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Michael Jackson and His Doctor: What Can We Learn?

31st August 2009 by Carol Posted in Uncategorized

It appears that for some reason, Michael Jackson was given a very powerful anesthetic in order to help him sleep. While this drug must have worked at least for awhile, because Jackson apparently requested it from another health care provider, it ultimately contributed to his death.

A doctor to a wealthy patient has an ethical dilemma when the patient wants drugs prescribed that are potentially dangerous and definitely off-label. The doctors know that “out there” somewhere is a doctor who will comply and this may be the justification for going ahead and making the prescription. At least the doctor remains able to monitor the situation, which might have been how Jackson’s doctor thought about the situation, but obviously his oversight did not prevent Jackson’s death.

Even the not-so-wealthy are in the position to pressure doctors for prescriptions and treatments. Pharmaceutical companies advertise on television, the internet, and in magazines in hopes that patients will do just this: ask their doctors for a specific drug. The vast amount of information, some of excellent quality and some the equivalent of snake oil, on the internet also sets people up to do their own diagnosing and to make demands of their doctors.

There are times when demands are appropriate. After all, along with pharmaceutical company ads and internet information, there are plenty of stories about people being inappropriately diagnosed and treated. When the diagnosis or treatment is in question, patients should by all means question their doctors.

What to do? We hire doctors because of their expertise. Doctors have an undergraduate degree, four years of medical school, a residency, and specialists may have even more education on top of all that. They have been taught about the body and about disease processes as well as treatment. An internet search on a set of symptoms leading to a web page selling vitamins is not the educational equivalent of a doctor, even a not so great doctor.

Yet when doctors tell us something as a diagnosis or treatment plan, we still must listen critically, seeking to understand why the doctor thinks the diagnosis is correct or the treatment is appropriate. It is also a good idea to take that information home and look it up on the internet, particularly when the disease is serious.

It is also a good idea to get a second opinion, particularly when the diagnosis is serious, the treatment has serious side effects, as well as when a doctor does not seem to be listening to what the patient is saying. A diagnosis should account for the symptoms a patient is experiencing and if it does not account for all of them, the doctor should have a good idea of what else is going on and why. A treatment plan, likewise, should make sense and should address all the concerns. If a doctor rushes the consultation or intimidates patients into silence or just does not seem to hear what the patient is saying, a second opinion is critical.

As responsible patients, we need to walk the line carefully between asking our doctors to do something that is counterproductive and dangerous, as Michael Jackson apparently did, and yet making sure our treatment is appropriate to our problems.

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