Celebrity "Roadkill": A Black Box Warning for Physicians

Judy Garland, Marilyn Monroe, Elvis, Anna Nicole, Heath Ledger and now Michael Jackson. All dead at an untimely age. All enormously famous. (Five of the aforementioned also extremely talented.) All tortured souls. All in need of assistance with physical and psychic pain. All victims of enabling, celebrity-obsessed physicians.

After reading Deepak Chopra's and Dr. Drew Pinsky's superb blog about celebrity-treating physicians becoming "high" on the fame of their famous clientele, I noted that a critical point was missing. How can a vulnerable physician resist the temptation to "bend the rules" for these "tabloid elites?"

A "Black Box Warning" is the highest level of FDA-mandated admonitions for doctors that a particular prescription drug may cause serious or even life-threatening adverse effects. It is so named for the bold type and the black border that usually surrounds the text of the warning. The following is my "black box warning" for physicians who endeavor to treat celebrity clients.

My medical practice is situated geographically in the epicenter of Hollywood and of many physician-narcissists -- Beverly Hills, California. As a well-known primary care physician, I have watched in horror as my low-self-esteem M.D. "colleagues" attempt to amass a "celebrity practice" only to realize that these terribly damaged but wealthy, powerful, seductive and famous patients often become their worst nightmare.

These clients often attempt to manipulate with words, performance skills, dollars and the reflected glory of their celebrity and then "entrap" the ofttimes well-intentioned but blindly ambitious physician into becoming a part of their "entourage." They typically demand that the doc manage their psychological pain with physical pain medications like opiates. The outcomes are predictably disastrous and have now become a tragic cliche in the entertainment world.

The fix is simple. Physicians need to check their egos at the exam room door and learn to "Just Say No."

A "self-esteem check" is critical before any medical professional opens their narcotic prescription pads. Just because the patient elicits a strange type of "respect" from your colleagues and your clinical staff (probably just misguided envy) does not mean that you are somehow an "elite" physician who is entitled to bend to the whims of your famous patients or break the rules of good doctoring.

These patients are every bit as mortal as any other vulnerable soul who enters your office doors. You have taken a sworn oath to treat the whole patient -- physical and psychic pain symptoms included -- in a responsible manner that is in accordance with accepted standards of medical practice. And you also have the added responsibility to monitor these extraordinarily "at risk" humans ever more vigilantly for signs of drug dependence and abuse.

Every California physician has access to a widely available but little-publicized tool which can be critical to your patients' well being. The California Department of Justice's CURES (Controlled Substances Utilization Review and Evaluation System) database allows a licensed, treating physician to request a "Patient Activity Report" -- essentially a complete historical listing of all of the controlled substance a particular person has been prescribed -- by ANY physician.

All the doc need do is take a moment to fax a form requesting prescription information to the state's CURES Program and the list is then faxed to your office within 24 hours. The treating physician can then determine quite easily whether a particular patient is "doctor-shopping" with several physicians for multiple controlled substance prescriptions. If so, the patient can be confronted, counseled and referred to a formal pain management program, substance use counseling and/or a psychiatric professional.

To my fellow physicians: Do you really want a medical practice filled with demanding and unreasonable patients who ask you to cross the boundaries of medical ethics and accepted standards of practice just to feel good about yourself? Do you truly want to sacrifice your medical license on the altar of celebrity "culture?"

I am "famous" -- and respected -- for saying the word "no" to my celebrity clients when their requests cross the line. I gently inform them that a good physician is not like the drive-thru lane of a fast food restaurant. You can't just bark your order into the physician's ear and expect to pick up your narcotic prescription at the next window. That's why my name is on your prescription bottle -- because I am taking responsibility for your health as it relates to this particular medication.

Why do I maintain and consistently apply this policy to ALL of my patients? It's because I am sworn to a Hippocratic Oath that mandates primum non nocere -- "first, do no harm."

I realize that I may be the one person in their sphere of friends, lovers, agents, studios and fans that may be in the position to speak truth to celebrity "power." I have the privilege, the responsibility and the opportunity to protect these vulnerable souls from themselves. If I am unable to rise to this challenge, then I have no business treating celebrity patients in the first place.

If the celebrity patient leaves in a huff to "doctor-shop" after I refuse to fill their order for inappropriate prescriptions, then so be it. After a quarter century of medical practice I know that I cannot control the reckless actions of wealthy and entitled people.

If, however, they respect the doctor-patient relationship, heed my advice about how to manage the massive stressors of their own careers, then they should be able to navigate the dangerous high seas of fame, remain healthy, pain-free and productive and, most importantly, avoid becoming Hollywood "roadkill."