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| The Medical Lessons for Us In Michael Jackson’s Death |
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by David Mittman, PA - July 17, 2009
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Provided by Clinician 1
Michael Jackson’s death stunned many but as a clinician it raised questions for me that few others who are not in medicine would have. Some questions that went right to my heart.
I agree, all the facts are still not in. But, can you get a more bizarre tale of death and what has occurred postmortem than poor Michael Jackson’s tale?
I know he may have had a dark side but it seems we all created him for what we needed him to be. There is another message there but Michael needed love and needed it from ALL of us, it seems all the time. After all when you are nine and ten and told that audiences have to love you....... Anyway, I digress. I am impressed about how much his children loved him. I feel for them very much. Despite Michael’s troubles and dark side, they have still lost their father. There was love there.
The question for us as clinicians is what can Michael teach us? Did he leave us a medical message along with his great music, lyrics and dance moves? I think yes.
Lesson One is Michael left behind three kids who all are not genetically related to him. That’s fine. My two children are both adopted and I love them more than anything in the world. But they were protected in the adoption process by very strict legislation and legal representation. All of the decisions made about their life were made with their future in mind first. To me, it seems it was not the same for Michael’s children. Did medicine or nursing advocate for these children at their birth or before? Did a social worker visit his home as they did ours and subject him to a series of interviews to see if he would be a “good parent”? Who really thought of the kids best interests? Was it the physician who was the alleged sperm donor? Was it the birthmother who had the children for Michael and it seems was paid very well to do that? Who spoke up for the children when they were covered in public with what looked like burkas from Afghanistan? When the decision was made not to send them to an outside school? Did anyone care? I am sure that I am ruffling some feathers here. Are these children entitled to know who their genetic parents were? What diseases they may be prone to? Any mental illness in the family? Those my colleagues are medical questions. Those of us that take care of children must be concerned with all under our care and speak out for those that can’t or don’t know better.
Rumors now say that Debbie Rowe may not be the the genetic birthmother, just the surrogate of her two children given to Michael. The youngest child, well God only knows. I hurt for these children. Their best interest, it seems, was never the primary question. As medical professionals we must think about these things. Are children entitled to know why they were conceived? Are they entitled to know they were loved by all the people involved? Are they entitled not to be loved at all, even to be conceived because their biological parents were paid for them? I am not a pollyanna but these are questions our professions should lead on. As technology grows, someone has to protect the people who will have to deal with these problems later in their lives. I don’t know what I am thinking specifically but I know it seems that the children were not the primary interest to many of those concerned. Did they have an NP or PA who treated them? A pediatrician? What counsel did they provide? Maybe Michael will teach us that ALL CHILDREN deserve to know who their genetic mothers and fathers are. Part of this is the fault of the medical profession. Today anyone with money can adopt or find a surrogate. That’s a bit unfair but the physicians that cater to the stars take it a step further and there is no protection of the children. It’s the “Wild West” and the docs are the cowboys and the children are the Indians. When you don’t know who you are or where you came from there is a bullet hole in your heart. It can be fixed, but few if any of the players here cared about the children, only the money.
Lesson two is Jackson’s medical care. Let’s start with the dysmorphic plastic surgery he kept on getting. Disfiguring surgery. What physician kept doing that? All done as he continued to lose weight and take more and more medication. Was that a thought? Who prescribed the meds? Who continued the refills? Skin bleaching. Wonder if anyone suggested therapy? And what’s up with the uber concierge care the super stars get? The medical society and the Board of Medicine are so very, very worried when a PA or an NP owns a practice and hires a physician to work with them. Even when we work in a town with no physician, the AMA wants it to be unethical for us to hire a physician. They see it as a huge conflict of interest.
I have not heard the medical society comment on the FACT that anyone (except NPs and PAs) with enough money can hire a physician. Sorry to say, we have not heard a word about stars who are addicted to pills hiring physicians to give them care and whatever else they need 24/7. I guess that’s ethical. As long as the money stays in the “family”. Where is the AMA on these ultra concierge superstar physicians? Who watches out for their conflicts? Ethics is in the eye of the beholder?
Michael had a number of personal physicians but it seems he was still neglected by most. From his meds to his CPR being done ON HIS BED, we can all agree that medicine for the ultra rich is not much better than that for the very poor. What a joke. It’s not just Michael, Elvis had one. So did Marilyn Monroe. In fact her doc called in her suicide (and that’s another story).
God bless Michael Jackson. It seems he was a good father and a haunted soul. God Bless his children whom all agree it seemed loved him very much.
May the physicians, all of them, that took all the money they could grab and wrote all the prescriptions they could write and continued to contribute to his dysmorphia and addictions be haunted forever by what they did. And may the officials look into all the professionals who contributed to the folly regarding the children. Those of us who are child advocates should learn something from this. Maybe some good can come out of all of this after all.
We can hope.
Dave
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| RF (Westcliffe Colorado) |
on 26 Aug 2009 at 4:40 pm |
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Michael Jackson died? Say it isn't so. One would have seen it on the news. They would have had a memorial. It would have made the papers.... Oh wait, I guess it did make the news, and has been "Breaking News" on CNN for over a month now. "Michael Jackson" (like Fransisco Franco on SNL) is STILL dead.
Ha. What I've learned from the death of MJ is that no matter how sick or deranged or dysfunctional someone is, if they are a celebrity they will dominate the news.
Meanwhile, uninsured people die daily due to corporate greed by Insurance companies that deny care, deny claims, and increase rates. THAT is the real crime in this country. MJ? Ok, he was a sick, addicted person who bought his own death by finding a practitioner to do his bidding. That is sad too. As to how it affects my practice? Pain control is a specialty and if someone needs pain medication for more than one refill, they also need a referral to a pain specialist, a contract for narcotic use if appropriate, and frequent visits to monitor progress.
As to owning a business, that argument for PA's or NP's is bogus. Owning a business should not change one's style, ethics, and mode of practice. |
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| Carolina (Carolina) |
on 17 Aug 2009 at 4:40 pm |
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It ALL proves that some physicians can become WHORES, for their GREED goes beyond sensible logic.. and causes them to loose sight of sensible boundaries.
From Elvis' MD, to typical Stars, to the Michael Jackson fiasco.
Many doctors have an INFLATED SENSE OF ENTITLEMENT anyway! WHY IS HEALTHCARE SO EXPENSIVE? Doctor's CHARGE TOO MUCH!!! Certainly, an over-simplification. But, lot's of truth there.
It runs through the whole healthcare industry. A Wal-Mart spoon for $1 sold by a medical supplies distributor becomes a $16 spoon.
"Usual and Customary Services should be enough if insurance won't pay more, and PATIENTS should have no more out-of-pocket than their co-pay. Patients without Insurance ought not be charged even as much as insurance is expected to pay.
Insurance companies are crooked, and should be MADE to honor their contracts and COVER what they enticed people to think they covered. That will take federal gov't. enforcement.
AS A CONSUMER, a patient is at a bigger disadvantage with their MD, as a consumer would be with a shyster USED CAR SALESMAN. At least, you know the cost of the clunker. At the "docta's" -- you are fresh meat for the slaughter: you have to TRUST them for what you REALLY need, and that it is FAIRLY PRICED (labs), and that time charged for is not excessive.
We all know that is exploited. How many of you that work for a doctor who insist on a strep test on a throat that clinically HAS strep throat, and the test is overpriced?? They could buy the Pen VK generic for less than half? Right?
PA's and NP's are going to be the salvation to save this country in rising health care cost. But MD GREED has to be curbed, and they must resist using their medical license to LEGALLY BE A DRUG PUSHER. I HOPE AND PRAY that ALL the Michael Jackson Docs LOOSE THEIR LICENSE... and at least one is jailed for MANSLAUGHTER. So fitting. Docs are NOT above the law, though so many think they are. Why do you think Medicare and Medicaid FRAUD is pandemic? It is all about MORE $$$$. |
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| Jamila Ali WHNP (New York) |
on 07 Aug 2009 at 9:40 am |
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| What happened to Michael Jackson's Healthcare proxy or living Will. Why did he not have a care plan and a coordinated team as Nursing promotes for every patient (in patient and out patients). He deserved that much at leastI agree with much that has been said if a Nurse had administered the medication to him she/ he would be hung high. Not physcians, though the AMA has been silent thus far. My guess is they (physicians )must be protected at al cost. |
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| Renee MPAS, PA-C (Oregon) |
on 04 Aug 2009 at 4:07 pm |
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I think Dr. James and Deborah Lewis hit the nail on the head regarding the article and the ridiculous comments by Dr. Classen.
There is no public knowledge of the childrens' background, genetic parents or health history-that does not mean Michael and his family did not. They choose to remain private..what is wrong with that? How many patients do you see that are adopted and have no knowledge of family history? Too many assumptions in Dave's article. |
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| Robert M. Chavis, RTR, OD, PA,NMD (Ahoskie North Carolina) |
on 02 Aug 2009 at 8:11 am |
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| I agree very much with the article and I disagree with Dr. Classen, I know for a fact that physician get by with a great deal more than PA,NP. The medical boards across the USA come down harder on PA and NP for far less than what a physician has done.Oh and most PA and NP could complete a medical school training, but that training in most places in the USA is so old school that one had to be rich and or have a great deal of time on their hands. Medical school is not a race based item it has always been a class based item. Yes some people outside the norm have broken down barriers but the good boy item of the upper class is still around more than it should be. Medical school or none physicians should not be allowed to get by easy when other medical professionals can not. |
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| PA-C Soon to be MD (Atl, GA) |
on 29 Jul 2009 at 12:42 pm |
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As a PA in Medical School I have to agree with you both. The Supervising MD takes all the risk if something goes wrong. The PA provides CYA for many MD's that do miss things due to high volume.
There is no "I" in TEAM. We must work as a Team and heal the patient not just treat. Michale Jackson should have been admitted to rehab by Court Order and all his personal Physician suspended from the practice of Medicine. His Cardiologist( Dr. Greed!), and the Geco of the medical profession, should have been Board Certified in Anesthesiology and sedate Michael in a hospital setting to administer OR meds. He may still be alive if admitted to rehab sooner.
LJ |
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| Emily (Michigan) |
on 29 Jul 2009 at 12:27 pm |
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I agree with Deborah Lewis on many points. I believe there are many aspects of his personal life and medical care that is not known to us and never will be. Superstars are still entitled to patient confidentiality, and given that we don't know the whole story, I believe it is wrong to assume his caregivers are guilty until a jury says so.
Dave, have you ever had a patient whose care was not "by the books?" A patient who required a morphine pump after a simple surgery, or a patient who responded well to the off-label use of a medication? I am sure that at some point in your career, you have made decisions that could be viewed by others as \"wrong\" but in fact, it was the right thing for the patient at that time. I have no idea if Jackson\'s doctors were \"wrong\" or not, but if we are so ready to accuse eachother based on limited information, then we are only hurting ourselves by making our profession look bad. |
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| NW NP (Washington State) |
on 28 Jul 2009 at 4:12 pm |
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| Actually, Dr. Classen, NPs in my state are indeed licensed to practice independently. |
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| GB (Hawaii) |
on 26 Jul 2009 at 4:38 pm |
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Dave/Dr Classen and All
First Dave your article is well written and certainly begs the question of appropriate medical management period. I agree that the ethics of medical care for M.J and family were ignored for a price. For certain in the months to come, investigations will likely reveal this over and over again. Really now, Diprivan???
On the other hand, it is regrettable that the very heart of the tragedy it seems, at least in this forum, has opened and fuled deep conflict between PA/NP and MD. Aren't we all Patient Advocates putting the patient's well being first, above all else, including status and monetary gain. Don't we all have a code of ethics? Doesn't the patient, be it an individual or family unit, always come first?
The content of Dave's article touches on very important qualities and integrities that "Medical Professionals" ALL are sworn to abide by without divisions of practice. |
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| Deborah L. Lewis, RN, BSN, MPH (Plantation, FL.) |
on 22 Jul 2009 at 11:17 am |
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Dave:
I think that you need to take a step back from the whole event of Michael Jackson's untimely death. First of all, you are making statements regarding the birth histories of his children of which you know nothing about. It is obvious that Michael loved and cared for his three children. That is really all we know or will ever know regarding him and his family. The whole area of genetics, IVF, and Surrogates has also opened up much debate on ethics, morality, technology, and the impact on humanity as a whole. I cannot discuss each topic appropriately within the confines of this comment section, so I will leave further discussion alone.
W e cannot, however, as professionals, sit back now and second guess every physician, nurse, physician's assistant, or other health care provider involved in his life and medical care during his short time here on earth. We were not involved in his care and didn't know the circumstances surrounding his health, emotional well-being, etc. Michael Jackson was larger than life. . . Of this fact, all of us can agree. The rest is assumption and speculation. We have a complex healthcare system that is broken and in need of reform on many levels. Perhaps the event of Michael 's death will help bring about change in how medicine and nursing is practiced in our country. We must develop a process to manage wealthy patients in a responsible manner, and not just prescribe a drug or perform a surgery because they ask for it or can pay for it. We must also be willing to collaborate more fully across disciplines for the good of the patient. We have a lot of work to do! |
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| Bob (MA) |
on 22 Jul 2009 at 8:52 am |
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| Dr. Classen from Ft. Worth Texas! What did you say? It didn't make any sense. |
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| Robin (Tennessee) |
on 21 Jul 2009 at 3:28 pm |
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| Even in states which allow NPs to practice independently, the benefits of collaboration with MDs are obvious. MDs collaborate with each other all the time; why not NPs/PAs and MDs? It is all about providing appropriate care. Why is it inappropriate for an NP or PA to hire a physician? Why must this be considered as "hiding under the umbrella of a physician"? I suggest this structure is an option for providing the best possible, most efficient, broadest scope of health care service. Good medicine or bad medicine is rooted in the provider's application of professional medical, interpersonal, financial and organizational skills. |
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| Dr James (Washington, DC) |
on 21 Jul 2009 at 3:18 pm |
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| Dr Classen I think a point is being missed here. First many physicians hire PAs/NPs for just that money. In turn, the physician is responsible for the errors as they might occur with the PA, NP, RN, MA, or other staff member in the practice they direct or own. Many corporations hire physicians and other medical professionals where the style of practice is guided and in some cases directed by non-medical policy. I find it important for any one who delivers health care or physician services to do so by the standards of doing no harm and improving ones health. This standard applies to the physician, PA or NP alike. We all have a choice form whom we work and the ownership status of the entity has no real bearing on sound medical ethics. |
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| Dave Mittman,PA |
on 21 Jul 2009 at 2:45 pm |
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Dr. Classen: I have no idea what you are talking about. NONE?
Was there any word about an NP or PA corporation in the above article. Did that cardiologist who did the CPR on Michael work for one?
Who was the PA or NP that hired him?
And BTW, I PRACTICE MEDICINE and did go to medical school.
I Clearly did not go to physician school.
I think you are jealous of NPs and PAs from the tone of your remarks.
Dave |
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| Angela (Texas) |
on 20 Jul 2009 at 11:16 am |
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| Well put, Dave! I enjoyed reading your comments! I agree with you 100%. Unfortunately, we have to live and practice in this unethical society. Thanks for taking the time to write this. |
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| Dr. A Classen (Fort Worth, Texas) |
on 20 Jul 2009 at 10:51 am |
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| Amazing how quickly and easily fingers are pointed at the physicians by NP's and PA's when the disasterous results of their prescribing turns into the disaster that anyone with a modicum of sense could have seen coming years ago. The NP's and PA's who own corporations which "hire" doctors just because they have the money to do so are no less culpable than the physicians they hire, especially when they could have some influence over the practice styles from the beginning, but fail to impose it by copping out on the fact that they don't have a license to practice independently. If the temperature is too hot for you, go back to school and get a medical degree so you can take over the practice of medicine rather than hiding under the umbrella of a physician. |
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