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VIP SyndromeWhy the rich and powerful might get substandard medical care.

By Zachary F. Meisel and Jesse M. PinesPosted Thursday, Oct. 30, 2008, at 6:26 AM ET

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In the "Human Nature" blog, William Saletan examined the "awake craniotomy," the operation Ted Kennedy's doctors used to remove his tumor. Zachary F. Meisel and Jesse M. Pines argued that hospitals are killing E.R. patients and explained why people overuse the emergency room.

VIP syndrome is compounded when the patient is in critical condition. After President Ronald Reagan was shot, the doctors couldn't hear one another because so many people were shouting at the same time. Imagine trying to make a good medical decision or communicate when the E.R. is teeming with administrators, Secret Service agents, and gawking hospital staffers not involved with the case. Even when doctors have the time to think clearly, they still make mistakes when dealing with celebrities: Former President Gerald Ford was discharged from the hospital with the diagnosis of an inner-ear infection when, in fact, he had suffered a stroke.

As we have both encountered as practicing emergency physicians, some VIPs travel to the hospital toting their own doctors. While a trained advocate can be helpful, it can sometimes interfere with medical decision making and lead to diagnostic delays and mistakes. In this story from the Boston Globe, when a VIP came into the E.R. complaining of chest pain from swallowing a large pill, the "boutique bedside bodyguard" insisted on an immediate echocardiogram, a heart test rarely performed in the E.R. VIPs also have issues with privacy because everyone is interested in their health. In 2007, after super-VIP George Clooney was in a motorcycle wreck, 27 hospital employees were investigated for inappropriately peeking at his X-rays and leaking his test results to the media. VIP privacy is a common problem: UCLA Medical Center workers have snooped into the medical records of Britney Spears, Farrah Fawcett, and Maria Shriver.

Since most of us are not VIPs, why should we care? Because VIP syndrome can affect you, too, especially if you're in the same hospital—the VIP will get her MRI first, so you may have to wait a little longer. But if you don't happen to be waiting for the same MRI scanner, you can benefit from an ill VIP. When a celebrity comes down with your disease, the illness can suddenly become more important: VIPs sometimes start foundations when they get sick—like Michael J. Fox did with Parkinson's disease.

But the truth is that most VIPs, especially the very famous ones, actually want to be treated as regular patients. In addition to having to deal with clicking cameras and googly-eyed autograph-seekers, VIPs probably know that fame can also mean star-struck doctors and nurses. So, what can wary VIPs do to make sure that they don't get VIP syndrome? Alas, not much. Even when the VIP checks in under an assumed name, going incognito in a hospital can be next to impossible. Trust us. Sunglasses might help them avoid paparazzi on the street, but a thin hospital gown doesn't do the same trick. Word spreads quickly among nosy hospital staff.

Though doctors don't always do right by their prominent patients, VIPs do have ultimate access. And for anyone who has tried to navigate the U.S. health care system, access to doctors is paramount. VIPs don't wait for appointments, they don't get bounced to the E.R. for routine care, nor do they get boarded on E.R. hallway stretchers for 12 hours. But access and attention don't always translate into better outcomes, especially if the care team doesn't follow protocols. The truth is that there is probably a happy medium: If you are Joe Six-Pack, it may help to be mistaken for a VIP because you won't have to wait weeks for a doctor's appointment. But if you are a candidate for vice president, you'd be better off if hospital staff thought you were just a hockey mom.

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Zachary F. Meisel is a practicing emergency physician, a Robert Wood Johnson Foundation clinical scholar at the University of Pennsylvania, and a senior fellow at the Leonard Davis Institute of Health Economics. Jesse M. Pines is a practicing emergency physician, an assistant professor of emergency medicine and epidemiology at the University of Pennsylvania School of Medicine, and a senior fellow at the Leonard Davis Institute of Health Economics.

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