It’s wrong to treat VIPs better than other patients
It’s wrong to treat VIPs better than other patients
By Douglas S. Diekema, MD, MPH
Associate Professor of Pediatrics and Medical History and Ethics
University of Washington School of Medicine
Attending Physician, Emergency Services
Children’s Hospital and Regional Medical Center
Seattle
Many VIPs expect to be treated differently. That expectation is not restricted to restaurant reservations and first-class air travel. A VIP requiring a visit to the ED also will often expect special treatment upon arrival. Treating VIPs differently, however, might not always be the best medical or ethical course of action.
Although a VIP coming to an ED might think that special treatment will mean better medical care, that’s not always the case. For example, if the chief of staff comes into the ED with abdominal pain, there might be a tendency not to subject him or her to a rectal exam. Assuming that a rectal exam is needed, you are depriving that person of the best possible care. One study has shown that the spouses of physicians are less likely to get pelvic exams than other patients would be. When you break out of protocols to try to deliver "better" care, there’s always the risk that, in reality, you deliver inferior care.
All patients need confidentiality
Many ED physicians would prefer not to know if they were treating a celebrity. We find ourselves second-guessing what we’re doing for a given chief complaint by asking, "Is this really necessary?" Sometimes those questions can be good, but not if the answer is different when the patient is a celebrity. Most of us deliver our best care when we’re not trying to practice differently simply because someone is a VIP.
There still might be some things we ought to do differently for celebrities in order to provide them with the same protections we would provide to all patients. All patients can expect confidentiality regarding their ED visit, and a celebrity is no different. You can make a good argument that easily recognizable celebrities shouldn’t be made to sit in the waiting room where others will notice them. Rather, they might be offered a more private location where they could wait their turn. It is important to recognize that the justification is to provide them with confidentiality similar to that of others, not to provide them with preferential care.
Special care given to celebrities can fall into two categories: It might mean trying to deliver a different level of medical care, or it might mean providing the celebrity with amenities that other patients don’t get. For example, celebrities might be seen in the ED immediately regardless of their triage level, or a nurse might be assigned to pay constant attention to a celebrity rather than seeing two or three other patients. In a teaching hospital, the celebrity is likely to see only the attending physician or a consultant, while everyone else gets evaluated by a house officer.
Consider ethical implications
This leads us to the question: Is it ethically appropriate for some patients to be treated differently with regard to emergency care? It’s difficult to mount an ethical argument for giving better care based on celebrity status.
Emergency medicine traditionally has used the triage system to determine which patients will be seen first. Triage emphasizes medical need as the criterion by which we distribute the fastest medical care. When you change the system by taking a celebrity out of order or by focusing the attention of the attending physician on the celebrity and away from the other patients, there is no question that you are being unfair to others. Other patients are getting less attention and waiting longer because the VIP has been treated preferentially.
Money and potential donations are the driving forces behind the desire of many institutional administrators to provide celebrities with a good experience during their hospital visit. It’s not unusual for an ED manager to get a phone call from the CEO of the hospital saying a local celebrity or a board member is coming to the ED. Institutions feel they have an interest in providing special care to such people because they hold the power to help financially and will be more disposed to giving a donation if they have a good experience.
Management might say all patients will benefit in the future if a celebrity makes a donation. I would counter that argument by saying that in reality, most patients would benefit more if the celebrity had the same kind of experience provided to all patients. If you want to improve the system for everybody, then those who wield the most power should be subjected to the same system. If a three-hour wait is considered tolerable for other patients with a nonemergent problem, it ought to be as tolerable for a VIP as well. If the VIP complains about the wait, administrators are much more likely to change the system than if John Doe has made the same complaint. If financial donors have an optimal experience that no one else has, management might overlook problems of overcrowding and understaffing.
There also might be some risk management issues related to a VIP in the ED. If a patient had a bad outcome as the result of a longer wait or received less attention because there was a celebrity in the ED attracting all the resources, you would have a potential risk management problem.
Our society tends to feel egalitarian about medical care. There is no question that in the minds of most people, emergency care is not something that should be distributed based upon social status. Imagine a case in which a patient was harmed because he or she wasn’t seen quickly enough because a celebrity was in the ED. The jury almost certainly would sympathize with the harmed patient. Such a case would also present a public relations nightmare.
Celebrity status might warrant a special parking place or reservation in a restaurant, but it shouldn’t be relevant to emergency care.
[Contact Diekema at Children’s Hospital and Regional Medical Center, Emergency Services, CH-04, P.O. Box 5371, 4800 Sand Point Way N.E., Seattle, WA 98105-0371. Telephone: (206) 526-2599. Fax: (206) 729-3070. E-mail: [email protected].]
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.