Did Joan Rivers Die of VIP Syndrome?

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Did Joan Rivers die of VIP Syndrome—that constellation of poor medical decisions (and selfies) by preoccupied medical professionals that invariably ends in the demise of America’s most adored celebrities? I believe so.

I get asked medical questions all the time, but over the past several weeks since the death of Joan Rivers, the tempo has definitely increased. The questions are all over the place, ranging from “is it safe to have procedures done at an outpatient facility” to “why didn’t the anesthesiologist perform an emergency cricothyroidotomy?” Now to a physician, most of these questions are basic, if not idiotic, but to the non-physician they are real and of critical importance.

With regard to the specifics of the Joan Rivers case—the truth of the matter is that I have no idea what happened. I do know that she was undergoing some sort endoscopic procedure at an outpatient endoscopy facility, presumably under anesthesia. Exactly what type of anesthesia and administered by whom is not publicly known. Recently, we have heard that an impromptu vocal cord biopsy was performed by Ms. Rivers’ personal ENT physician. Again, this may or may not be true. The bottom line is that we don’t know a lot more than what we do know. We doctors, just like everyone else, must wait until the NYS Department of Health concludes it’s investigation. I do know one last thing, however, that upper endoscopies, when routinely performed, are extraordinarily safe. In fact, over 8 million are completed in the United States annually—almost always without any complications. So what happened to Joan Rivers?

When I was a surgical resident, I would occasionally get a call from the Emergency Room requesting that I come down for an immediate consultation for a “VIP.” I always thought that this was a bit of an odd request. Did they think I was normally eating popcorn while watching another episode of “Dancing with the Stars” when they call me? Did they think that my usual response time or manner in which I take care of patients was inadequate? In any event, I would politely listen to the case history and then come down as soon as possible. But as the years went on and the same inevitable request for “special service” arose, I became increasingly inquisitive and then frankly hostile to the innocent practitioner on the other end of the phone. Why? Because I like to think that the care I administer to my patients is first class—everyday, every time—from the homeless guy in the street, to the Queen of England, to my own mother. That may not always be true, but I, like most of my colleagues, strive for it.

Celebrities, like many of us, want to be treated like royalty. We want the best possible car, the best possible house, and the best possible health care. Hospitals and the medical industry as a whole have adapted to this desire. There are “fancy floors” in most major hospitals where patients pay a premium for a hotel-like experience in a private room. They are staffed by a hodgepodge of nurses that often do not possess the specific experience or skill set necessary to take care of whatever ailment that brought you to the hospital. Those nurses are on the non-fancy, hospital-like “insert medical problem here” floor. There are “doctors to the stars” that cater their practices to the who’s who of the world and are driven not by academic achievement or technical ability, but by PR firms and guest appearances on Dr. Oz. The end result is poor care.

Earlier, I used the term “routine” when describing the overall safety of upper endoscopies. The reason that so many of these procedures end up without complication is because they are performed in a routine fashion. Air travel is not the safest mode of transport by coincidence. It’s safe because the airline industry and the FAA, over many years, have indoctrinated pilots and mechanics to run checklists. “The Checklist Manifesto: How to Get Things Right,” is a book by Dr. Atul Gawande, a general surgeon, that discusses the importance of checklists, not only in medicine, but in just about everything you do on a daily basis. His basic argument is that if you do something the same way, every time, you’re generally going to get good at it. It doesn’t take a brain surgeon to know that.

So Joan Rivers died because the doctors taking care of her didn’t follow a checklist? Maybe yes, maybe no. What I can tell you is that she died because of VIP Syndrome. She died because her VIP status caused the people taking care of her to alter their routine. They departed from their checklist. It is, therefore, my advice to the VIPs of the world who want the best possible care—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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Manhattan Plastic Surgeon