How Do You Treat VIP Patients?

Robert M. Centor, MD; Nicholas Genes MD, PhD; Theresa Polick, RN; Graham A. Walker


July 17, 2007

In This Article

Nicholas Genes, MD, PhD: All Kinds of Very Important Persons Seen in the Emergency Department

I doubt that many of us chose medicine with a goal of providing anything less than egalitarian care -- and treating the same complaints with different care is a bothersome concept, to say the least.

Since I work in an emergency department (ED), though, I can safely say that the most important person is the sickest one; they will always get preferential treatment. Beyond that, we do give special considerations to certain individuals, although the specifics might vary from hospital to hospital about which individuals and which special considerations would be involved.

At the private academic centers where I've worked, a VIP could be anyone from a hospital board member to a world leader to a movie star. The ED attendings are always the first to be notified that such a patient has arrived, and the patient's degree of celebrity is inversely proportional to the chance that a resident will be tapped to collect the history and physical.

Still, I have been involved in a few such cases, and I've been pleased to see that the level of medical care provided was no different from that given to any other patient. No one is subjected to unnecessary tests, and no one is prescribed special medications that aren't indicated. Why not? Because more medicine is not good medicine. And, believe it or not, the "routine" level of care in the ED - the speed, the testing, the treatment -- is pretty thorough, and we do a good job of weeding out true emergencies from more benign presentations. When staff members are asked to deviate from that routine by cutting corners or by trying to rule out esoteric disorders, complications can arise.

However, celebrity VIPs do receive a little more bedside time with an attending. They might get moved to a quieter part of the ED. They might get wheeled to the computed tomography scanner by a doctor or nurse, instead of waiting for the hospital transporter. I usually try to take care of little things for all patients, like giving them a cup of water or a fluffy pillow, but for the celebrity VIP, I'll go even farther, making sure there's nothing they can complain about.

Because that's what is ultimately driving special care of VIPs. We don't think their lives count for more, but we worry that their opinions do. Taking a few small steps to make sure that a VIP's needs are met while they're in the ED is a small price to pay, to stave off a complaint or to earn good publicity.

To be sure, there are certain VIPs who do receive extra medical care, but it's only because they deserve it. Academic hospital EDs are often populated with "medical VIPs," such as the patient with multiple organ transplants, or one who has a rare, chronic disorder. These patients often are well known by the staff because of their frequent visits, and their presentation almost always warrants a prompt admission. Sometimes, other patients get jealous: "Why have a dozen specialists come to see that guy?" "Why was he admitted so quickly -- I thought he only had a cough?" I can never seem to console these patients enough, even though they're much better off with their routine, generic health problem.

When I work at public hospitals, I see a different kind of VIPs. Here, it's the police officer, or firefighter, or paramedic who got hurt on the job who gets the special attention, the stretcher in the quieter area, the extra visitors at the bedside. This might not seem fair to other patients, but it serves a purpose by bolstering relations between the hospital and vital community agencies. And sometimes, treating these patients promptly can aid in an investigation.

Finally, I must confess, there is one kind of patient for whom I do expedite my evaluation, testing, and treatment. This kind of VIP is someone I don't want sitting around for hours without being seen, the kind of patient who always needs a thorough laboratory and radiological workup. I'm referring, of course, to my fellow healthcare professionals.

If I have two 40-year-old patients waiting to be evaluated for chest pain, with no other risk factors or medical history, and one of those patients is a physician, there's no question who I'll see first. But it's not that I think doctors or nurses are more worthy; it's that no one is better at judging their own symptoms and determining whether they are really sick.


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