How to avoid ‘VIP syndrome’
How to avoid VIP syndrome’
Are you suffering from "VIP syndrome"? Treating celebrities differently often results in worse care, warns Steven J. Davidson, MD, MBA, chair of the department of emergency medicine at Maimonides Medical Center in Brooklyn, NY.
"Physicians are human and are all too easily cowed by the trappings of celebrity," he says. "If you are distracted by these trappings and the VIP’s entourage, you may omit routine components of the evaluation."
Problems arise when you start making exceptions to the rules, argues Gregory L. Henry, MD, FACEP, vice president of risk management for Emergency Physicians Medical Group in Ann Arbor, MI.
"The first thing you should remember is you are dealing with a human being. If a rectal exam is good for anyone else, it’s smart for a former president," he says. "Don’t avoid doing things because these are somehow special people."
Celebrities do not deserve better care, but you may inadvertently provide worse care, says Stephen Colucciello, MD, FACEP, assistant chair and director of clinical services for the department of emergency medicine at Carolinas Medical Center in Charlotte, NC. "That’s because you aren’t doing what is tried and true, what you know to be good medicine," he says.
Here are some ways to avoid VIP syndrome:
• Follow routine procedures with the history and examination. Don’t cut corners by avoiding asking potentially embarrassing questions about alcohol and drugs or avoiding important tests such as rectal exams, says Colucciello. Don’t worry that you are going to offend VIPs by taking a thorough history, he advises. "Don’t skirt any of the tough questions. Don’t avoid the routine exams just because you want to avoid inconveniencing the patient."
• Have an ED physician treat the patient. The biggest mistake you can make with a VIP is to have the patient seen by someone other than an ED physician, says Norman J. Schneiderman, MD, FACEP, chief of staff for the emergency and trauma center at Miami Valley Hospital in Dayton, OH.
"If you call in the orthopedic chairman of the department, that individual may not have been seeing patients for a number of years," he emphasizes. "Therefore, he or she is not in tune with the common problems we see every day in the ED."
ED patients need a physician who is experienced and comfortable and knows the routine, explains Colucciello. "Calling upon an esteemed, white-haired celestial figure who is out of the tumble of day-to-day clinical practice is doing a disservice to the patient," he stresses.
That practice also might lead to a misdiagnosis, he warns. "Assuming the most obvious explanation is a diagnostic pitfall. The ED physician needs to at least consider the worst, and work down from there." ED physicians are trained to ask themselves, "In what way could this patient fool me and die?" he adds.
ED physicians also are generalists and consider the overall picture, notes Schneiderman. "An ED physician will look at an injury and ask, Why did this patient fall?’ It may be that the patient had an arrhythmia which caused the fall," he says.
When treating a VIP, it’s important that the ED physician be experienced, he recommends. "It’s not unusual, if I am working and a member of the board of trustees comes in, for the nurse to let me know so I can see [that patient] personally," he says. "[Such patients] are reassured because I am the chief of staff and know them personally." Other ED staff members still can be involved in the patient’s care, he explains.
With high patient volumes and overcrowding, the ED can’t possibly be at its best 100% of the time, but you should try to make sure your "best face" is seen when treating VIPs, urges Schneiderman.
• Don’t allow a celebrity’s entourage to interfere with care. Public relations people and aides who come in with celebrities interfere with medical care at times, says Colucciello. "A classic example of this is a football player who comes to the trauma center with the team doctor. That individual may start to give orders, when he really does not know how to manage multiple trauma," he notes.
You may need to instruct the entourage to step back and be quiet, or if need be, remove them, Colucciello says. "They need to be ignored by the medical staff," he urges. "You cannot have your best judgment corrupted by nonexperts or people who have their own agendas."
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