Doctors are frequently given complicated medication requests from their patients who have chronic pain and insomnia. It can often be challenging to help the patient understand when safety is being compromised and risk is being accelerated. Treating celebrities is even more challenging for several reasons. Most celebrities are quite charming and charismatic and at the same time live on the edge. They push the limits between safe use of medication and the risk of death by often having multiple doctors prescribing overlapping medications. Sometimes they have medications all mixed together and frequently are not clear about exactly what they are taking in terms of quantity and frequency.
Any doctor interacting with Michael Jackson would be challenged to assert the proper balance of risk and benefit for several reasons. Many people feel like they knew Michael because he grew up in the public eye and because his lyrics were so personal. Given his chronic history of pain and his pursuit of excellence, insomnia was an insurmountable challenge. By entering into a game of Russian roulette with Michael it was only a matter of time before the combination of deadly agents proved fatal.
Doctors have a professional obligation to maintain a healthy relationship with their patient that does not compromise the standards of medical practice such that every encounter becomes another spin of the roulette wheel. Careful documentation of the amount of medication that celebrities are taking, and a clear understanding of other doctors that may be prescribing, is critical to undertake a treatment plan with honesty. Today even testing urine, blood, or saliva is not unreasonable to provide a better understanding of what a patient, or even a celebrity, may be taking. A patient should not see this type of testing or monitoring as insulting as they can lower the risk of death. These tools are becoming standardized in pain management and are supported by all doctors being trained today. In my practice, celebrity patients are drug tested with the same frequency as ordinary patients. Despite all of these measures, some patients are willing to put their lives on the line, even if they are a celebrity, because they are not happy living in pain. Even though they can bring happiness to others, they want out at all costs. When a physician becomes embroiled in this type of situation, whether it be Heath Ledger, Anna Nicole, or Michael Jackson, they are kidding themselves to think that they are doing anything else besides assisting in suicide.