title: Caring for 'Very Important Patients'--Ethical Dilemmas and Suggestions for Practical Management.
abstract: The care of Very Important Patients (VIPs) is different from other patients because they may receive greater access, attention, and resources from health care staff. Although the term VIP is used regularly in the medical literature and is implicitly understood, in practice it constitutes a wide and heterogeneous group of patients that have a strong effect on health care providers. We define a VIP as a very influential patient whose individual attributes and characteristics (eg, social status, occupation, position), coupled with their behavior, have the potential to significantly influence a clinician's judgment or behavior. Physicians, celebrities, the politically powerful, and philanthropists, may all become VIPs in the appropriate context. The quality of care may be inferior because health care professionals may deviate from standard practices when caring for them. Understanding the common features among what may otherwise be very different groups of patients can help health care providers manage ethical concerns when they arise. We use a series of vignettes to demonstrate how VIPs behavior and status can influence a clinician's judgment or actions. Appreciating the ethical principles in these varied circumstances provides health care professionals with the tools to manage ethical conflicts that arise in the care of VIPs. We conclude each vignette with guidance for how health care providers and administrators can manage the ethical concern.
authors.affiliation: Veterans Health Administration National Center for Ethics in Health Care, New York, NY; New York University School of Medicine, New York, NY. Electronic address: david.alfandre@va.gov.
authors.forename: David
authors.initials: D
authors.lastname: Alfandre
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Sarah
authors.initials: S
authors.lastname: Clever
authors.affiliation: University of California, San Diego.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Farber
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Hughes
authors.affiliation: University of Colorado Denver Health Sciences Center.
authors.forename: Paul
authors.initials: P
authors.lastname: Redstone
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Lisa Soleymani
authors.initials: LS
authors.lastname: Lehmann
mesh_terms: D004992:Ethics, Medical; D005197:Famous Persons; D019983:Guideline Adherence; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000941:ethics / Q000523:psychology / Q000592:standards; D020399:Practice Management / Q000941:ethics* / Q000592:standards*; D011787:Quality of Health Care / Q000941:ethics* / Q000592:standards*
keywords: Ethics; Influential patients; VIP