Financial Times Weekend Magazine | July 22, 2011

By Kiran Gupta

VIP or not, it is the doctor’s job to treat their patients with respect, not to cater to their whims and fancies

It was near the end of intern year that I had my first close encounter with a “VIP” – a very important patient. In the same way elite hotels and restaurants cater to celebrities with roped-off sections and private tables, many US hospitals will set floors or rooms aside for the rich and famous.

Caring for the VIP presents a dilemma for the physician. We are bound by a moral code to treat all patients equally, whether they are a homeless drug addict or a king. Yet, when a VIP patient is hospitalised, the daily workflow is disrupted, every type of specialist is brought in, and a multitude of tests and procedures are considered. Security guards police the patient’s room, while junior doctors are sometimes forbidden to interact with the patient unless the VIP’s entourage parts the seas.

VIP patients do face legitimate concerns when it comes to privacy and safety. It is as important to protect their health information as that of any other patient and, in some cases, they do need extra security. But creating a “VIP aura” around a patient can lead to misuse of resources and less effective care. Doctors often tiptoe around them, couching bad news in softer terms and putting off unpleasant tests for fear of causing discomfort.

Michael Jackson’s death put the VIP patient-doctor relationship in the spotlight. His personal physician stands accused by prosecutors of providing Jackson with a lethal dose of the sedating drug propofol in his home. In my opinion, most doctors would not have provided such a medication to a “non-VIP” patient at home. But because Jackson had fame and money, it appears he was able to retain a doctor privately and commission him to do things which many physicians would consider at odds with acceptable medical practice.

Unfortunately, as this famous episode seems to show, doctors are not immune to the lures of money and celebrity. They can be blinded by a patient’s reputation and provide a different type of care. Ironically, such care often falls far short of that provided to “normal” patients.

A colleague once recounted his experience with a terminally ill VIP patient in the hospital where he works. Not one of the doctors on the case told the VIP’s family that death was likely, and that no level of aggressive care would prevent it. If this patient had been anyone else, caregivers would most likely have advised the family to pursue medical care directed only at the patient’s comfort. But no one in that mix wanted to tell these relatives the obvious truth.

The presence of a VIP on my own service proved very frustrating. We had to devote three to four hours each day to meeting relatives and hospital higher-ups. On ward rounds, the VIP’s relatives would hover over us with the subtle implication that we should go to the VIP before anyone else.

For the average patient, the hospital is an uncomfortable place. In order to provide good medical care, we doctors poke, prod and stick our patients, waking them up at all hours. The hospital is not a luxury retreat: it is our job to treat our patients with respect, not to cater to their whims and fancies.

The VIP on our service remained in hospital for a long time. Eventually, after another lengthy meeting with hospital heads, it was decided that the VIP could finally go home. After a flurry of activity, the entourage was gone. As I watched the patient roll down the hall on a stretcher, I felt relieved and sad. Relieved that we would no longer have to deal with the pomp and circumstance, but saddened by the fact that the very status of celebrity in this country can mean you receive inadequate care.

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