Peter Moore: The patient’s interest must always come first

Matthew Perry, the star from the American sit-com Friends, died in his hot tubs apparently following a large dose of the drug ketamine. 

It made me wonder how easy it was for stars to get the drug. With the recent arrests it appears that it is easy, provided you know the right (or wrong) doctors.

Is there a problem with some of the doctors to the stars in Hollywood? They can make a fortune provided they “play ball”. A good or bad review from a well-known celebrity can make or break their career. To continue their lucrative career they must give way to every whim of their celebrity patients. They love being the doctor to the stars and if they refuse  inappropriate treatment there are plenty of other doctors who will oblige. Many of these stars also have assistants who pander to their every need. No one ever says no.

Michael Jackson, desperate to help his insomnia, was killed by a general anaesthetic which should only be used under close supervision in hospital. Earlier in his career he kept demanding more and more plastic surgery. I suspect that this was only a symptom of a deeper psychological problem. An ethical doctor would have had a long discussion about the real problem rather than reach for the knife.

Not surprisingly as a Torquay GP I did not look after any Hollywood superstars which was fortunate.

This whole life-style flies in the face of ethical medicine. To use the jargon doctors must show “beneficence”. They must always act in their patient’s interest. This is not the same as giving in to all their patient’s demands.

In my career patients with backache would often ask for an x-ray. The evidence and our guidelines made it clear that an x-ray for the normal “wear and tear” simply exposed the patient to unnecessary radiation and did not help the diagnosis. It was in the patient’s interest to refuse an x-ray, but I tried to explain the reason.

Working in prisons could be more challenging. Inmates, who were already seeing the substance misuse team and being weaned off drugs, would often try to “blag” a drug.

“I need dihydrocodeine for my backache”. 

After a careful examination I could prescribe an anti-inflammatory such as ibuprofen or diclofenac. These are equally effective for joint pain but did not always make me popular.

Sadly many of the Hollywood doctors to the stars seem to have forgotten this basic rule of medical ethics. They all want to be a doctor to the stars. 

When Matthew Parry was demanding ketamine an ethical doctor should have offered him a treatment programme to help his withdrawal. 

There is a nasal spray for depression but this can also only be administered by a doctor who must monitor the patient for two hours after the dose. Giving ketamine as a recreational drug on the patient’s demand is not only unethical but illegal. In the UK, any doctor would probably be struck off the medical register and never allowed to practise again.

In my career I only had one patient who was taking ketamine and that was prescribed by the specialist pain clinic. It was effective but closely monitored by the specialist.

The NHS was set up on the principle of providing services to all based on “clinical

need”. 

This is not the same as on demand. If these principles were followed by the

doctors to the stars both Michael Jackson and Matthew Perry might still be alive.