“Do You Know Who I Am?“ Anesthesia for the VIP (Very Important Patient)
Every doctor has, at some point, been requested to care for a VIP patient. This may happen more often to anesthesiologists, given the terror of the general public at the prospect of “going under”. The rich or celebrity client is no different and, from their perspective, they may request “special” treatment, as a strategy to enhance their chances of coming off from the anesthesia.
So, what do you, the anesthesiologist, DO in this case? Of course, we are all human and it is flattering to be requested by a VIP. There may also be the added prestige or even generous tokens of gratitude at stake.
In this article, Dr. Hadzic looks over the dangers of allowing your ego to overrule your head; how to emerge with your integrity intact; and what really is the best treatment that you can offer to a VIP.
Treating a VIP patient: is it an honor or a poisoned chalice?
Even though we doctors should know better, it can be tempting to opt for a bespoke treatment involving a different anesthetic for a VIP patient, something different from what you do on a daily basis. I have on a few occasions even heard my colleague doctors “drop” the names of the celebrity patients they took care of.
Name-dropping is a serious breach of patient confidentiality, so here is a reminder that “who” you treated should never take precedence over “how” you treated them.
Think – Michael Jackson: With all his fame and financial resources, he did not receive the best care the U.S. medical system has to offer. His celebrity status actually contributed to him receiving a lower standard of care, leading to a much less desirable outcome than he would have received as just a regular guy on the street.
Is it acceptable for a VIP to request “special treatment”
There are many institutions and countries where it is not only accepted, but expected. Germany is one, where VIP patients are routinely treated by the Chiefs of Service or reputable Professors. While this may offer the VIP patient some assurance that they are getting the best care possible, in reality, ARE THEY?
DEEP DIVE: Who is best equipped to conduct anesthesia?
The Head of Department may be a much-decorated eminence-gris, writing away in his ivory turret, and venturing out only occasionally to the operating room or to lecture his students.
And, two or three times a year, just to keep their hands in, they dust off their scrubs and make it out to the operating theater, hoping they can remember the drill from last time. And, my goodness, aren’t the surgeons looking younger these days?
Is this really who you would trust to take your life in their hands? Or would you prefer the gifted young clinician, bang up to date with the latest techniques and guidelines, who regularly takes his patients safely through the procedure, day in, day out?
I know who I would choose!
And If you’d like to know what I actually chose when I was offered the opportunity to choose my anesthesiology team, I recorded a video about my experience “What happened when the Anesthesiologist became a Patient” and you can go here to watch it (LINK ON SCREEN or in Description below the video)
So, what do I do differently when I am asked to administer anesthesia to a VIP patient?
As always, regardless of the patient, I deliver the best service I have available. My “best service” is not some sort of “top drawer” offering reserved for special occasions.
The best service is the service that we, as a team, have tried and tested and perfected until we know the drill as second nature. This is also the safest service and our standard service. In fact, any deviation from that standard service would introduce a weak link to the procedure until fully tested.
This is a serious downside to the “special” treatment, and there are others.
For example, when treating a VIP, doctors may try to spare their special patient from painful or time-consuming care, by opting to skip basic tests or procedures — even when those analyses yield vital information. Others may choose to go in the opposite direction and soup up the VIP treatment with extra, unnecessary tests — either because the doctor, aware of the high profile of the patient and the added scrutiny, tags on additional measures just to be sure, or, even worse, just to be seen to be doing something “special!”
The Prima Donna factor
And there’s more! The Prima Donna factor, where the practitioner pulls out all the stops to attempt an impromptu performance of an anesthesia technique they haven’t yet mastered or they haven’t done in a long time! Would you want to put your life in the hands of someone more concerned about showing off their rusty repertoir than prioritizing your safety?
An example is where patients having orthopedic surgery benefit from regional anesthesia and nerve blocks. However, these regional anesthesia techniques are effective and safe only in the hands of practitioners who are highly trained to deliver them.
An “occasional regionalist” is much more likely to deliver subpar results for the patient.
Can you see the dangers mounting up?
The extra attention afforded the “special” patient, and pressure felt by the practitioner, can soon turn into “VIP syndrome” — a series of bad judgments, unnecessary tests, second-guessing, and, ultimately, substandard care. So, how can it be avoided?
VIP patients should be treated exactly the same as any other patient with a similar presentation, and care should be taken to follow standard clinical procedures as closely as possible.
When someone asks me what I would do special for a VIP patient, my answer is “Nothing different from what I do every day.
What do you do for VIP patients? Check out the video and join the discussion by leaving a comment with your thoughts on this subject.