Practice Strategies
Why Wealthy People Receive Sub-Par Healthcare And How To Fix It

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.