Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

Diagnosed with COVID-19 and given supplemental oxygen, United States President Donald J. Trump was helicoptered from the White House to Walter Reed National Military Medical Center nine miles away. After beating the Beltway’s notorious traffic, Trump was greeted by a team of doctors. Besides Regeneron Pharmaceuticals Inc.’s experimental antibody drug cocktail, a five-day course of the antiviral drug remdesivir, and the generic steroid dexamethasone, in short order he was given a batch of minerals and vitamins that included zinc and D. Anyone who has waited hours inside an emergency room or a doctor’s office was understandably jealous. Yet the extra treatments given to Very Important Persons are not always ideal. When doctors meet their demands despite protocols and procedures, they risk reputations and even the patient’s life. That’s why VIP medicine is often bad medicine.

Front-of-the-line Privileges

In 2014, comedian Joan Rivers died at age 81. The medical examiner’s report concluded she’d died from therapeutic complications which caused a lack of oxygen resulting in brain damage. Undergoing a routine procedure to diagnose the raspiness in her voice, the New York Department of Health later cited the Yorkville Endoscopy center where she’d received treatment for not recognizing her deteriorating vital signs nor recording the accurate dose of Propofol, among other things. Sometimes called “milk of anesthesia,” Propofol doesn’t dissolve in water and is refrigerated in a solution made up of soybean oil, fats purified from egg yolks, and glycerol.

A popular anesthetic, it was administered to VIP patient Michael Jackson in 2009, with a similar tragic outcome. Dr. Conrad Murray, who gave the drug as an insomnia treatment, left Jackson alone. Murray was found guilty of manslaughter and served half of his four-year prison sentence. At Yorkville, a staff member even took selfies of Rivers while she was sedated. In the investigation’s aftermath, several physicians lost their jobs while the center’s reputation was damaged and a medical malpractice suit was settled. 

During a 2017 meeting of the American Society for Healthcare Risk Management, Dr. Kenneth explained that VIPs often ask for care from the highest ranking physician on staff. Unfortunately this person may not be the most qualified to give direct treatment. This is why the VIP Medicine given celebrities like Joan Rivers is often non-standard and potentially subpar. Despite the risks, a 2014 survey revealed that most physicians who responded admitted they felt pressured by VIP patients or their family members to perform unnecessary testing or treatment. It isn’t just celebrities; wealthy donors can also make demands. Bad outcomes always trigger an investigation, but health care providers worry the administration will call them on the carpet for refusing demands––even ones for treatments that are unnecessary or even contraindicated. 

It’s not a new problem. In 1964, Dr. Walter Weintraub wrote in The Journal of Nervous Mental Disease: “The treatment of an influential man can be extremely dangerous for both patient and doctor.” Quite so; or as Dr. Andrew Wright tweeted: VIP Medicine is bad medicine. Trump’s medical regimen included multiple medications usually not given concurrently. Although cleared for emergency use, some worried that taking them at all once could increase the risk of side effects or even a fatal outcome. As Dr. Lew Kaplan, a surgeon at the University of Pennsylvania, explained to ABC News, one of the fastest ways for things to go wrong is to be treated as a special person.

VIP medicine isn’t just dangerous, it’s unfair. As the American Board of Internal Medicine website explains, offering preferential care to those with fame or fortune violates both the social justice and primacy of the patient principles set down in The Physician Charter. Someone with limited resources probably won’t get the same package of treatments enjoyed by Trump––unless they are enrolled in a drug trial. 

Still, there are VIP options available for those with neither fame nor fortune. In the U.S., many are finding a concierge doctor as the best way to get more focused attention and lower wait times. Costing from around $100 to $200 a month––on top of insurance––a concierge doctor isn’t cheap. Neither are the ones that eschew insurance entirely. In numerous counties with government health care, people often spend out of pocket to avoid long waits for treatment. Before the pandemic upended global travel, even middle class consumers were getting not just plastic surgery but necessary surgical and dental procedures in Central and South America. The cost difference was enough that even with hotel rooms and airfare, it was still cheaper to be a medical tourist. In 2017, nearly 1.5 million people in the U.S. left the country for a medical procedure. 

You don’t need VIP medicine or a concierge doctor to improve your standard of care. Before a doctor’s visit, write down your symptoms, your pain, and any questions. Be prepared to talk about what you’re willing to do and what you have already done for treatment. At your appointment, you may want to bring a companion to help you remember the interactions. No matter your status, don’t be afraid to ask your doctor questions. While bringing up that unusual cure you read about on social media might not improve your care, being an advocate for your needs is a great way to be a Very Important Patient.

References

• V.I.P. syndrome can lead to bad care
• Propofol: the drug that killed Michael Jackson
• Highlights from Joan Rivers’ death and lawsuit
• Perceived safety and value of inpatient “very important person” services
  “The VIP Syndrome:” a clinical study in hospital psychiatry
• What to know about concierge medicine
• Medical tourists: incoming and outgoing