I just posted on my first experience as a migraineur. I was working in the hospital reading ECGs and called my favorite neurologist who saw me in the office later that day. Was I being treated as a VIP or as a friend/colleague and is there a difference between the two?
Don't the majority of doctors take advantage of their status/friendships/connections within the health care system they work to obtain such "VIP" treatment?
I know an acquaintance who doctor shops, gets so many opinions how would she know the best one (well the one she wants to hear must be the right opinion until tomorrow) and jumps the line. It drives me nuts. She can get an appointment for this week or next even though if I was to call the wait is 1 year from now for the "guru" of the next medical crisis. Then a lot of time she cancels or never goes back! All that time and effort to onboard her as a patient, do a new patient exam and she comes for one visit! Theny next worse pet peeve, as a PT, is people getting 2 or 3 opinions for orthopedic issues even though they won't want surgery. And Medicare pays for these 3 opinions, only to end up with PT which is what they were doing before even the first Ortho opinion. Talk about wasted healthcare dollars and time. No wonder when you break a wrist you can't get in for 10 days. They were busy seeing Mr. Johnson for his 3rd Ortho opinion for his shoulder pain!
I generally agree vip’s get poorer care. For a period of time I cared for many colleagues and their family. I would not allow a vip label. I made them a routine part of the practice flow. This is exactly why. They got my usual excellent care not something else.
I was fortunate in that most C suite people left me alone. But when a VIP wanted treatment under my program I refused - and went to the top with my reasoning despite the fact that the VIP was a huge donor to the system. But the problem was that - since the patient wasn’t anonymous - I had my other patients to look out for. Drug and alcohol treatment is a dirty, muddy part of the outfield. Fortunately I was able to relay this directly to the VIP and since this person knew me from another career it was a mutual decision to go elsewhere. Sadly a leech provider got ahold (a celebrity treatment provider) and the VIP tragically passed. So my long winded way to say THANK YOU FOR the courage and insight to write this. I’ll be leaving substack soon so this might be my last comment. Suffice to say Sensible Medicine kept me here longer than I thought I’d be here. Thank you so much for being you!
VIP care here means you get seen instantly in ED, without being ramped in an ambulance for hours or waiting however long your triage category requires... personally that's a good for the VIP. It also means your privacy is protected a little more, also to me a good. You'll get a single room even if not clinically required, a good. In psych, you won't have to do group therapy - personally I'd hate group therapy, so another win. Give me VIP status every time. Even as a medical student, we get privileges like all known medics... Like reduced ED waiting time. No gap fee treatment. This is absolutely a benefit. Something I deliberately seek out as a dirt poor student. And yes, I was very grateful for the ED that saw me immediately even though not clinically necessary. I'll take VIP treatment every time if I can get it.
When anyone sends a patient my way forewarning me they are a "VIP", or a patient introduces themselves with their "VIP" titles, I tell them I promise not to hold it against them.
Unfortunately, in the real world we can't have both the best care and equal care for everyone because of scarcity of resources. There's also the issue of who is paying. Adam's scenario of the homeless man and the woman whose name is on the hospital brings this into focus. She has health insurance for her care *and* she pays taxes that support medicaid. She also happens to have provided the capital for the hospital building the homeless man is receiving care in. She probably owns a BMW, but I don't think anyone would argue we should give the homeless man a car. If we did, would it be a BMW, or a Nissan Versa? There is no escaping two facts: healthcare comes in varying quality levels, and someone has to pay for it. Pushing for "equal care" without having complex conversations about the entire healthcare market will result in "bad quality care for everyone," even if conservative medicine (not VIP excess) is what we define as "good quality." [I think these complex conversations involve the opacity of insurance/hospital negotiations, insurance being tied to employment, medicare rate-setting, regulations that limit how many MDs can graduate and how many beds a hospital can add, the fact that pay-out-of-pocket options aren't standard, and on and on.]
Good comment, Elizabeth. I'm reminded of a comment and my reply regarding a Sensible Medicine article from Apr 17 2025: "Choosing the Diagnosis".
Sara Bajuyo wrote:
"As a former fee-for-service family doctor who escaped into the heavenly arms of direct primary care, I rejoiced at the seminal rite of passage: throwing billing and coding into the lake of fire where it belongs. No hand-wringing or gnashing of teeth over what flavor of former smoker to call my patient. I just document "former smoker- congratulated patient on his success" and move on with my day."
My reply:
"I'm a computer scientist, not a healthcare professional, but I am familiar with the expression "He who pays the piper calls the tune". The third party payer is stuck in the position of having to justify payments, and this inevitably means lots of bureaucracy and red tape for payers, providers, and patients. Congratulations on your escape from the system."
I am reminded of the time one of our staff physicians came into the ER with chest pain and the first words out of his mouth were "Treat me like just another patient." He was well aware of the possible problems often brought about by the need to "do something".
Happy to say that our primary concern with well known patients is privacy here in Alaska. Alaskans couldn’t care less about societal important people. It was interesting to read the cases regarding the adverse outcomes for VIPs. That was not something I had considered before.
As in cardiologist in the military, we would bring back every bypass patient at 90 days for a heart catheterization. We wanted to make sure the grafts were open. This was in the Stone Age 1984. Interestingly 15% of all graphs were closed. We had a four-star general, who simply came back, went to the ward. The Nurse's knew him so they gave him a bed. The interns came and did their usual physical. Yes we actually admitted people for our catheterizations as well .8 Fr catheters full heparin. I had fingers of Steel holding groins
Eventually, the C suite found out and went bonkers.
We were taught interestingly, that if a general gets bumped off you could survive that, but if you lost an airman not so much. The culture was really troop oriented.
When one of our presidents was hospitalized with a fib at Walter Reed- the doctors on TV from his team were discussing his treatment. Meanwhile, it was the cardiology fellow who wrote all the orders and made the decisions. It was pretty funny because everyone knew what was actually happening.
We were taught that when you deviate for VIPs, you could really harm them.
Finally, there's a very famous person in political circles . He had a cardiac surgery. The cardiologist went in to talk to him the phone rang, and the person asked to cardiologist to step out because the caller ID said PUTIN.
VIPs get creature comforts that's life . When world leaders call you after surgery you'll get VIP treatment too.
In the meantime, you'll get the same medical care because you don't want their care for sure..
I disagree, say a doctor who provides good care to many falls ill and needs intensive care, but there are too many patients. A person from skid-row does not deserve the same care as someone who works and PAYS for their healthcare, and also RETURNS A VALUE TO SOCIETY, they deserve and are entitled to healthcare. The bum is looking for charity, a handout, a freebee while being drag on society. If you are a bum you deserve bum treatment. No one should benefit from another man's labor.
An uncomfortable but real issue in medicine ... the creation of the “Very Important Patient” (VIP) whose status, wealth, or connections can subtly (or not so subtly) alter the way care is delivered. Thank you, Dr. Cifu, for putting this issue in clear terms. These are the conversations we need if we want to protect both patient care and the integrity of medicine.
Very good points! I emphasized to my residents that patients on the other end of the spectrum(hostile, argumentative, difficult family, non-compliant...) must be given the same, best care possible, as patients that we like.
Hate to one-up you here but the hospital I trained at learned this the hard way....
Royal family member needed a kidney. Hospital rolled out red carpet. Literally redecorating an entire wing .Chief of cardiology decided he should perform cardiac Cath. Perforation ensued. Patient was kept alive but would never recover Went ahead with transplant. The family of the now severely disabled VIP not only never made the large donation that was thought to be a "no brainer", but sued the hospital for millions..
I just posted on my first experience as a migraineur. I was working in the hospital reading ECGs and called my favorite neurologist who saw me in the office later that day. Was I being treated as a VIP or as a friend/colleague and is there a difference between the two?
Don't the majority of doctors take advantage of their status/friendships/connections within the health care system they work to obtain such "VIP" treatment?
Would you eradicate this behavior?
-ACP
In reality, it’s hard to treat all patients equally in healthcare that is after all still a business.
And on a lighter note, I often tell my patients they are VIPs in my practice. It’s a kind of gratitude they remember.
I know an acquaintance who doctor shops, gets so many opinions how would she know the best one (well the one she wants to hear must be the right opinion until tomorrow) and jumps the line. It drives me nuts. She can get an appointment for this week or next even though if I was to call the wait is 1 year from now for the "guru" of the next medical crisis. Then a lot of time she cancels or never goes back! All that time and effort to onboard her as a patient, do a new patient exam and she comes for one visit! Theny next worse pet peeve, as a PT, is people getting 2 or 3 opinions for orthopedic issues even though they won't want surgery. And Medicare pays for these 3 opinions, only to end up with PT which is what they were doing before even the first Ortho opinion. Talk about wasted healthcare dollars and time. No wonder when you break a wrist you can't get in for 10 days. They were busy seeing Mr. Johnson for his 3rd Ortho opinion for his shoulder pain!
The NYU Langone reference is snark or iykyk?
I generally agree vip’s get poorer care. For a period of time I cared for many colleagues and their family. I would not allow a vip label. I made them a routine part of the practice flow. This is exactly why. They got my usual excellent care not something else.
Follow the link. Adam
I was fortunate in that most C suite people left me alone. But when a VIP wanted treatment under my program I refused - and went to the top with my reasoning despite the fact that the VIP was a huge donor to the system. But the problem was that - since the patient wasn’t anonymous - I had my other patients to look out for. Drug and alcohol treatment is a dirty, muddy part of the outfield. Fortunately I was able to relay this directly to the VIP and since this person knew me from another career it was a mutual decision to go elsewhere. Sadly a leech provider got ahold (a celebrity treatment provider) and the VIP tragically passed. So my long winded way to say THANK YOU FOR the courage and insight to write this. I’ll be leaving substack soon so this might be my last comment. Suffice to say Sensible Medicine kept me here longer than I thought I’d be here. Thank you so much for being you!
Wait. You can’t go!
VIP care here means you get seen instantly in ED, without being ramped in an ambulance for hours or waiting however long your triage category requires... personally that's a good for the VIP. It also means your privacy is protected a little more, also to me a good. You'll get a single room even if not clinically required, a good. In psych, you won't have to do group therapy - personally I'd hate group therapy, so another win. Give me VIP status every time. Even as a medical student, we get privileges like all known medics... Like reduced ED waiting time. No gap fee treatment. This is absolutely a benefit. Something I deliberately seek out as a dirt poor student. And yes, I was very grateful for the ED that saw me immediately even though not clinically necessary. I'll take VIP treatment every time if I can get it.
When anyone sends a patient my way forewarning me they are a "VIP", or a patient introduces themselves with their "VIP" titles, I tell them I promise not to hold it against them.
Unfortunately, in the real world we can't have both the best care and equal care for everyone because of scarcity of resources. There's also the issue of who is paying. Adam's scenario of the homeless man and the woman whose name is on the hospital brings this into focus. She has health insurance for her care *and* she pays taxes that support medicaid. She also happens to have provided the capital for the hospital building the homeless man is receiving care in. She probably owns a BMW, but I don't think anyone would argue we should give the homeless man a car. If we did, would it be a BMW, or a Nissan Versa? There is no escaping two facts: healthcare comes in varying quality levels, and someone has to pay for it. Pushing for "equal care" without having complex conversations about the entire healthcare market will result in "bad quality care for everyone," even if conservative medicine (not VIP excess) is what we define as "good quality." [I think these complex conversations involve the opacity of insurance/hospital negotiations, insurance being tied to employment, medicare rate-setting, regulations that limit how many MDs can graduate and how many beds a hospital can add, the fact that pay-out-of-pocket options aren't standard, and on and on.]
Good comment, Elizabeth. I'm reminded of a comment and my reply regarding a Sensible Medicine article from Apr 17 2025: "Choosing the Diagnosis".
Sara Bajuyo wrote:
"As a former fee-for-service family doctor who escaped into the heavenly arms of direct primary care, I rejoiced at the seminal rite of passage: throwing billing and coding into the lake of fire where it belongs. No hand-wringing or gnashing of teeth over what flavor of former smoker to call my patient. I just document "former smoker- congratulated patient on his success" and move on with my day."
My reply:
"I'm a computer scientist, not a healthcare professional, but I am familiar with the expression "He who pays the piper calls the tune". The third party payer is stuck in the position of having to justify payments, and this inevitably means lots of bureaucracy and red tape for payers, providers, and patients. Congratulations on your escape from the system."
Wow, that’s a good reply. Could you give me 800 to 1200 words of that?
I think most doctors are vip patients to other docs.
I am reminded of the time one of our staff physicians came into the ER with chest pain and the first words out of his mouth were "Treat me like just another patient." He was well aware of the possible problems often brought about by the need to "do something".
Happy to say that our primary concern with well known patients is privacy here in Alaska. Alaskans couldn’t care less about societal important people. It was interesting to read the cases regarding the adverse outcomes for VIPs. That was not something I had considered before.
Matt Phillips
Matt’s Substack
5h
I have some great stories.
As in cardiologist in the military, we would bring back every bypass patient at 90 days for a heart catheterization. We wanted to make sure the grafts were open. This was in the Stone Age 1984. Interestingly 15% of all graphs were closed. We had a four-star general, who simply came back, went to the ward. The Nurse's knew him so they gave him a bed. The interns came and did their usual physical. Yes we actually admitted people for our catheterizations as well .8 Fr catheters full heparin. I had fingers of Steel holding groins
Eventually, the C suite found out and went bonkers.
We were taught interestingly, that if a general gets bumped off you could survive that, but if you lost an airman not so much. The culture was really troop oriented.
When one of our presidents was hospitalized with a fib at Walter Reed- the doctors on TV from his team were discussing his treatment. Meanwhile, it was the cardiology fellow who wrote all the orders and made the decisions. It was pretty funny because everyone knew what was actually happening.
We were taught that when you deviate for VIPs, you could really harm them.
Finally, there's a very famous person in political circles . He had a cardiac surgery. The cardiologist went in to talk to him the phone rang, and the person asked to cardiologist to step out because the caller ID said PUTIN.
VIPs get creature comforts that's life . When world leaders call you after surgery you'll get VIP treatment too.
In the meantime, you'll get the same medical care because you don't want their care for sure..
L
I disagree, say a doctor who provides good care to many falls ill and needs intensive care, but there are too many patients. A person from skid-row does not deserve the same care as someone who works and PAYS for their healthcare, and also RETURNS A VALUE TO SOCIETY, they deserve and are entitled to healthcare. The bum is looking for charity, a handout, a freebee while being drag on society. If you are a bum you deserve bum treatment. No one should benefit from another man's labor.
Would you write that with a name on your account? ;-)
An uncomfortable but real issue in medicine ... the creation of the “Very Important Patient” (VIP) whose status, wealth, or connections can subtly (or not so subtly) alter the way care is delivered. Thank you, Dr. Cifu, for putting this issue in clear terms. These are the conversations we need if we want to protect both patient care and the integrity of medicine.
Very good points! I emphasized to my residents that patients on the other end of the spectrum(hostile, argumentative, difficult family, non-compliant...) must be given the same, best care possible, as patients that we like.
Hate to one-up you here but the hospital I trained at learned this the hard way....
Royal family member needed a kidney. Hospital rolled out red carpet. Literally redecorating an entire wing .Chief of cardiology decided he should perform cardiac Cath. Perforation ensued. Patient was kept alive but would never recover Went ahead with transplant. The family of the now severely disabled VIP not only never made the large donation that was thought to be a "no brainer", but sued the hospital for millions..