Wednesday, September 23, 2015

The VIP syndrome in medical practice

The V.I.P. Syndrome in medicine occurs when influential or powerful people receive special treatment, such as hospital rules and regulations being bent to keep them happy. Not only do VIPs demand and expect deferential treatment, most of us have been conditioned to provide them with this and doctors are quite happy to toe the line.  Touting the fact that you are treating a VIP can be a major ego boost for doctors, and some will "leak" this to the media as a publicity stunt in order to attract more patients. Doctors compete for the attention of VIPs, and many play a game of one-upmanship when a VIP is hospitalised, because they want to show that they were selected as his doctor of choice. Many bend over backwards in order to keep the VIP happy for their personal selfish reasons ( for example, because they want a promotion).  Others do it out of fear, because they don't want to be punished for failing to satisfy the VIP's whims.

VIPs include:  politicians in power ; the uber-rich , who are used to buying privileges; and celebrities. Interestingly, senior doctors can also suffer from the VIP syndrome when they fall ill,  because their colleagues and juniors treat them with respect and kid-gloves.

Not all doctors like treating VIPs, and some even resent them. They are often “difficult” patients , and it can be humiliating when such a patient ( who thinks of himself as being a "big shot") treats a health care provider with contempt.  Taking care of VIPs is not a bed of roses, and being subservient is not good for the doctor's self-respect. 

Ironically, the VIP syndrome can be bad for VIPs as well ! Too many cooks spoil the broth, and the quality of medical care for these VIPs often suffers because there are too many consultants jockeying for control.  Also , these medical decisions are subjected to the harsh glare of publicity, which is why the doctor overthinks them, and often ends up overtesting and overtreating the VIP to protect himself.  A major risk is that if the VIP dies, the doctor's reputation takes a beating , and angry mobs have been known to beat up doctors and even burn hospitals down.

Dr. Walter Weintraub warned doctors way back in 1964: “The treatment of an influential man can be extremely dangerous for both patient and doctor.” Physicians “afflicted” by V.I.P Syndrome violate the basic principles of social justice and equity , which are the bedrocks of medical professionalism. For example, some doctors allow an influential politician's relative to jump the queue and go to the head of the waiting list for kidney donation . When these facts come to light, this causes heartburn and resentment amongst other patients.  Lots of doctors cave in to political pressure, and these bad apples corrupt the system. This is unethical and unfair, because patients should be triaged and treated according to their medical problem, not their social status.  The VIP syndrome is not restricted to India, but is much more prevalent here, because politicians are used to getting their own way!

The truth is that most VIPs want to be treated as regular patients because they know that being star-struck can impede the doctor's medical judgment.   They actually admire the rare doctor who has a backbone and treats them the way he treats all his other patients, because they are smart enough to respect professionalism when they encounter this. Drs Mariano and McLeod offered three directives for caring for VIPs:
•    Vow to value your medical skills and judgment
•    Intend to command the medical aspects of the situation
•    Practice medicine the same way for all your patients.

Many wise doctors go out of their way to treat their poor patients as VIPs .  While they may not be able to grant you favours, they can shower you with their blessings - something which mature doctors value because they focus on the emotional income which medical practise provides them. This is why doctors continue to admire heroes like Albert Schweitzer , who treated all his patients as VIPs .

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