V.I.P. Syndrome Can Lead to Bad Care

A section of the tabloid, US Magazine, called “Stars – They’re Just Like Us”, shows pictures of celebrities doing mundane activities like walking the dog or taking out the garbage. This helps to remind us that, just like the average Joe, they walk their dogs and take out the garbage and— because they are people, too—might even need medical treatment from time to time. Unfortunately, some doctors treating celebrity patients don’t see them “just like us.”

V.I.P. Syndrome in medicine has been defined as when influential or famous people receive special treatment. Special treatment may include access to appointments and treatment without waiting, the bending of rules and regulations and anything else to acquiesce to the request of an influential person. Being star-struck or wanting to have a positive interaction with an influential person is understandable, but physicians must be able to set aside these feelings in order to provide the best possible care and maintain their professionalism. I think Dr. Walter Weintraub said it best in his 1964 article in The Journal of Nervous Mental Disease: “The treatment of an influential man can be extremely dangerous for both patient and doctor.” Quite so. Physicians “afflicted” by V.I.P Syndrome violate two of the principles of the Physician Charter:

• Social justice – Providing patients with special treatment based on their status does nothing to eliminate discrimination or to promote just distribution of resources.
• Primacy of the patient – Additionally, a physician may want to believe he or she is putting the patient first by acquiescing to special requests; however, by disregarding rules, regulations and guidelines, he or she may actually be putting the patient at risk.

A recent high-profile case has shone a spotlight on such egregious and risky behavior, and unfortunately, its consequences. The medical examiner’s report on Joan Rivers’ death was recently released and states she died from therapeutic complications which caused a lack of oxygen that resulted in brain damage. Additionally, a report released by the New York Department of Health cited Yorkville Endoscopy center (where she received treatment) for several deficiencies, including:

• not recording the accurate dose of Propofol;
• failing to recognize Ms. Rivers’ deteriorating vital signs;
• failing to provide intervention in a timely manner;
• allowing a non-staff member to perform a procedure; and
• allowing a staff member to take pictures while Ms. Rivers was under sedation.

Several physicians have lost their jobs with Yorkville over these allegations and the reputation of the Yorkville Endoscopy Center has been damaged beyond repair. One wonders if the physicians and staff there provided a different than usual care to Ms. Rivers. It is doubtful that Yorkville would have allowed an average patient’s physician to come in and take part in a procedure when they do not have privileges at the medical center. Given that this special treatment may involve going against guidelines or bending rules, it is not surprising that this special treatment does not always result in better care.

V.I.P. Syndrome is a threat to patient safety and medical professionalism. One would like to believe that all patients are treated equally and fairly, but this is not the case. As long as V.I.P. Syndrome exists, care will never be equal for the influential and the non-influential. This gap violates the principle of social justice and can put patients in danger.

Physicians need to ensure all patients—celebrity or not—are treated equally with care and respect. Organization and system-level policies need to support physicians when they are confronted by demands for care that wouldn’t normally be afforded to regular patients (e.g., Cleveland Clinic’s nine principles for caring for VIPs). Perhaps the best way to avoid V.I.P. Syndrome is to remember that a V.I.P. patient is first and foremost a patient and like all other patients deserves the best and appropriate care.

Alison Brecher
ABIM Foundation