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Should physicians as patients be given VIP ("Very Important Person") treatment by the patient's healthcare providers?

What is the VIP syndrome? The Very Important Person (VIP) syndrome is a pattern of behavior by both the ill physician and his/her healthcare providers that may be deleterious to the established standards of medical care. From the ill physician’s point of view, his or her illness as a physician requires special attention by the caregivers not given to the other patients. The physician is to be treated as a professional and is to be kept fully informed about all the clinical details and is to be consulted as a colleague by the treating physician. The ill physician may request that appointments or lab tests take priority over others for personal convenience. When hospitalized, the physician may be demanding about which nurses are assigned and how they respond to requests. Also, the family of the sick doctor may be similarly demanding.

I suspect that the VIP behavior by the ill physician is not as common as the potential for altered behavior by the treating physician. Unless the treating physician has had lengthy experience caring for medical colleagues, the experience of being a doctor’s doctor can be emotionally traumatic with anxiety, uncertainty, anger and guilt. From the outset, history taking of the doctor may be more incomplete than the average patient since there may be a tendency to avoid asking important but personally embarrassing questions such as involving mental illness, family problems, sex or drug and alcohol use. Physical exams of the ill physician may be more casual and pelvic, breast or rectal exams may be omitted. Testing may be inadequate especially if the appropriate test is uncomfortable. Telling the ill physician the diagnosis and treatment options may be difficult if the treating physician is personally uncomfortable with the conclusion and identifies with a patient with whom he or she has professionally interacted. All of these VIP elements do nothing but worsen or delay proper diagnosis and treatment

Proper communication with the ill physician is essential and probably the most important thing that a treating physician can do is at the outset to make it clear that the sick doctor is going to be treated as a patient and not as a doctor.

I would like this Question to be limited to the issue of VIP treatment for physicians and its implications toward the treatment of the general patient public. The other issue, of course, is the VIP treatment by healthcare providers for "notable persons" and the ethical and value implication of that type of treatment. I will set up another question on that issue but let's keep the discussion here limited to that of physicians since how physicians want or don't want to be treated when they are sick may have reflections upon how non-physician patients are looked upon and treated by their doctors and the medical system. ..Maurice.

For more reading on this topic: "’Doctoring’ Doctors and Their Families” by Stuart A. Schneck, MD
JAMA. 1998; vol.280, pages 2039-2042.
asked Aug 15, 2010 at 12:26PM in Other
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  • 2
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    answered Aug 16, 2010 at 03:53PM
    Not only would a doctor -patient not.put up with this but the doctor's doctor would never allow this to happen. Thanks for reminding us your experience. ..Maurice.
  • 1
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    answered Aug 17, 2010 at 10:41AM
    Maurice,

    Once again thanks for asking a very important question. In the ideal world and unlimited resources all patients must be treated like VIP. It is natural if a colleague falls sick, the hospital staff will pay greater attention than other patients. Some hospitals provide Executive check up for few thousand dollars to CEOs in a single day, where top physicians and facilities are reserved for the executive in priority over ordinary patients.

    In the traditional Indian system of medicine Ayurveda, it was stated that all patients should be treated like kings and the treatment was mostly free and dispensed by the leaders of the society. Later on it changed as forms of payments in kind or service entered the system. In some hospitals in India paying (30-40%) and non paying patients are treated the same way. Doctors are blinded to the payment status of the patient. Many hospitals in Europe treat the patient irrespective of the paying status. The right wing and ultra nationalists are gaining strength in many countries in denying health services to refugees, asylum seekers and foreigners.



    I read about some hospital
  • 3
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    answered Aug 17, 2010 at 11:13AM
    Krishan, you may want to continue your previous posting on an new Answer.

    I did want to emphasize that since as with all humans, physicians are not frequently running to their doctor with symptoms nor having tests performed so the effect of VIP treatment of physicians affecting the care by the treating doctor of non-physicians (the general public) would be rare. What might not be rare in the VIP approach toward physicians would be the diagnosis and treatment of the doctor's condition. I have described in my original commentary the slacking off of standards of practice established for non-VIP patient when the patient is a doctor... perhaps inadequate history, inadequate physical or avoiding certain uncomfortable testing.

    What has been the personal experience as patients of other physicians reading this Question?. When I was hospitalized, as a physician, I made it clear that I refuse VIP treatment. And yet, I found out later that instead of waiting along with other patients in emergency room beds for a permanent bed to become available on the appropriate ward, I got transferred to that ward bed ahead of others who waited longer and I doubt I was any sicker than the others! You can't win! The occupation of a physician seems to healthcare providers to trump the needs of all the others who are not doctors. ..Maurice.
  • 2
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    answered Aug 17, 2010 at 02:41PM
    In an ideal world, everyone should be treated the same, but they aren't. I think that in Western societies at least, where there is no universal health coverage, money talks, and if you add the status of a physician to that, I am sure preferential treatment occurs. Even with universal coverage, if a physician patient can pay extra for VIP services, it creates a hierarchy of medical care I am opposed to. I have taken loved ones on occasion out of emergency rooms because they were put on the lowest priority, waiting for hours without attention, even though they were probably close to death. I understand cardiac emergencies and severe trauma should be priorities, but hopefully if a physician comes into emerg, nurses and docs won't drop others to attend to the physician's or similar status patients' needs. After all, we are born with nothing and die taking nothing with us. Why not equality in medical treatment?
  • 2
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    answered Aug 17, 2010 at 05:42PM
    Kim, I suspect that much of the VIP treatment given to physicians is related to an inherent conflict of interest and secondary gain by mainly the hospital but also possibly by the treating physician. After all, the ill physician is usually on the staff of the hospital to which he or she is admitted. And who is the one that contributes to the financial benefit through participation/referrals and the character of the hospital but that very physician? Even if not on the staff, the hospital most likely will benefit from that physician's referrals. From the point of view of looking at the treating physician there still is some element of conflict of interest since there is importance to maintain collegiality and reminder of skills between the two since most likely if they are in different specialties they both provide patient referrals to each other. Do you think I am too cynical in this emphasis of conflict of interest?

    The other issue is that of the danger to the ill physician of inadequate workup by the treating physicians and a potential lack of normal supervision of the physician patient's condition within the hospital if that doctor has his or her way in ordering hospital staff to change their monitoring protocol in order, for example, to avoid night time awakening or make other requests that if followed could affect the patient's safety. Doctors who are just patients are first and foremost patients and the rest of the medical profession should treat them as such. ..Maurice.
  • 1
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    answered Aug 18, 2010 at 03:17AM
    Maurice raises an excellent point regarding conflict of interest. I enjoyed reading everyone's contribution to this thought-provoking issue.

    I believe that physicians shouldn't receive VIP treatment, but unfortunately, that's the way the medical system works. Maurice raises a great point about the fact that even physicians who refuse VIP treatment often still get it. In this case, the physician is ethical, but the system is not.

    I think it is important that physicians who are admitted to a hospital know -- really know -- what it's like to be a patient. There are many empathetic physicians, but I would think this experience as a patient would hopefully make them better doctors because they would know a patient's perspective.
  • 2
    Votes
    answered Aug 18, 2010 at 08:11AM
    I can see from your points, Maurice, that there are pluses and minuses to being a "physician patient". I am glad you mentioned the multiple awakenings necessary for care and recovery, that might be waived for VIPs but which are necessary to assess patient status and administer drugs. While appearing deferential, waiving this activity could put the physician's health at risk. Another issue is how frank physicians wish to be about co-morbidities or corollary issues to a medical concern that may not be properly addressed or even probed by other medical staff, to respect the privacy or status of the physician. Such issues as addictions or substance mis-use, suicidal ideation or plan, domestic violence, or unethical conduct, which may or may not be related to the primary medical presentation and addressed as such. Physicians are human, and while rightfully valued and respected for the ability to heal and save lives, they have the same strengths and weaknesses as everyone else. I knew someone who worked in an emergency room of an American hospital for two years, who enlightened me to this fact. As for the hospital gaining from according a physician patient VIP treatment because he or she brings in the bucks for the institution, perhaps that is an ethical issue but one that is understandable. Physicians are assets as well as healers, and the fact is, we live in a materialistic world that assesses human beings for moneymaking potential. But for me, that diminishes the physician as a healer, which is how most like to view themselves. You are not cynical, Maurice, just realistic and wise.
  • 1
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    answered Aug 18, 2010 at 10:07AM
    Well the discussion has progressed well with several new points raised. In human history, there have always been priority groups. Jenner first vaccination for smallpox was reserved for the military and politicians first and the merchant navy and general populations had to wait for several decades. During last year Pandemic 2009 H1N1 influenza, several countries had priority lists during the initial vaccine shortage. Politicians, governments, healthcare providers and company executives and industry leaders were in priority lists

    For organ donation, politicians, CEO, celebrities go on top of the general waiting list. It was good to read the news about late Dr M DeBekey becoming the oldest patient getting the aortic dissection by DeBekey procedure. His treatment and 8 months stay in the hospital cost over 1 million dollar but returned the great heart surgeon to good health for 2 more years. Tom Starzl, the liver transplant pioneer at 84 and since retirement in 1991 has become the most cited and most prolific author in clinical medicine. If he has any health problem, he should always get priority over others.
  • 1
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    answered Aug 18, 2010 at 10:24AM
    Krishan, in a catastrophic influenza pandemic where there is a high degree of triage of patients because, for example, the limited availability of mechanical ventilators, would you expect all M.D.s be given VIP treatment over all others with regard to access to life-supporting treatment including the scarce ventilators? How about the police and garbage collectors and others who could help keep the society together in a period of potential chaos? ..Maurice.
  • 0
    Votes
    answered Aug 18, 2010 at 11:17AM
    Maurice, Kim, Beth,

    Once again good points, the 2009 H1N1 priority list of course included high risk patients. In France there was a movement to have Police, customs, administration, military, fire fighters, security included in the priority list in 2009 during the initial months of pandemic vaccine shortage. I believe that preferential treatment has always been given to certain categories of population over ordinary patients. I doubt if it can be eliminated?
    • In the ventilator shortage case, guidelines like the organ transplant priority waiting list probably already exist or were prepared to cope with the 2009 H1N1 pandemic, maybe the CDC site has these guidelines?
      Krishan Maggon PhD commented Aug 18, 2010 at 12:21PM
  • 2
    Votes
    answered Aug 20, 2010 at 11:33AM
    I read Medscape Oncology and Medscape Daily News, and noticed an article about an Oncologist and Researcher who recently passed away from Multiple Myeloma, Dr. Merrill J. Egorin. I thought about our discussion on VIP status for physician patients. Dr. Egorin passed away in the same unit he worked in for 12 years. He had contributed much to oncology research and treatment, and it is a great loss, in my opinion. What is amazing about Dr. Egorin, is that used his status as a hospitalized cancer patient, not to benefit himself, but as teaching tool for colleagues and students. He took conference calls from interns and aspiring physicians while in his hospital bed, to teach them what it is really like to be "a cancer patient", surely hoping it would contribute something unique to their medical education and patient care. I suppose something like this is a gift that only a physician patient can bestow. The link to the article is: http://www.medscape.com/viewarticle/727191?sssdmh=dm1.633176&src=nldne&uac=149349MX

    One has to sign up to Medscape to access it, so for those not a Medscape member, I am also putting the article up in PDF format on the Medpedia Lymphoma patient community.
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