Caring for ‘Very Important Patients’—Ethical Dilemmas and Suggestions for Practical Management

Alfandre, David; Clever, Sarah L.; Farber, Neil J.; Hughes, Mark; Redstone, Paul; Lehmann, Lisa Soleymani

doi:10.1016/j.amjmed.2015.09.019

Cited by 23 publications

(44 citation statements)

References 16 publications

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“…3,5 We found that more than one-third of physicians who reported the presence of VIP services at their hospital also reported receiving pressure from hospital representatives to provide care to VIP patients that was not medically indicated. These findings highlight an example of the tension faced by physicians who are caught between patient requests and the delivery of value-based care.…”

Section: Discussionmentioning

confidence: 88%

“…Recent publications in the medical literature and lay press have stirred controversy regarding the use of inpatient 'very important person' (VIP) services. [1][2][3] The term "VIP services" often refers to select conveniences offered in addition to the assumed basic level of care and services provided by a hospital. Examples include additional space, enhanced facilities, specific comforts, or personal support.…”

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confidence: 99%

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Perceived Safety and Value of Inpatient “Very Important Person” Services

Allen‐Dicker

Auerbach

Herzig

2017

Journal of Hospital Medicine

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Providing care to "very important person" (VIP) patients can pose unique moral and value-based challenges for providers. No studies have examined VIP services in the inpatient setting. Through a multi-institutional survey of hospitalists, we assessed physician viewpoints and behavior surrounding the care of VIP patients. A significant proportion of respondents reported feeling pressured by patients, family members, and hospital representatives to provide unnecessary care to VIP patients. Based on self-reported perceptions, as well as case-based questions, we also found that the VIP status of a patient may impact physician clinical decision-making related to unnecessary medical care. Additional studies to quantify the use of VIP services and its effect on cost, resource availability, and patient-specific outcomes are needed. Recent publications in the medical literature and lay press have stirred controversy regarding the use of inpatient 'very important person' (VIP) services.1-3 The term "VIP services" often refers to select conveniences offered in addition to the assumed basic level of care and services provided by a hospital. Examples include additional space, enhanced facilities, specific comforts, or personal support. In some instances, these amenities may only be provided to patients who have close financial, social, or professional relationships with the hospital.How VIP patients interact with their health system to obtain VIP services has raised unique concerns. Some have speculated that the presence of a VIP patient may be disruptive to the care of non-VIP patients, while others have cautioned physicians about potential dangers to the VIP patients themselves.4-6 Despite much being written on the topics of VIP patients and services in both the lay and academic press, our literature review identified only 1 study on the topic, which cataloged the preferential treatment of VIP patients in the emergency department. 6 We are unaware of any investigations of VIP-service use in the inpatient setting. Through a multisite survey of hospital medicine physicians, we assessed physician viewpoints and behavior regarding VIP services. METHODSThe Hospital Medicine Reengineering Network (HOMERuN) is a nation-wide learning organization focused on measuring and improving the outcomes of hospitalized patients. 7 We surveyed hospitalists from 8 HOMERuN hospitals (Appendix 1). The survey instrument contained 4 sections: nonidentifying respondent demographics, local use of VIP services, reported physician perceptions of VIP services, and case-based assessments (Appendix 2). Survey questions and individual cases were developed by study authors and based on real scenarios and concerns provided by front-line clinical providers. Content, length, and reliability of physician understanding were assessed by a 5-person focus group consisting of physicians not included in the survey population.Subjects were identified via administrative rosters from each HOMERuN site. Surveys were administered via SurveyMonkey, and results were analy...

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Section: Discussionmentioning

confidence: 88%

mentioning

confidence: 99%

Perceived Safety and Value of Inpatient “Very Important Person” Services

Allen‐Dicker

Auerbach

Herzig

2017

Journal of Hospital Medicine

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“…A very influential patient (VIP) is a patient or family member whose ‘individual attributes and characteristics, coupled with their behavior, have the potential to significantly influence a clinician's judgment or behavior’ . This incorporates the patient or family member expectation of qualitatively different care, as well as the practitioner altering care based on the patient's entitlement.…”

Section: Example Scenario and Guidancementioning

confidence: 99%

“…A very infl uential patient (VIP) is a patient or family member whose 'individual attributes and characteristics, coupled with their behavior, have the potential to signifi cantly infl uence a clinician ' s judgment or behavior' . 4 This incorporates the patient or family member expectation of qualitatively different care, as well as the practitioner altering care based on the patient ' s entitlement. The pressure to alter care may come from those with a supervisory role who wish to garner favour from the VIP and may, intentionally or unintentionally, apply inappropriate expectations to the provision of care.…”

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confidence: 99%

Maintaining quality of care for very influential patients

2017

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“…Dignitaries have a unique set of healthcare needs [1], different than the general public, including the need for preventive and protective medical care, 24-h high-quality personalized healthcare, and an even greater degree of privacy than ordinary citizens. The power, prestige, and station that a dignitary has may result in providers being awestruck and providing dignitaries with sub-optimal care [2][3][4]. In addition, dignitaries are commonly surrounded by an inner circle of important family members and advisors who can hinder the doctor-patient relationship [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

A dignitary medicine curriculum developed using a modified Delphi methodology

Mulhim

Darling²,

Sarin

et al. 2020

Int J Emerg Med

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Background: Dignitary medicine is an emerging field of training that involves the specialized care of diplomats, heads of state, and other high-ranking officials. In an effort to provide guidance on training in this nascent field, we convened a panel of experts in dignitary medicine and using the Delphi methodology, created a consensus curriculum for training in dignitary medicine. Methods: A three-round Delphi consensus process was performed with 42 experts in the field of dignitary medicine. Predetermined scores were required for an aspect of the curriculum to advance to the next round. The scores on the final round were used to determine the components of the curriculum. Scores below the threshold to advance were dropped in the subsequent round. Results: Our panel had a high degree of agreement on the required skills needed to practice dignitary medicine, with active practice in a provider's baseline specialty, current board certification, and skills in emergency care and resuscitation being the highest rated skills dignitary medicine physicians need. Skills related to vascular and emergency ultrasound and quality improvement were rated the lowest in the Delphi analysis. No skills were dropped from consideration. Conclusions: The results of our work can form the basis of formal fellowship training, continuing medical education, and publications in the field of dignitary medicine. It is clear that active medical practice and knowledge of resuscitation and emergency care are critical skills in this field, making emergency medicine physicians well suited to practicing dignitary medicine.

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Caring for ‘Very Important Patients’—Ethical Dilemmas and Suggestions for Practical Management

Cited by 23 publications

References 16 publications

Perceived Safety and Value of Inpatient “Very Important Person” Services

Perceived Safety and Value of Inpatient “Very Important Person” Services

Maintaining quality of care for very influential patients

A dignitary medicine curriculum developed using a modified Delphi methodology

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