Several years ago, I was approached by a grandparent of one of my patients in the ICU who told me, "Treat this girl as if you were treating the President of the United States." Luckily, this kind of request has been relatively rare during my career. However, I am proud of my response - "Sir, I treat every patient that I have as if he or she was the President of the United States. My ICU is full of "very important patients" tonight."
There seems to be a belief that health care providers can adjust up or down their ability to treat the patients that are in front of them. It's almost like some would have you believe that doctors and nurses are saying to themselves, "You know what, I am kind of tired tonight. Maybe I will take the night off and just give 50% effort tonight." Alternatively, when confronted with a patient who happens to be related (or as more commonly the case, the relative of a friend of a friend of a friend) to someone important, these same health care providers say, "Wow. I better be on my 'A game' tonight." Really?!?!? Come on. I am absolutely, 100% confident that in the vast majority of circumstances, everyone working in health care today are giving their absolute best effort for every single patient, every single time.
VIP ("very important patient") care is not the best care. First, place yourself in the shoes of the healthcare worker in front of you. Knowing that the patient you are caring for is someone important (or at least knows someone that is important) can be intimidating and anxiety-provoking. Second, at times the VIP demands to be cared for by the senior most physician (frequently one of the physicians in the C suite) - never mind that in many cases, these senior physicians infrequently provide care and don't have the requisite volume of patients to maintain the skills that got them to their station in life. As an example, on the night that President Abraham Lincoln was shot, a young physician named Charles Leale happened to be at Ford's Theatre watching the same play. Dr. Leale immediately responded by conducting what would now be described as a primary survey - noting no pulse, he opened Lincoln's airway by repositioning his head and neck and depressed his tongue by placing two fingers in the President's mouth (note - this is not how we do this now!). Lincoln started breathing again and his pulse returned. Leale was later joined by more senior physicians (the Army Surgeon General, Dr. Joseph K. Barnes, for one). While Leale was only 23 years old, he was familiar with all of the latest theories on the care of battlefield injuries. He disagreed with the care being provided by the senior physicians but was overruled due to his "inexperience." Significantly, two modern-day neurosurgeons reviewed Lincoln's care and suggested that if Leale's instructions had been followed, Lincoln may have survived the assassination attempt, albeit with significant neurological sequelae! There are several additional cases in the more recent literature, especially when care is provided to Hollywood celebrities, such as Michael Jackson, Joan Rivers, and Prince.
We can do better - and we should. We need to recognize "VIP syndrome" and do our best to avoid it. Drs. Jorge Guzman, Madhu Sasidhar, and James Stoller recently published an article on the VIP syndrome, suggesting nine different things that health care administers should do to guard against it:
1. Don't bend the rules.
2. Work as a team, not in silos.
3. Communicate, communicate, communicate.
4. Carefully manage communications with the media
5. Resist "chairperson's syndrome"
6. Care should occur where it is most appropriate
7. Protect the patient's security
8. Be careful about accepting or declining gifts
9. Be careful about working with the patient's personal physician
To these guiding principles, I would add another. Sending a senior member of the hospital to "check in on the patient" may or may not be appropriate (I happen to believe that it is not). However, at a minimum, these kinds of visits need to be conducted tactfully, respectfully, and carefully (in terms of the providers at the bedside and NOT the VIP). Visitation guidelines and HIPAA laws should still apply here. Finally, and perhaps most importantly, please don't insult the integrity of the caregiver at the bedside by informing her or him that the patient is a VIP. To all providers at the bedside, every patient is a VIP!
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