M&H, Boundaries, and Michael Jackson's Homicide

I have been thinking about this for a long time, certainly since June 25th. It takes amount of personal integrity to Just Say No to rock stars and other celebrities. They are powerful, rich, glamourous, and in the public eye. Who wants Michael Jackson to fire him or her as his $150,000/month private physician and tell Rolling Stone that we won't give him the one thing he needs to be happy? (It's the same in the Sports Medicine world where elite athletes beg, whine, and cajole to be shot up with performance enhancing drugs and pain killers.)
In Medicine and Horsemanship, an equine-assisted learning program, our activities with the horses portray doctor patient communication scenarios. They dramatize and reflect back to us where we stand on the spectrum of wanting to be liked vs. Tough Love in the best interest of our patient's health. Other activities reveal how comfortable we are being permissive vs. assertive. To what extent do we yield to patient pressure and prescribe the Purple Pill whether or not we think it's indicated? To what extent do we seek to avoid conflict and inch down the slippery slope of just one more prescription, just 6 more months to put off quitting smoking. (My Celebrity Patient wanted oral antibiotics for septicemia. I was doing a locum tenens for his primary care physician up in Marin County. I argued and argued that he needed to be admitted for IV antibiotics, but he refused. And in the end, I capitulated and wrote the scrip for Diclox.) To what extent do we as physicians take the more assertive, controlling, authoritarian role in the doctor-patient relationship?
Tonight the Michael Jackson homicide story will hit the public blogs and talk radio. I don't know if I can stand to listen to all the harsh recriminations on one hand and the harsh exonerations on the other. We will certainly be talking about these issues--and enacting them with the horses--in Medicine and Horsemanship this quarter.