VIP patients should be treated differently

By Larry Mellick, MD, FACEP

Chair and Professor, Department of Emergency Medicine

Section Chief, Pediatric Emergency Medicine

Medical College of Georgia, Augusta

Consulting Editor, ED Management

We in emergency medicine have become experts at managing unique sets of patients with special needs. It is my opinion that VIPs and celebrities comprise just another set of those patients with special needs. Organizational rank, positions of authority, and celebrity status bring with them certain risks and social and cultural demands. It is impossible to deny the fact that VIPs have special needs.

In fact, dangers exist in not carefully managing the emergency medical care of VIPs or celebrities. Besides the obvious dangers and risks that presidents and other national leaders may experience, there are issues of privacy, comfort, and confidentiality that must not be ignored. It is common sense to protect a celebrity from exposure to the paparazzi or news media, autograph seekers, and the curious. By treating them differently, we care for them as valued patients with special needs.

Recently, when there was some disagreement on this issue in my own department, we asked a discerning question. "What if Tiger Woods presented to our ED with a medical condition during the week of The Master’s golf tournament? Would his presence in our waiting room put him at any special risks? By not treating Mr. Woods differently, would there be disruptions to the care of others?" The answer was obvious.

What if the patient is the CEO of your hospital? Is it practical to not act or respond differently to such patients? We can’t deny the fact that the unique needs of these patients require us to treat them differently.

Everyone would agree that the president, a senator or congressman, the city mayor, local professional sports team members, or your hospital CEO could be considered VIPs at some level. Do your family members qualify as VIPs? Perspectives seem to transition when opponents to special treatment for VIPs are given specific examples. One young physician opposed to a policy for VIP patients stated, "To the waiting room with them all." However, when asked how he would like to have his wife treated, his perspective faltered.

Why do we resist? Let’s admit it. The reasons some of us resist treating celebrities or VIPs differently are based more on our disdain for the social elite than on altruistic feelings for the common folk, the poor, and socially disenfranchised. Or perhaps, we harbor vestiges of an "anti-establishment" outlook left over from an era past. Others might think this is an ethical issue based on Judeo-Christian tenets that discourage treating the privileged differently. Here are my suggestions:

o Show deference, but don’t practice bad medicine. What’s wrong with showing a degree of honor and deference to those who have been vested with positions of honor? Isn’t this part of social structure that gives some degree of community cohesion and order? On the other hand, we cannot compromise the medical care of the celebrity or other patients in the process of showing special respect to the VIP or while meeting their unique needs.

o Shouldn’t everyone be a VIP? Let’s consider the possibility that if we aren’t treating everyone like a VIP, then our system might need some operational improvements. The very fact that we have to treat patients differently should be a bellwether that our service needs to be overhauled. Why not move all of our patients immediately out of the waiting area and into a treatment room using bedside registration? Why isn’t timely turnaround of laboratory and radiology tests and patient throughput a priority for everyone? Are confidentiality and patient safety aggressively safeguarded for all of our patients?

"To the waiting room with them all" is not the correct attitude and is unfair to all of our patients, VIP or not. Let’s treat everyone just as we would like to be treated. There has to be a happy medium. Of course, we can’t compromise medical care of other patients in the ED during the process of caring for a celebrity. However, the confidentiality, safety, and comfort of the celebrity should not be placed at risk, either. Policies for the management of VIPs must be developed. (See policy, p. 91.)

Like it or not, the potential for disruption will always be present when a VIP presents for medical care in your ED. It is our responsibility to have an adequate plan for meeting the needs of the celebrity patient as well as the needs of our other patients.

[Contact Mellick at the Department of Emergency Medicine, Medical College of Georgia, 1120 15th St., Augusta, GA 30912. Telephone: (706) 721-1083. Fax: (706) 721-7718. E-mail: LMellick@mayo.mcg.edu.]