Joan Rivers' death shines spotlight on 'VIP Syndrome'

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The death of comedienne Joan Rivers has thrown a spotlight on a little-discussed "malady" that affects the rich and famous.

VIP Syndrome happens when doctors – perhaps star-struck, or weighing public and media scrutiny – veer from common treatment protocols to suit the whims and wishes of their celebrity patients.

Interestingly, the result often is that influential and wealthy patients get worse care – not better – as their medical teams stray from standard practices.

It's too early to say if that happened to Rivers, the New York Times reports. She died at age 81 earlier this month after going into cardiac arrest following an endoscopy, a routine procedure in which a tiny camera is inserted down the throat.

Questions have been raised because the clinic doctor treating Rivers also let the comic's own ear, nose and throat specialist examine her, even though that doctor was not authorized to practice at that clinic – a violation of New York law.

Did that amount to VIP Syndrome? It's not yet clear – an investigation continues, and neither doctor has been implicated in the comedienne's death. A medical examiner ruling has not been finalized.

But doctors have said that if the clinic granted Rivers a privilege, it could be viewed as VIP Syndrome – and offer lessons for doctors who experts say can become "overly deferential, suspending their usual medical judgment," the Times notes.

VIP Syndrome history

VIP Syndrome is not a new phenomenon. Psychiatrist Dr. Walter Weintraub wrote about it in 1964, noting that doctors can end up resenting their manipulative celebrity patients, which can also hurt quality of care.

There have been high-profile cases, perhaps the most famous of which unfolded when Dr. Conrad Murray, private physician to Michael Jackson, served two years in prison for contributing to the singer's death. Prosecutors said Murray recklessly catered to Jackson's demands for a sleep aid when he gave the pop star the anesthetic propofol.

Two doctors writing in Slate in 2008 noted that Sen. Edward Kennedy assembled his own private group of national cancer experts, an extraordinary "tumor board," to discuss his case and recommend treatment. The pair of physicians writes:

"Doctors who would normally ask, 'What's the best care for a 76-year-old man with a malignant glioma?' instead wonder, 'What do we do now that Senator Kennedy has a malignant glioma?' The answer is sometimes different because of the tendency to overthink decisions and overemphasize treatments celebs think they need—even if those treatments are experimental and not necessarily the standard of care."

What's a star-struck doc to do?

Three doctors writing in the Cleveland Clinic Journal of Medicine compiled nine principles for doctors who have to deal with famous patients, including specific suggestions for working with a celeb's personal physicians. They also urge doctors to stick to their protocols: Don't bend the rules, work as a team, and deliver care in the place where it is most appropriate.

Writing in Forbes last week, Dr. Elan Singer, a plastic surgeon, had tips for the celebrities themselves. Singer suspects that Rivers died because her VIP status caused doctors to alter their routine.

His advice to rich and famous: "change your name, put a wig on, and ask your doctors to treat you like a homeless guy in the street."

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