sports medicine and has cared for his share of famous patients. His clinic is the official medical center for the NHL's Los Angeles Kings and the NBA's Los Angeles Clippers.

Some celebrities "are really, really nice" but "others are extremely manipulative, and there is a lot of drug-seeking behavior," Dr. Brazina said. "They have a true sense of entitlement where there's a sense of, 'I'm special, I'm different; I don't have to follow the rules.' "

Dr. Brazina recalled one famous patient who refused to fill out paperwork, saying, "Oh, my assistant does that." The physician took a stand.

"Well, then, I guess I'll have to treat your assistant, because I'm not going to treat you until you fill it out," he told the star.

Still, the doctor admits to getting starstruck at times. "Sometimes you do just pinch yourself," Dr. Brazina said. "I'm a small-town kid from eastern Pennsylvania and I have movie stars coming into the office. ... You have to be wary of not being caught up in the celebrity."

Guidance lacking

Neither the American Medical Association nor the American Academy of Family Physicians has policy explicitly addressing the special challenges posed by celebrity patients. The American College of Physicians briefly notes that "physicians of patients who are well-known to the public should remember that they are not free to discuss or disclose information about any patient's health without the explicit consent of the patient."

Celebrities' fame can lead doctors in the wrong direction, said Frederick E. Turton, MD, chair of the ACP's Board of Regents and former chair of its Ethics, Professionalism and Human Rights Committee.

"It is a power issue," said Dr. Turton, a Sarasota, Fla., internist. "In a normal doctor-patient relationship, there is a well-defined power relationship. The doctor has the power to prescribe, and he follows his professional tenets to do that appropriately, and we depend on him for that. But if the patient has power over the doctor, then it short-circuits those professional guidelines and safeguards. ... That is the conflict of interest -- who are you really taking care of here, yourself or your patient?"

Many doctors said celebrities rightly believe they easily can get another physician to see them immediately if the doctor does not accede to their demands. This kind of doctor-shopping also changes the power dynamic.

Another way celebrities may attempt to influence physicians is with gifts. The AMA says doctors should be wary of taking gifts if those gifts are intended to alter medical decision-making.

New York internist Ronald A. Primas, MD, calls himself a "doctor to the stars," having treated a number of hip-hop celebrities. He makes house calls for many patients and handles about five inquiries daily from famous patients.

He frequently gets backstage passes to see his favorite recording artists, as well as tickets to movie premieres. But he does not believe these gifts affect his ability to deliver high-quality care.

"I have been doing this for 18 years, and I never have been swayed in my judgment by that," said Dr. Primas, also a travel medicine specialist. "In my brain, a perk is a perk -- if you don't get it, it's no big deal. I don't expect anything. I can always buy the tickets on my own anyway. If I don't get to go to your movie premiere, I'll just watch it on DVD."

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Celebrity can change care

High-profile patients "stir up irrational feelings in their caregivers," according to a 2002 study in The Primary Care Companion to the Journal of Clinical Psychiatry. Celebrity patients can make doctors and other health professionals lose their objectivity and "unearth narcissism in the caregiver-patient relationship," the report said. Some ways physicians and other caregivers may deviate from standard medical procedure when caring for celebrity patients in the hospital:

  • Alcohol and substance abuse may go untreated.
  • Issues of death, dying and "do not resuscitate" orders may be neglected or handled oddly.
  • Feelings of shame and fear of being sick can go uncomforted, as caregivers may forgo standard listening skills.
  • Neuropsychiatric symptoms may be overlooked to avoid "insulting" the patient.
  • Personal issues of toileting and hygiene of the patient may be neglected or handled awkwardly by staff.
  • Ordinary clinical routine may be short-circuited to prevent "inconveniencing" the patient.
  • Issues around sexuality may be avoided, even in clinical situations well-known to affect sexual function.

Source: "Celebrity Patients, VIPs, and Potentates," The Primary Care Companion to the Journal of Clinical Psychiatry, Volume 4, No. 6, 2002 (link)

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