January 8, 2007

When doctors can't say no to big-shot patients with drug problems.

Rehnquist's wife got it right:
In the FBI report, the doctor who helped Rehnquist get off drugs said the justice's family blamed the prescribing physician and the pharmacist and suggested that they were intimidated by high-ranking government officials. Dr. Russell Portenoy, chairman of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York, says Mrs. Natalie C. Rehnquist may have been right....

"I have some sympathy for the doctor" who was treating him, he says. "The doctor realizes that an esteemed scholar, a person of high personal wealth or a head of a major corporation has been engaging in significantly problematic drug-related behavior," such as Rehnquist exhibited. "The reality is, it can be difficult for a physician to handle."
The doctor who lets himself be manipulated by big shots deserves no sympathy!

12 comments:

Ken Stalter said...

Imagine the reverse situation. What if a federal judge allowed his or her professional judgment to be intimidated or manipulated by the stature of a high-profile physician? That would be abhorrent. Neither case deserves sympathy. I agree with Ann.

R2K said...

Doctors have to say the right thing, even if that is hard for them to do. That is why they get over 100,000 a year.

R2K

Pogo said...

Re: "The doctor who lets himself be manipulated by big shots deserves no sympathy!"

I agree entirely.
Patients seem to believe that the rich and famous get better care than everyone else. But most MDs recognize that the VIP label is not always a plus.

While VIPs do get to be first in line, the advantages after that are often exceeded by the errors, over-testing, and avoidance of touchy subjects caused by being a big shot.

There are two wishes for myself in my own medical care:
1) Never to be "an interesting case". Boredom in your MD's eyes is a very, very good sign.
2) Never let them discover I am a doctor. Special treatment is quite often worse than average treatment. (Useful tip: if possible, don't wear dressy clothes to an office visit.)

David53 said...

The doctor who lets himself be manipulated by big shots deserves no sympathy!

Easy to say when you work in a tenured position. It's not so black and white for the rest of us.

Tibore said...

I understand what you're trying to say, David53, but I don't think that can be applied to the medical field. Doctors are professionally and ethically obligated to give the best care possible, even if that means delivering bad news and absorbing the fallout from it. I'd be worried if my doctor was willing to modify my care to my detriment just because he or she was worried about my status or social position. And the few doctors I know personally (as in, I know them without being their patient i.e. socially) would agree with that; they'd rather choose to risk the problems associated with difficult patients than compromise themselves ethically. Besides, best medical judgement, as long as it agrees with best accepted practices, is the ultimate defense.

In short, the fact that doctors are not tenured shouldn't matter in whether they give sensitive or undesireable advice to a patient. As long as advice is medically correct, conforms to accepted practices, and is in the patient's best interest, I believe doctors are ethically obligated to deliver it, regardless of consequences.

vbspurs said...

The doctor who lets himself be manipulated by big shots deserves no sympathy!

Both my parents are physicians, and both have had celebrity patients (albeit, relatively 'minor' ones, like Frank Borman).

One time, a very famous Italian gentleman came to my dad's surgery. He asked the receptionist to give my father a letter of introduction. Dad read it, and allowed him a consultation without referral.

Turns out the guy just wanted a narcotic prescription re-filled, because, horrors!, he went to a chemist here, and they didn't give him his drug of choice, without prescription (heavily suggesting to dad, that that is the modus operandi in Italy -- not true of course, but then, I'm not Italian or famous).

Dad told him no very calmly (I happened to be there), diplomatically.

Celebrity, wearing cool black shades even after sundown, stalks out, muttering oaths about cazzos, quacks and fascist Bush America.

999 times out of 1000, doctors will do as my father did, even with VIPs.

But then, all you need is that one, like Rush Limbaugh's doc who is crooked, to hook you up.

I daresay this guy (and his chum) was sniffing out my father, to see if he could be placed on the crooked list, whereby the word would spread faster on the international party circuit than you can say Robertino Rossellini.

Tough life.

Cheers,
Victoria

Pogo said...

Re: "It's not so black and white for the rest of us."

While some patients can't handle the truth (e.g. dementia, the mentally retarded), this is rather rare. A doctor that can't tell the truth to his patient isn't worth very much. Medicine is no place for yes-men and sycophants.


Yes-Men and the Sycophants, acid rock from the Bay area, circa 1968. Their one hit "Baby, you look greeeaaaat" became the anthem for free-love brown-nosers everywhere.

Anonymous said...

Pogo said...

While some patients can't handle the truth (e.g. dementia, the mentally retarded), this is rather rare.

Obviously you don't work in the medical field! As normal human beings, we find it difficult to believe that others cannot understand simple rules, laws and generally what's best for us. However, it is more the rule than the exception that people will "understand the truth" when the actual truth isn't the truth they were looking for (ie: Percocet, now!).

That being said, it is the medical professional's responsibility to do what is best for the patient and to follow the law to the best of his ability, whether the patient likes it or not. I don't understand doctors, of all people, feeling intimidated by anyone; tell the jerk to find another doctor he can take advantage of. What's the "high-ranking official" going to do? Out the doctor as... a professional? Who conducts himself appropriately and in the best interest of the patient? His reputation will instantly go down the tubes, obviously.

Anonymous said...

Ann, speaking of being manipulated, you might want to turn on CNN right about now.

They are reporting that the origin of that Drudge report you cited a couple of days ago was a request by House Minority Leader John Boehner (who is apparently a huge Ohio State fan) to Pelosi.

And if she had said no, then they would probably go after her for not keeping her pledge to increase the level of civility in the house.

So yes, it sounds like Drudge was manipulated. And next time Pelosi gets a request like that, maybe she will think twice about it.

Anonymous said...

This issue isn't strictly about big shots.

People who suffer from chronic pain often build up a tolerance to their medication. They need higher doses of medication (which is often addictive) to relieve pain.

Doctors are put in the position of finding a balance between pain relief and the risk of addiction for their patients. Often patients don't exhibit strange behavior until they cut down on the medication.

David53 said...

I understand what you're trying to say, David53, but I don't think that can be applied to the medical field.

Tibore, I don't believe you do understand. I do not condone or approve of the prescribing physician's behavior in any way, shape, or form. I do believe some sympathy might be in order though. Apparently Dr Portenoy agrees with me.

Pogo said...

Re; "Obviously you don't work in the medical field! "

I'll have to alert my employer then.