VIP Medicine and JFK

With this blog I morph into my doctor mode. No pictures, no alphabet, no feigned surprise at the world, and no allusion to escapades real & imagined (well, not really..but I'll leave the reader to pick and choose). This thought germinated with my trip to Boston about 6 years ago. One weekend before the trip to Woody's L Street Tavern (memorable for more than one reason) I spent a Sunday afternoon at the Kennedy Museum. I'm a fan of presidential museums, and think we should have one in every state. I ran across the book An Unfinished Life, by Robert Dallek. I was intrigued as much by the title as the content, so picked it up and started the read on the plane flite back to Detroit. As usual, the book never saw the light of day after the first few chapters, so it was forgotten. Forgotten until I was given a Kindle as a gift recently. For some reason it seemed the right time to restart the book. It's a bit creepy to me now these years later to reflect on the title, but this time it's the content that interests me.

First to "VIP" medicine. Most doctors including me, squirm when we hear that we are put in charge of managing a bigwig. It's not that these CEO's, lawyers, wives of other doctors, newspaper editors, etc have more complex medical issues, it's just that one feels a bit of pressure to nail the diagnosis and treatment plan without a hint of a mistake, much less a nanosecond of hesitation or uncertainty. It's like the spotlight is on us to be the master clinician. And it's almost entirely self-inflicted. These people are for the most part just like any other sick person, they just want to get better.  But it's us poor slobs of doctors who are always hell-bent on not making a mistake. 

Which leads to VIP medicine being bad medicine. In our effort to be the perfect physician (and mostly not to look really stupid), we order more tests, we make more unnecessary referrals, and  for the most part recoil back to our 3rd-year med school days, and in an effort to "not miss the hoofbeats" we think zebras instead of horses. I've had colleagues who thrive and speak with great pride that they take care of the elite in Louisville. They can have them. I don't want the turmoil and anxiety that goes along with it. Plus, the VIP's have never brought me a sack of fresh tomatoes as thanks for my work.

For his book Dallek had access to records not previously made available to biographers of Kennedy. Especially interesting are the passages about Kennedy's mojo. From teenage years on he had a remarkable uber-narcissism and appetite that would make a grown man blush. The areas on bread & butter politics are worth it if for no other reason as to realize that money talks. Votes, like women are bought unabashedly. On the other hand, I was amazed about the medical facts that were presented. JFK was a victim in my opinion of VIP medicine. I've researched the topic and can find no other reference to this theory. You are reading it here first.

As a teenager Kennedy had recurrent bouts of abdominal pain. He was evaluated by experts from New Orleans, Great Britain, NYC, and other places. But most of his care was centered at the Mayo Clinic. In those days he was submitted to a brutal series of x-ray procedures and colonoscopies. In fact it became so bad, he at one point tried to put a sexual spin on a procedure involving a tube & a light by hitting on the nurse during the procedure (It worked).

Nevertheless, no precise diagnosis was ever given him (although I suspect he had simple irritable bowel syndrome or biliary dyskinesia), but he was given the new drug of the day: corticosteroids. Steroids were for the most part first used at the Clinic, and their long-term side-effects were not understood, although they worked well for his complaints. Of course JFK, being the VIP, was submitted to the most tests and the latest treatments. He subsequently developed the well-recognized adverse effects of steroids including the chipmunk face, Addison's disease, and vertebral fractures. The last two side-effects plaguing him until his death. The patient was in and out of hospitals more than any otherwise healthy young man I have ever seen. If he had been any other Irish-Catholic from Boston, he would have been given a diagnosis of colic, treated with seltzer water, and he would have been better off for it. Perhaps if he wasn't treated as a VIP  in 1940 the world would be a different place today.