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  • VIP syndrome, treating colleagues, staff etc.

    Have you guys seen examples where knowing your patient has led to care that is actually worse than if it were just a random patient off the street. I have witnessed this, and the problem lies in once the medical provider starts deviating from what they would do in any other situation it doesn’t necessarily lead to better care or outcomes. And the problem is it’s impossible to treat the person the same as you would treat a joe off the street. In some cases treating a colleague or staff member has tangible benefits: such as going out of your way to expedite an admission or consult, more frequent visits and emotional support; however I’m pretty much convinced that knowing the patient on a personal level starts to pervert the treatment process in ways that are unforeseen. I write this as there was recently a colleague who was hospitalized for a very minor issue (an issue that usually wouldn’t even warrant admission) this led to quite a lengthy hospitalization much more so than I suspect if it were just a random person off the street. VIP medicine- not always the best thing...

  • #2
    I agree 100%. Just had such a VIP for an "emergent" MRI of the spine here today (just the 3rd in 3 months) which to obtain "overnight" we bent over backwards x3. Local VIP with lung cancer but the poor oncologist can barely treat his inoperable cancer because his concierge PCP has consulted everybody and their brother and they are all doing  the maximum possible (orthopod is getting ready to kypho his metastatic thoracic vertebral body pathological fracture, pulmonologist gives steroids which prohibit part of the immuno/chemotherapy he should have gotten, PCP orders CT scans every other week which prompt a change in direction). None of the involved follows the usual order of events - all in an attempt to facilitate and accelerate treatment but it is working not in favor of consistent treatment.

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    • #3
      It seems like more and more people are VIPs now. They're like the 3rd cousin of the sister of this doctor so we have to treat them different. I don't get it.

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      • #4




        I agree 100%. Just had such a VIP for an “emergent” MRI of the spine here today (just the 3rd in 3 months) which to obtain “overnight” we bent over backwards x3. Local VIP with lung cancer but the poor oncologist can barely treat his inoperable cancer because his concierge PCP has consulted everybody and their brother and they are all doing  the maximum possible (orthopod is getting ready to kypho his metastatic thoracic vertebral body pathological fracture, pulmonologist gives steroids which prohibit part of the immuno/chemotherapy he should have gotten, PCP orders CT scans every other week which prompt a change in direction). None of the involved follows the usual order of events – all in an attempt to facilitate and accelerate treatment but it is working not in favor of consistent treatment.
        Click to expand...


        this is so sad
        Blogger at Physician Finance Basics

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        • #5
          "The purse of the patient often protracts his case."

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          • #6
            I try to facilitate care for my firemen and policemen(having my back office staff call for imaging studies, referrals, PT). Everyone else gets shuffled to the metaphorical DMV line.

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            • #7
              My wife trained at a "fancy" west coast hospital where you might expect more rich/famous/VIPs than average and she has countless examples of this. Typically it will involves said patients asking for specific procedures/treatments that wouldn't normally be conducted. Sometimes is not a big deal, but in more than one case it deviated from the standard of care and could have certainly led to a worse outcome.

              These are also the patients who only want their operations done by the department head, who doesn't carry a lot of volume and spends their time on research and raising funds...

              I guess one undisclosed benefit of massive wealth is also knowing more than your doctor.

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              • #8
                VIP care, I think is okay, when it’s used to facilitate friction points: like I can quickly arrange labs, testing for a colleague or have someone seen the same day by a cardiologist but the problems arise during the medical decision making process. I suspect it is much more of a thing with regards to inpatient care rather than outpatient care.

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                • #9
                  I absolutely hate knowing when my patients are co-workers, VIPs at the hospital or people's family members before I give them anesthesia.  I'm usually oblivious to who the C-suite people in my hospital are, so until a nurse says something they get treated the same as everyone else, which I prefer.  I actually agree with FLP in that I have witnessed colleagues deviate from their normal plans to accommodate a VIP.

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                  • #10


                    These are also the patients who only want their operations done by the department head, who doesn’t carry a lot of volume and spends their time on research and raising funds…
                    Click to expand...


                    When I was a resident a VIP asked the attending to do the Circ for his son rather then us lowly residents.  My attending talked him out of it saying that I had done 100 in the last 12 months and he has done 3.


                    I suspect it much more of a thing with regards to inpatient care rather than outpatient care.
                    Click to expand...


                    I see a lot of unnecessary testing in the outpatient world.  Leading to costly workups for incidentalomas.

                    But from a poor outcome perspective I agree inpatient likely has the higher risk.

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                    • #11




                      I absolutely hate knowing when my patients are co-workers, VIPs at the hospital or people’s family members before I give them anesthesia.  I’m usually oblivious to who the C-suite people in my hospital are, so until a nurse says something they get treated the same as everyone else, which I prefer.  I actually agree with FLP in that I have witnessed colleagues deviate from their normal plans to accommodate a VIP.
                      Click to expand...


                      Rumor has it... at the hospital my wife trained at VIPs were given a prominently visible physical item that, unbeknownst to them, marked them as a VIP so doctors and nurses could tell quickly.

                      The wife was disappointed in this.

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                      • #12
                        @ OP - So what do you think about that Kaiser gold card?  Good/bad?   Stratification all starts somewhere.   That gold card (physician and family only) is very distinguishing; and all the front desk know it.

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                        • #13





                          These are also the patients who only want their operations done by the department head, who doesn’t carry a lot of volume and spends their time on research and raising funds… 
                          Click to expand…


                          When I was a resident a VIP asked the attending to do the Circ for his son rather then us lowly residents.  My attending talked him out of it saying that I had done 100 in the last 12 months and he has done 3.


                          I suspect it much more of a thing with regards to inpatient care rather than outpatient care. 
                          Click to expand…


                          I see a lot of unnecessary testing in the outpatient world.  Leading to costly workups for incidentalomas.

                          But from a poor outcome perspective I agree inpatient likely has the higher risk.
                          Click to expand...


                          This brought a smile.  We were blessed with 4 uncomplicated spontaneous vaginal deliveries.  The only one with a shred of difficulty was with the first when the Chair of my department insisted on delivering, out of a sense of responsibility only I think - I certainly knew that he was somewhat out of practice (having been a resident under him). The next one was delivered by the PGY2 and the final two by med students. The med students were excited having delivered the babies of two staff physicians!

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                          • #14




                            @ OP – So what do you think about that Kaiser gold card?  Good/bad?   Stratification all starts somewhere.   That gold card (physician and family only) is very distinguishing; and all the front desk know it.
                            Click to expand...


                            Whaaaaaat?!

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                            • #15
                              I’ve seen plenty of bad medicine when you treat colleagues off the books or without proper office visits (eg chat when on call etc).

                              I took over a number of concierge / executive medicine patients as they moved here or a doc left. Tons of worthless outpatient tests that lead to incidental findings and needless anxiety, workup, etc. saw an unnecessary head ct for a VIP in ER lead to a thyroid ultrasound a chest ct, a liver ct, and a kidney MRI, all bogus findings. I do have do some explaining about why my practice pattern is different. And I’m willing to bend a little (a CBC Thyroid or UA) but not annual stress test or other foolishness.

                              Doing more is not doing better.

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