When is Personal Service Bad Medical Judgment?

As if  Michael Jackson’s stunning death this past summer was not tragic enough, last week  his personal physician was formally charged with manslaughter . Dr. Conrad Murray, a cardiologist who was with Jackson at the time of his death, is accused of medical behavior that led to his demise. Murray is claimed to have  administered  the sedative propofol to help Jackson sleep.  Shortly thereafter Jackson was found unresponsive, and was declared dead after arriving at the hospital. These charges against Dr.Murray are sure to be the prelude to another sensational celebrity courtroom drama set to play out later this year.

Until this event occurred, most people had never heard of the drug propofol. Known as the ‘milk of amnesia’ amongst anesthesiologists, this white-colored liquid sedative has undoubtedly performed perfectly during millions of surgical procedures – certainly for many surgical patients who are reading this very column. Propofol is intended  to be administered only by an anesthesia professional in a medical setting, because it depresses breathing and heart rate while lowering blood pressure.  Propofol is absolutely not an insomnia medication .  How then did the ‘milk of amnesia’ come to be in use at a private residence?

It’s my belief that the thing that killed Michael Jackson is the very same thing that led to his facial disfigurement from  multiple plastic surgeries.  The ‘fame’ monter and the opportunity to rub shoulders with a pop star is capable of  making anyone, let alone a physician, cross the  line between appropriate behavior and  irresponsibility. Dr. Murray will ultimately pay a steep price for his short time as a celebrity’s physician but the deceased is not a guilt-free victim. A lifetime of privilege and asking for the ‘extraordinary’ created a pattern of behavior that ultimately proved fatal. It is one thing to demand the best room in the hotel or to make special accommodations for your private plane at the airport…but pushing the envelope in medical treatments can have different consequences.

Ultimately, the doctor should have used better judgment. The use of propofol at home can not be defended at any level. We are certain to hear in court testimony, however, a fantastic story that will justify his actions. It probably will be as equally convincing as the glove that did not fit O.J.’s hand.

Even in a small, Midwestern practice, our best judgment as physicians is tested. When a friend or family member asks for a Vicodin prescription for a ‘bad back’, or a patient expects us to write off her co-payment, or when a local celebrity asks for pain medication that is waaaaaay more than what is necessary for a simple elective surgery, we’re expected to uphold our professional standards and do the right thing.  We’re supposed to say no.    Because when you don’t refuse, and when you do write that ‘questionable’ prescription because you feel obligated, you’ve opened the door to further indescretions.  And before you know it, you’re saying ‘yes’ more often than not, and over time you allow the patient to dictate the course of treatment.  And sooner or later you wind up like Dr. Murray.

Dr. Barry Eppley