The VIP Syndrome and Medicine


Everyone will agree that we are a celebrity-addled culture. We get autographs, we name drop and even the most staid professional will show some level of perverse interest when in proximity to "someone." It might be a media-fueled extension of our status awareness that tells us subconsciously where the person in front of us stands in the pecking order. It is probably an evolution thing, for food, sex and power. Or if you are a well-trained doctor, we take note of how the person's status might figure in a diagnostic and treatment evaluation.

Celebrities and other VIPs, such as the wealthy and those in a position of authority, are accustomed to getting preferential treatment — more service, usually at a higher cost, and a deferential attitude. Sometimes, I am told, gossip columns mention how many of these types have a sense of entitlement that may lead to poor tipping or even expected gratis service "just for the privilege."

Sycophancy is alive and well. Just look at the entourages that follow CEOs, celebs and Chiefs of Services. And a doctor who does not treat these folks with deference will find their follow-up visits cancelled. Yet, there are some hospitals and doctor's offices that cater to this trade. Whole floors are dedicated to the privileged in some Tinseltown hospitals and internationally known medical clinics. You might have to guess which ones, because these locations of necessity place a great weight on discretion. People want their privacy, you know, and I am not talking about HIPAA type privacy alone.

These people also tend to gravitate to concierge practices, which I wrote about recently. I know a number of people here in Silicon Valley who subscribe, largely because they can. When I ask if they have seen an actual difference from their previous level of care, mostly I receive shrugs or responses like, "I haven't been there yet." As I wrote, the jury is still out on this one until there is more hard data.

Where the issue of VIP treatment gets sticky, and also undocumented, is how doctors consciously, or unconsciously, change their manner and behavior when confronted with such a personality. Most of us will say that we don't know if we would act differently because we haven't had the occasion to find out. And among those doctors who have been in such situations, I am sure that the most common, reflex reaction is to assert their continued egalitarian professionalism. "All my patients are VIPs!" Sure, and do note that we also triage by clinical urgency to establish a "VIP by need."

We occasionally see things in the media; for instance, Michael Jackson’s physician who allegedly received $150,000 per month to allegedly administer drugs such as IV Propofil to help the singer sleep. That type of situation brings to mind the old cynical adage: "We know what we are; we're just haggling over the price!" Seriously, those rare cases do get untoward press and tarnish us all.

The much more common ethical VIP dilemma for the average doctor is how we treat other doctors and their families. If you ask the average civilian, as I have many times, "Do doctors receive any different medical care than non-doctors?" the answer is always "Yes!" And a casual survey conducted over a long time by me of other doctors and their spouses almost unanimously gives the same answer, but with a twist. "Yes, I get faster access, but once inside, many doctors get nervous and give me short shrift" as one wife told me.

Pre-insurance, doctors gave gratis care to medical families as a mutual courtesy. After the onset of mass insurance, some doctors started balking at the practice due to decreased need on the part of medical families. Or worse, doctors would rush through the visit because they were losing revenue during those visits. Finally the custom died a sometimes awkward death as the older doctors felt compelled to continue what to them was a noble tradition, while the newer doctors simply saw it as an obsolete curiosity.

Do all doctors react this way to other doctors and their families? No, but I, my family and friends have all experienced it more often enough to mention. We get VIP access, followed by a certain discomfort, a hurried experience and a skimpy explanation. Once I actually was told, "You know all this!" Maybe yes, maybe no. But being present as a friend or relative is not the same as acting as a referring physician. And a lack of a careful explanation in an anxious situation — such as a sick child — and hurried assumptions can be dangerous.

Doctors might be afraid of being judged, fairly or unfairly, and other doctor's opinions do matter more than most others’ do. Just as the VIP's opinions matter more, fair or not. And opinions can have considerable financial implications as far as referrals and reputation goes. And reputation is what we trade on.

So we might hurry to get through an uncomfortable situation. Or we might suffer from what the psychologists call "reaction formation" and become overly solicitous. But either response is an abrogation of our professional methodology and ethics, and should be watched for. That's part of what our training should involve. But did you get any training about this? I didn't. Just On The Job Training. Not even the benefit of See One, Do One, Teach One. And we really do need to prepare for and deal with the common human phenomenon of VIP syndrome.

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