Pitfalls of VIP Syndrome

Slate has an article today by two doctors discussing VIP syndrome in health care and how it can lead to worse care for the rich and powerful, such as Sen. Ted Kennedy, who following a diagnosis of cancer convened his own tumor board.

The authors lay out the pitfalls of VIP syndrome here:

VIP syndrome affects not only treatment but also testing decisions. If
Joe the Plumber requests a CT scan he doesn’t need, doctors simply say,
"No, Mr. Plumber." But Joe Biden can get any CT he wants. Some health
care programs
for corporate executives even involve routine full-body CT scans as
screening tests as part of the "chairman’s physical." The problem is
that these expensive and detailed tests may actually increase the risk
of cancer from radiation exposure
and have never really been shown to improve anyone’s health. And if
there is an incidental finding, as there often is, more tests might be
ordered, which may lead to unnecessary biopsies. And doctors perform
heroic procedures on VIPs not just when there is clear benefit but when there is any question of benefit.

Bob Wachter wrote a few months ago about VIP Syndrome, noting there is a sizable medical literature documenting this shift in practice for the rich and powerful.

Wachter writes, "Every hospital I know keeps some sort of a VIP list, a tripwire to
alert the organization of the arrival of a dignitary or billionaire.
Even when there isn’t a formal list, you can be sure that a single call
to the CEO’s office is more than enough to lift the velvet rope. That’s
a simple fact of life, and to me, not worthy of a big fuss. Unless,
of course, they’re getting better care than Joe and Jane Average. But
are they? Believe it or not, I really doubt it."

Something interesting that both articles point out is that the top researcher or surgeon often directs the care or operates on the VIPs. Often, these top doctors haven’t been in the OR for a long time.

2 replies »

  1. Once during a hospitalization, I had my family bring a fleece blanket from home. It was red. A nurse saw the blanket, and asked, “Are you a VIP?” It turns out that VIPs get very similar red blankets at this hospital, so everybody knows they’re a VIP. Of course, I kept the blanket on my bed for the duration. I don’t know that I received better care in quantifiable terms, but I do think the staff were a lot more responsive to my requests.

  2. You should include “doctors” to your VIP syndrome list. Yes, doctors. They want to be treated above and beyond the call of duty when it comes to them. They want the special testing or procedures done because they know it is more accurate and reliable than the so-called “standard of care” but private payors refuse to cuff up the bucks to pay for them. I do not fault doctors wanting better care for themselves, I fault the system for not allowing John Q. or Mary Public those services.