Have you ever been given a patient assignment and hear the words "You have a VIP"? I cringe when I am assigned the Very Important Patient (VIP)- a.k.a. Very Influential and Very Intimidating Patient. My resentment begins to bubble over and I find it offensive that I am expected to treat one patient "better" than another. I also resent the additional pressure from my supervisor, administration and the VIP. I have never cared for a famous celebrity, but I have witnessed the effects of VIP syndrome when caring for local politicians, CEOs, influential and local celebrities. Although nurses do care for high profile celebrities, this article will focus on the more frequently occurring local VIPs.
What makes an individual a VIP? Any patient whose status has the potential to influence the judgment and care of healthcare providers is a VIP patient. The first VIP image to pop into my mind is the national celebrity. However, this article will focus more on VIP status due to occupation, position or social status. Common VIPs may include hospital administrators, physicians, local athletes and any patient with influence. The ethical and moral issues surrounding the care of a VIP is often referred to as "VIP Syndrome" and results in care that can be of greater or lesser quality. Let's take a closer look at common ethical issues that surface when treating a VIP.
The principle of social justice implies patients will be treated fairly and with equal distribution of access to care and resources. Providing preferential treatment is often a difficult, if not impossible, pill for a nurse to swallow. V.I.P. treatment deviates from the nursing code of ethics of approaching all patients with the same level of attention and care regardless of social status. VIP Syndrome challenges the principle of social justice by resulting in greater access, attention and resources from healthcare providers, including nurses. Examples include:
Schedules adjusted to accommodate physician appointments, consults, diagnostics and treatment
Decreased waiting times (MD office, emergency department, hospital call light)
Access to additional resources (diagnostics, specialists, equipment, transportation)
When providing VIP treatment, the healthcare team often steers away from standard practices, protocols, policies and procedures. Therefore, care surrounding the VIP often becomes chaotic and pulls resources away from other patients.
Autonomy is the right patients have to make informed decisions about their medical care independently without the healthcare provider attempting to influence their decisions. Therefore, patients have the right to receive clear information and education regarding care so that an informed decision can be made. Let's look at a case study:
Mr. Jones is a well-known local meteorologist on a popular morning news program. Mr. Jones fell at home and presents to the emergency department with a broken femur. The triage nurse notes a strong odor of alcohol from the patient. The nurse does not want to embarrass Mr. Jones, therefore, does not complete a thorough history or physical. The physician, not wanting to upset the patient, does not determine if alcohol was a contributing factor in the fall. The patient is impatient and to avoid inconvenience, minimal lab work is ordered.
In this scenario, only a limited patient history and assessment is performed to avoid inconveniencing the patient. The VIP will be asked to make decision regarding treatment, but does not have the benefit of a thorough assessment. The patient's drinking habits are not explored,therefore, the patient will not have the opportunity to make decisions on participating in an alcohol protocol.
Healthcare providers often deviate from standard practices and protocols. Breaking rules when treating VIPs occurs when staff do not want to inconvenience, cause anxiety or tell the patient (or family) "no". This deviation places the VIP at risk for lower care quality and substandard outcomes (Alfandre, 2017)
Privacy often becomes an issue for VIP patients. In my career, I have been tempted to share details a VIP's situation and had to make a conscience effort to maintain confidentiality. Staff may bend rules safeguarding privacy and share details of the VIPs situation to other staff or individuals outside of the hospital. To protect privacy, high profile patients may be moved to a more secure area of the hospital.
Tips for Care of the VIP
In 2011, The Cleveland Clinic published "Caring for VIPs: Nine Principles" to address the challenges of VIPs. Although the principles are geared towards physicians, the article provides several "takeaways" for nurses.
Do not bend rules. Provide care with effective clinical judgement and practices congruent with standards of practice and the institution's policies and procedures.
Work as an interdisciplinary team and communicate frequently.
Avoid assigning only certain nurses to care for the VIP. This will help to maintain the usual flow of care.
Always protect the patient's confidentiality and follow your institutions policies and procedures regarding communication with media.
Be careful about accepting or declining gifts. Speak with a supervisor if questions regarding gifts.
Caring for VIPs brings the potential of ethical dilemmas to healthcare providers. Being aware of common challenges will help to reduce pressure and frustration when assigned a VIP. What challenges have you personally experienced? What tips would you like to share with readers?
David Alfandre et at. Caring for "Very Important Patients" -Ethical Dilemmas and Suggestions for Practical Management. Am J Med. 2016:129:143-147.
Gusman et al. Caring for VIPs: Nine Principles. Cleve Clin J Med. 2011:78(2):90-94.
Davis, M. Do You Know Who I Am? Treating a VIP Patient. BMJ 2016:358:i2857.