One of the hospitals I trained at caters to the “elites of this world.” Some of these “VIP patients” are celebrities, and some of them are billionaires. What I have noticed about this patient population is that their “care” can be VERY wrong to the point at which sometimes I have pity for these patients. The condition in which uber wealthy patients are grossly medically mismanaged has been coined–“VIP Syndrome.” I know it seems hard to believe. Poor patients may receive suboptimal healthcare due to the inability to afford care or to limited access to good providers. But how could patients with the highest levels of wealth and status also receive inferior medical care? How is it possible? Let me explain.
1) Polypharmacy: The high end, big donor patients have trouble sleeping… “Here’s a sleeping pill.” They have anxiety… “Here’s Xanax.” They have pain… “Here’s Vicodin.” The threshold for being aggressive about symptoms is very low because if “important people” feel like they aren’t getting tangible or quick relief of their symptoms, they may see someone else or go somewhere else. There is a presumption that any potential donations will go to the provider or medical institution that provides a fast remedy. That’s why I see so many young, well-to-do people with long lists of medications and accompanying diagnoses like “fibromyalgia” and “chronic pain syndrome” to justify all their medications and their higher opiate and benzodiazepine tolerance. The VIP patients end up with horrible side effects from all these medications or potentially life threatening drug addictions.
2) Overly Aggressive Care: The combination of wanting to show off expensive, state-of-the-art medical equipment to wealthy patients, build prestige, collect more money, and reduce liability when treating patients with connections to high-powered attorneys leads to a lot of questionable behavior by physicians. I’ve seen knee-jerk bronchoscopies for bronchitis, laryngoscopies for sore throats, coronary CT scans for young people with no risk factors and mild costochondritis, annual whole body CT scans, and the finding of the inevitable “incidentalomas” that then require follow-up biopsies which have their own host of complications. If a doctor wants to cover himself on a high-end client, he will order a ton of labs and inevitably some come back with false positives. Doctors panic about a borderline ANA and give steroids or read into a borderline elevated TSH in a patient with fatigue and prescribe Levothyroxine. If the patient has a small chest nodule on CT and the guidelines recommend follow-up imaging in 6 months, the doctor calls up his CT surgeon friend to proceed directly to video assisted thoracoscopy. The doctor says to his patient, “Don’t worry. I got this. We’ll use a fiberoptic camera, small incisions and you’ll be cured before it has a chance of becoming something serious.” The doctor then becomes the hero.
3) No Deescalation of Care: It goes without saying that if your high-end client is on a treatment for a given diagnosis, you will be very reluctant to stop the treatment or reclassify a diagnosis as a misdiagnosis. More devastating is to see the widespread physician reluctance for deescalation of care for these VIP patients from the ICU. I have encountered too many prolonged admissions in patients with end stage diagnoses for whom I was forbidden from consulting Palliative Care. Physicians in training are advised by their superiors in the hospital to avoid giving a bad prognosis to these patients at all costs.
4) Can’t Say “No”: When the doctor of a celebrity is being paid thousands of dollars a month to be his or her private doctor and that celebrity says, “I have the worst insomnia and the last time I think I slept well was after that cosmetic surgery when they gave me Propofol. Why don’t we just use that?” The doctor often has a hard time saying “no.” “Uh… sure….I’ll place an IV and I guess I’ll monitor it myself. No problem.” The wealthy like to Google treatment options and then request them. Doctors will often concede to these demands, no matter how unscientific or risky they may be. People forget that Steve Jobs had the fortunately CURABLE form of pancreatic cancer but decided there was a holistic herbal regimen he wanted to try instead of surgical removal of the tumor. Some physicians actually supported him in trying unproven, off-label treatments with no scientific merit even though there was a scientifically backed cure available. The unproven treatments were fruitless and Jobs’ cancer spread to the point that it killed him.
5) All Roads Lead to the Doctor: “If you have pain or soreness, I have the remedy in the form of a pill. You don’t need to suck it up. If you’re overweight, I’ll get the lap band for you and you won’t need to diet. We don’t need to figure out why you’re tired all the time. You don’t need to waste your time being screened for depression. Take some growth hormone and testosterone and you’ll feel great.” Instead of the patient being “self reliant,” the doctor slowly creates a situation where his wealthy clients DEPEND on him to solve their problems. It’s like when a wealthy patient says “I have the greatest doctor! He is the absolute greatest,” I’m always thinking in the back of my head, “Is that because he completely suckered you into his facade of being the high-end, beautiful-officed, Armani-suit-wearing guy who solves all your problems for you?”
Why am I talking about this? Maybe you don’t feel sorry for the massive list of celebrities and wealthy people who die of prescription overdoses and the complications of ridiculous care. Maybe you secretly envy VIP doctors who regularly cash-in on these patients with impressive concierge fees or the billion dollar hospitals that collect millions of dollars from these patients to create new buildings and wings for their facilities. But regardless of your opinion of the victims and perpetrators, we must all become more aware of the perils of for-profit care models that cater to money and prestige and how these models evolve to become dangerous. The problem is rarely engendered by the fresh-eyed, new medical graduate full of idealism who makes clinical decisions based on a combination of sound ethical and scientific reasoning. It is more commonly crafted by the physician who becomes cynical and cultivates a persona to charm America’s wealthiest clients and create a dependency on him. There are too many doctors across the nation who make a living “selling themselves” rather than the quality of their care in order to endear themselves to wealthy clients. This is a major dilemma of our profession and one that is unfortunately amplified exponentially by the magnitude of the victims’ wealth and status.
The Introspective Intensivist–Editorial Contributor at DoctorCPR.com: America’s #1 Medical Career Site. For more articles, great deals, events, and job opportunities– “Like” DoctorCPR on Facebook Today