Prince memorial

Nicolette Shegstad leaves flowers at a memorial to Prince outside the First Avenue nightclub on April 22, 2016 in Minneapolis, Minnesota. Prince, 57, was pronounced dead shortly after being found unresponsive yesterday at his Paisley Park Studio in Chanhassen, Minnesota near Minneapolis. (Scott Olson/Getty Images)

Earlier this month, an autopsy concluded that pop star Prince died from an accidental, self-administered overdose of fentanyl. That powerful painkiller is linked to hundreds of overdose deaths in Canada. It's uncertain what, if any medical care Prince received shortly before he died. But that hasn't stopped some bioethicists from speculating that the singer is the latest victim of what's known as VIP Syndrome.

VIP Syndrome refers to the adverse influence that very famous or very wealthy patients can have on the sound medical judgment of otherwise excellent physicians. Dr. Walter Weintraub of the University of Maryland School of Medicine coined the term back in 1964.  The idea is that rich and famous patients can influence doctors to do risky things, including the prescribing of large quantities of narcotic painkillers, barbiturates and amphetamines.  It might mean ordering an MRI or prescribing a treatment that the doctor knows is completely unnecessary, just to curry favour with the patient.

Singer Michael Jackson died after receiving the anesthetic drug Propofol at home, a drug that made the singer stop breathing. Dr. Conrad Murray, Jackson's personal physician, acceded to the singer's demand to receive injections of Propofol to help him sleep.  Murray spent two years in prison after being convicted of involuntary manslaughter.

Some have wondered whether the medical care given to pop icon Prince influenced by VIP Syndrome. We don't know how Prince got the fentanyl that led to his death.  If it was prescription fentanyl made by a drug company, it could have been provided by one of Prince's physicians. That opens the door to questionable prescribing.  

According to an article in the Star Tribune, the day before he was found dead, Prince was treated by a Twin Cities physician for opiate withdrawal symptoms as well as fatigue and anemia.  The Star Tribune also reported that twelve hours before he was found dead, members of Prince's inner circle reached out to Dr. Howard Kornfeld, a pain and addiction physician in Los Angeles.  Kornfeld couldn't come to Minnesota immediately, so he sent his son (a pre-med student) and contacted a local Minnesota addiction specialist.  Both had intended to meet Prince at his residence, but the singer died before the meeting could take place.  

Dr. Robert Klitzman, a psychiatrist and bioethicist at Columbia University says the case of Prince raises red flags.  He told The Washington Post "VIP Syndrome may have been involved." 

I've treated well-known people. For obvious reasons of protecting confidentiality, I'm not going to tell you who I've treated or when or why. In general terms, when I treat patients who aren't famous, you don't have preconceived notions about them.  When the patient is famous, you feel as if you already know them because you've read about them in the media. If they're seen as noble, the physician might be tempted to ignore clues about infidelity, addiction, STDs and other social factors that could affect the diagnosis.  

Then, there's the fan aspect.  My heart skipped a beat when I thought Cleveland Cavaliers' forward LeBron James was following me on Twitter!  When a public icon answers my medical questions in the context of a doctor patient relationship, it's as if that person has brought me into their inner circle.  It makes you feel important.  And you may not want to do anything to make that famous person angry with you.  You might even agree to unsafe demands just to keep them happy. Things like saying it's okay to leave town by plane immediately when the patient's clinical condition is unstable. 

We're talking about famous patients.  Why should the rest of us care if doctors succumb to the VIP Syndrome? I think there are two reasons.  First, if the superstar comes to the ER, there's a good chance they'll receive expedited care and make you wait. Surveys of ERs in the U.S. have found that a majority routinely provide faster care to influential people.

The other point is that you don't have to be famous to get special treatment.  It can happen when you're treating (for example) the relative of a family friend or a friend or family member of a colleague.  The patient with a so-called 'special connection' may come to you expecting you'll see things their way because they see you as a friend or proxy for the doctor-colleague.  As with famous patients, there's a risk you'll suspend your medical judgment, and the patient will end up receiving risky or even bad medical care as a result.

The lesson for doctors is to pay attention to demands from famous patients and from people who have a special connection  and ask themselves whether the special connection is getting in the way of sound medical judgment.  If I'm feeling pressure to go against my medical instincts, I find it helpful to tell the patient what I would recommend if they weren't famous.  Often, that's enough to get them to think about what's best for them instead of what's most convenient.  

If you're a patient or a family member, do you want to ask the doctor or tell the doctor what needs to be done?  "The doctor who treats himself or herself has a fool for a patient," goes the old saying.  Why should it be any different for patients  famous and otherwise?