Caring for VIPs
NTR
MGR
Jayalalitha
Vajpayee
Arun jaitley
Chenna reddy
Manohar Prrikar
Jayaprakash Narayan
Balakrishna ( Malingering politicians )
death of Eleanor Roosevelt from miliary tuberculosis
JFK Addison's and his assassination
The care of President Ronald Reagan after the 1981 assassination attempt is a benchmark of how to release information to the public
“Usually, the VIP is relieved if the physician states explicitly, ‘I am going to treat you as I would any other patient.’ I very much doubt this happens in India
Medical tourism is on the rise,1 and since medical tourists are often very important persons (VIPs), hospital-based physicians may be more likely to care for celebrities, royalty, and political leaders
a patient’s special social or political status—or our perceptions of it—induces changes in behaviors and clinical practice
- Caring for VIPs creates pressures to change usual clinical wisdom and practices. But it is essential to resist changing time-honored, effective clinical practices and overriding one’s clinical judgment.
- Designating a chairperson to head the care of a VIP patient is appropriate only if the chairperson is the best clinician for the case.
- Although in some cases placing a VIP patient in a more private and remote setting may be appropriate, the patient is generally best served by receiving critical care services in the intensive care unit.
- Vow to value your medical skills and judgment
- Intend to command the medical aspects of the situation
- Practice medicine the same way for all your patients.
“Since the standard operating procedures […] are designed for the efficient delivery of high-quality care, any deviation from these procedures increases the possibility that care may be compromised.
ER LIGHTBULB INCIDENT
SLAPPING a VIP ATTENDANT
PRINCIPLE 2: WORK AS A TEAM, NOT IN ‘SILOS’
team work but also a sutradaar
medical practice “is not a committee process; it must be clear at all times which physician is responsible for directing clinical care.
PRINCIPLE 3: COMMUNICATE, COMMUNICATE, COMMUNICATE
PRINCIPLE 4: CAREFULLY MANAGE COMMUNICATION WITH THE MEDIA
Early implementation of an explicit and structured media communication plan
Away from the site of the President’s care.
senior hospital physician? problems
currying favor
penchant for fame
scapegoating
PRINCIPLE 5: RESIST ‘CHAIRPERSON’S SYNDROME’
The pressure may come from the patient, family, or attendants, who may assume that the chairperson is the best doctor for the clinical circumstance. The pressure may also come from the chairperson, who feels the need to “take command” in a situation with high visibility
encourage the participation of trainees in the care of VIP patients because excluding them could disrupt the usual flow of care, and because trainees offer a currency and facility with the nuances of hospital practice and routine that are advantageous to the patient’s care.
PRINCIPLE 6: CARE SHOULD OCCUR WHERE IT IS MOST APPROPRIATE
Caring for the VIP patient in a setting away from the mainstream clinical environment may offer the appeal of privacy or enhanced security but can under some circumstances impede optimal care, including prolonging the response time during emergencies and disrupting the optimal care routine and teamwork of allied health providers
a request to transfer a VIP patient to a special setting designed for private care with special amenities (eg, appealing room decor, adjacent sleeping rooms for family members, enhanced security) available in some hospitals15–16 can be honored as soon as the patient’s condition permits. The benefits of such amenities are often greatly appreciated and can reduce stress and thereby promote recovery. The benefits of enhanced security in sequestered venues may especially drive the decision to move when clinically prudent
PRINCIPLE 7: PROTECT THE PATIENT’S SECURITY
if a doctor has to go through a bodysearch to attend to a VIP medical emergency
(Story)
important to protect them from attacks on confidentiality via unauthorized access to the electronic medical record, and this is perhaps the more difficult challenge, as examples of breaches abound
PRINCIPLE 8: BE CAREFUL ABOUT ACCEPTING OR DECLINING GIFTS
Patients offer gifts out of gratitude, affection, desperation, or the desire to garner special treatment or indebtedness.
The acceptance of a gift from a VIP patient or family member may be interpreted by the gift-giver as a sort of unspoken promise, and this misunderstanding may strain the physician-patient relationship, especially if the clinical course deteriorates
( Pochampalli silk saree)
accept the gift at the end of the episode of acute care
affirm the commitment to excellent care that is free of gift
the recommendations of the American Academy of Pediatrics—ie, attempt to appreciate appropriate gifts and graciously refuse those that are not.
PRINCIPLE 9: WORKING WITH THE PATIENT’S PERSONAL PHYSICIANS
VIP patients, perhaps especially royalty, may be accompanied by their own physicians and may also wish to bring in consultants from other institutions. Though this outside involvement poses challenges (eg, providing access to medical records, arranging briefings, attending bedside rounds), we believe it should be encouraged when the issue is raised. Furthermore, institutions and caregivers should anticipate these requests and identify potential outside consultants whose names can be volunteered if the issue arises.
this should not be viewed as an expression of doubt about the care being received. Rather, we prefer to view it as an opportunity to validate current management or to entertain alternative approaches
Collegial interactions with these physician-colleagues can facilitate communication and decision-making for the patient
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