The following article, written by a senior figure in the medical profession, challenges preconceptions about health and wealth. It addresses the fact that, for all the wealth that HNW people have, their healthcare can often be poor, uneven and leave them with problems.

Being wealthy does not equate with being healthy or having a solid understanding of healthcare and how to manage it for one’s self and family. The author of this article, Jason W Siefferman, MD/medical director, Manhattan Pain Medicine, discusses these topics in the following article. The editors are grateful for this valuable commentary; the usual editorial disclaimers apply to views of guest writers. Email tom.burroughes@wealthbriefing.com and amanda.cheesley@clearviewpublishing.com

Why do so many wealthy and famous people receive suboptimal healthcare despite being cushioned from hardship in every other aspect of their lives? The answers lie in the way people respond when someone with a very important professional role, remarkable ability, or enormous fame becomes ill.
 
Overreliance on teams
Unlike “regular folks,” who may only have family support with no special access to concierge care, people with wealth and influence generally have a team ushering them through the healthcare system. This team might include family but typically consists of representatives from entities affected by this person’s illness. Businesses, projects, colleagues, and organizations all might suffer if a VIP gets ill.
 
In healthcare, we tout a multidisciplinary approach to comprehensive care, which, when coordinated, delivers phenomenal results. 
 
But sometimes, the static between the channels running a VIP’s life can compromise the speed, precision, and quality of healthcare for someone who has otherwise become accustomed to the highest standards of service and care. The diverse interests of their teams may be at odds with optimum health and wellness. When the patient cannot speak for themselves (or elects to have someone else manage their medical affairs), the opportunity for substandard outcomes begins.
 
There are several pitfalls for teams to avoid when a high-status person falls ill:
 
-- Miscommunication – This is the nexus of most problems. If a doctor gathers information about the patient through a third party, they lose the opportunity for intuitive, direct observation or asking precise questions with insistence on chiseled answers. Confusion and inaccurate reporting of symptoms cause further delays and errors. It is always best to have the patient meet directly with the doctor.

-- Mixed priorities – If a patient prioritizes their responsibilities over their own health, or if someone on their team does, crucial steps can get overlooked. Shedding light on everyone’s motivations while discussing treatment options is essential.

-- Confused coordination – A patient’s care is the doctor’s primary responsibility. But, stakeholders across multiple teams all have individual needs. With new diagnoses, teams scramble and lack coordination. This frequently results in numerous well-intentioned, redundant, and unnecessary communications, distracting focus from patient care. By designating a team lead, through which all communications will flow (ideally the patient!), doctors can devote more time to treatment.

-- Urgency and unrealistic expectations – An unexpected interruption to an important person’s schedule has many downstream effects. The most common request is immediacy: “Just fix it.” Urgent demands for ‘above and beyond’ care exacerbate miscommunication and confusion. With early and recurrent communication about expectations and goals, everyone can stay on the same page. Pushing for the ‘fastest’ solution isn’t always the best.
     
Haste makes waste
If a celebrity needs to be back on stage in a few days, or a CEO must attend a summit in Geneva next week, or a scion of wealth simply suffers from impatience, accelerator pedals get pushed. 

We doctors generally seek to be of service and aim to please our patients. However, the scope of what is medically reasonable is broad, so unnecessary procedures frequently occur in the rush to satisfy patient requests.  
 
A case study in haste
Edward, the CEO of a multinational company, suddenly developed sciatica with pain in the back and shooting pain in the right leg. He could not sit or stand comfortably. An MRI taken by his concierge physician showed a mild disc herniation irritating the right L5 nerve root. The doctor coordinated same-day consultations with two spine surgeons. Both recommended physical therapy, oral medications, and an epidural steroid injection before surgical intervention. Although it is generally unnecessary for this situation, the specialists presented the surgical option, knowing that someone else would offer it if they didn’t. (They were familiar with this demographic’s preference for swift, definitive action, which could have him back to work in two days with six weeks until full recovery).
 
Edward then consulted with a pain doctor who educated him on the frequency of this condition (80 per cent of people experience sciatica like his within their lifetime, 90 per cent [of cases] resolve within six to eight weeks without intervention). The doctor outlined a course of oral medications, which would take four to five days to start working, combined with physical therapy to treat the herniation’s underlying mechanical issues. Edward had a board meeting across the country in three days and several other responsibilities, including his daughter’s birthday party.  
 
Edward was inclined towards unnecessary surgery.
 
Most insurance requires six weeks of conservative care for the general population before an MRI is covered. Patients start with physical therapy, chiropractic care, or primary care before seeing a spine surgeon or pain specialist. So, by the time they get to the MRI, most cases will have resolved without further intervention. But because Edward was a person of means, he was steered toward procedures like an epidural or surgery, which only mitigates pain without accelerating the healing of the disc. Overtreatment and opting for immediate interventions carry significantly more risk than following standard care guidelines. 
 
The medical paradigms are diagnosis, treatment, maintenance. Ensuring a precise, fully-elucidated diagnosis comes first. For Edward, this meant clarifying whether the disc was the source of pain. How did that disc come to herniate? – Because this is what ultimately requires treatment.  

Edward had surgery and was fine for six months, then the pain returned. 

The downsides of exceptionalism
There is a perception that exceptional people have exceptional problems and may benefit from ‘exceptional’ treatments. (Exceptional, in this case, could mean fringe, experimental, guru-led, or off-market treatments). Sometimes, doctors become over-zealous in providing care for wealthy patients, broadening the workup and treatment scope in a way that produces false leads, distracts from the most likely primary diagnosis, and causes confusion. The lesson is simple: Even uncommonly privileged people can suffer from common conditions.
 
Medical care, especially for pain, is iterative. We learn from each step and collate that data into our larger understanding of the illness before taking the next step. Are there exciting new treatments that haven’t been widely adopted? Absolutely. Has a clinic in Panama (or the Swiss Alps or Micronesia) discovered a cure for your particular condition? Unlikely. Stem cells, for example, have tremendous promise, but outside of very specific guided applications, generally they aren’t helpful. 
 
Forgoing a balanced, thorough approach or attempting to reinvent this process usually results in unnecessary delays, complications, and suboptimal results. 
 
So, just like everyone else, VIPs should always begin with a trusted primary care doctor who knows you in health, and they will best guide you when new medical conditions arise.
 
About the author
Dr Jason W Siefferman is a board-certified expert in physical medicine and rehabilitation (PM&R), headache medicine and interventional pain medicine. He is clinical assistant professor at the New York University School of Medicine. His private practice, Manhattan Pain Medicine, offers a comprehensive, holistic approach to the diagnosis, treatment, and management of pain-related conditions. Dr Siefferman is also a speaker and author of several academic articles on chronic pain, treatment modalities, and care delivery through the lens of his multi-disciplinary approach.