I bet celebrities and other VIPs (as they’re known in hospitals) get some of the worst healthcare in America. And, when I mean worst, I mean the most.

I did my residency in the West Village in NYC. There seemed to be a new celebrity in the ER every other day. “Oh my god, Lindsay Lohan is in bed 3!” I took care of my fair share of them— I won’t say who. But there was always this understanding from everyone in the hospital that “they were VIPs” and needed extra special treatment. 

The problem with extra-special treatment in our healthcare system is that it almost always means more care than anyone else would get. For example, celebrities often get every test imaginable done on them in order to rule absolutely everything out. A hospital doesn’t want to be known as the one that killed Lindsay Lohan. This of course leads to more tests and sometimes, more procedures. More procedures can often equal more complications. You get the deal. One hundred thousand people in America die every year due to medical mistakes, unnecessary surgeries, hospital-acquired infections, and drug complications. And they’re not VIPs.

Everyone in the health community is speculating on what happened to Steve Jobs, so here’s the rough timeline:

• Some time in the second half of 2003: Jobs undergoes some sort of scan which finds an incidentaloma, which actually later that evening, it was biopsied and found out to be a pancreatic neuroendocrine tumor, a slow growing kind of pancreatic cancer.
• The next nine months: Jobs tries a special diet hoping to kill or slow the cancer’s growth. Either it doesn’t work and the cancer grows or the doctors convince Steve that there’s more evidence for a Western medicine intervention than a special diet.
• July 31, 2004: Jobs undergoes surgery to remove the tumor.
• June 2009: Jobs undergoes a liver transplant. It’s unclear why.
• August 24, 2011. Jobs steps down as Apple’s CEO because he is unfit for his duties.

As a physician, it’s our job to do something. We can prescribe pills or we can perform some sort of procedure on you. When we find something abnormal, it’s in our nature to do something about it. Sometimes, it’s in your best interest to actually not do anything about it. The problem is, we don’t know when we should not do something because we don’t always know how you and your body will handle something abnormal. All we have are stats from population-level studies, an intuition, personal experience, and some labs or imaging. I learned from a professor in medical school that we all get cancer a few times a day. Out of tens of trillions of cells in our body, it makes sense that a few of them will occasionally go haywire. But, there are very elegant processes in our body that ensure these mutated cells actually kill themselves (see Knudson’s Hypothesis).

Steve Jobs’ had an incidentaloma. It may have taken this tumor 15 or 20 years to cause symptoms. However, it may have taken 1 month. We won’t ever know. We do know that incidentalomas sometimes simply go away without rhyme or reason. And we do know that, in Jobs’ case, the doctors intervened with two major surgeries and, now, 8 years later, his health is severely compromised. Maybe if his doctors actually did nothing for him, he’d still be just fine today. There’s no real way to know. I do think that his docs did the right thing as competent doctors, but, again, there’s no way to know if they were competent in Steve Jobs’ case nor will we ever know that if they just left him alone, he would have been just fine. He probably doesn’t have many years, if not months, to live. And that makes me very, very sad. He was one of our heroes. But I’ve got to wonder to myself, how were his doctors affected by the fact that they had Steve Jobs as a patient? We’ll, of course, never know. But I surely wouldn’t want to be his doctor.

For further reading, please read The Atlantic article, How American Healthcare Killed My Father.