Medical Gray Zones
Michael Jackson died of cardiac arrest on June 25, 2009. Recently, a hearing started regarding his former personal physician Conrad Murray. In this hearing the physician is accused of involuntary manslaughter, negligence, and administration of a dangerous and unnecessary cocktail of medications that accelerated the superstar’s death.
While I won’t argue for the physician’s innocence, I do think we should ask – how common is the tendency to prescribe patients what they want? Is this a singular incident, a case of a drug-pushing “bad apple,” or could there be more general forces at play?
What I hear from my physician friends is that they feel tremendous pressure to please their patients, and they know that if they don’t give them what they want, some other physician will (or at least this is how they justify their overprescription).
A common case of this sort is the case of the influenza virus. When patients contract the flu, they go to their doctors, feeling miserable and begging for help. Doctors know that they shouldn’t prescribe anything for their viral patients (and that the best thing to do is nothing), but they feel a pressure to give the patients something as they walk out the door. And so, they prescribe antibiotics, which don’t treat the flu but do build up drug-resistant bacteria that may cause trouble in the future.
Doctors in this situation face a conflict of interest, between what the patient wants from them, what is good for their own wallet (to keep the patient happy), and what is the right medical thing to do. Moreover, the situation is not perfectly clear because while it is unlikely that the patient has a bacterial infection (one where antibiotics could help) it is still possible – creating a gray zone of medical practice.
The thing about medical gray zones is that they become grayer, more blurred, when patients are more powerful or high-profile. The minute a doctor has a patient like Michael Jackson who is wealthy and used to getting his way, the pressure to succumb has to be much higher.
In thinking about Michael Jackson’s physician, consider this. It’s easy to find someone guilty and lay the blame solely on that individual, one man who shamefully deviated from the standard of care, but it’s much more challenging to put ourselves in his position and think about what we would have done if we were in his position. I suspect we too would have prescribed those meds.
P.S. I can’t believe that I am writing a blog about Michael Jackson