September 23, 2014

'VIP syndrome': The trouble with treating the famous

Daily Briefing

    The recent death of comedienne Joan Rivers may be the most recent example of "VIP syndrome," in which celebrities receive special treatment that is not always in their best interest, Anemona Hartocollis writes for the New York Times.

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    It is unclear who coined the term "VIP syndrome." Psychiatrist Walter Weintraub described the syndrome in a 1964 article in the Journal of Nervous and Mental Disease, noting that "the treatment of an influential man can be extremely hazardous for both patient and doctor."

    Weintraub wrote that a VIP patient "cursed with the touch of Midas, arouses only resentment and fear."  Physicians often perceive such patients as demanding and manipulative—traits that can cause resentment and diminish the quality of care they provide. If deeply affected by VIP Syndrome, physicians may become overly deferential and not use their usual medical judgment, Weintraub warned.

    Apple founder Steve Jobs told his biographer that he regretted getting what he considered special treatment. He wished that he had been told that he needed to undergo surgery for a cancerous tumor on his pancreas and stop trying alternative treatments.

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    "Often with VIP patients, doctors won't say, 'Joe Famous Person, look, you have to take your medicine or you have to come in for surgery immediately,'" says Robert Klitzman, director of the masters of bioethics program at Columbia University.

    Klitzman notes that standing up to famous patient can be difficult, recalling a time when he cared for the daughter of a "household name" celebrity writer. "The household name was a very powerful presence and wanted things their way. It took more gumption than I usually had to stand up and say what was best for the patient," Klitzman says.

    Similarly, NYU Langone Medical Center internist Barron Lerner says that he has witnessed the change in a hospital when a celebrity is on the premises. He notes that physicians are warned to not become star-struck, but at the same time they are told "what to do and what not to do, given that they were famous."

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    Lerner became so fascinated by the phenomenon that he wrote a book about the problem called When Illness Goes Public: Celebrity Patients and How We Look at Medicine.

    In the book, Lerner discusses many famous patients, including Michael Jackson, who died after his private physician gave him the surgical anesthetic Propofol to help him sleep. The physician, Conrad Murray, was later convicted of involuntary manslaughter and spent two years in prison.

    As for Rivers' Sept. 4 death, the New York State Health Department is investigating whether any wrongdoing at Yorkville Endoscopy contributed to her death. According to Hartocollis, the physician who performed the endoscopy allowed Rivers' throat doctor to examine Rivers, even though the doctor was not authorized to practice at the clinic—a violation of state law.

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    "If things were going on there that were outside of the protocol, it's certainly possible that there was VIP Syndrome, [but] sometimes just bad things happen to famous people with very good doctors," Lerner says (Hartocollis, New York Times, 9/21).

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