Here's a true story. A guy we’ll call Junior VIP comes into a major hospital in the wee hours of the morning with abdominal pain, mostly located to the right and downward from the belly button. His lab values indicate he has some type of infection, and he has been running a slight fever. Appendicitis is suspected.
A CT scan is obtained, which neither rules in nor rules out appendicitis. At this point, about two hours after presenting to the ER, Junior VIP has been seen by the ER physician, ER nurse, senior surgical resident and chief surgical resident.
The attending physician now examines the patient and agrees that appendicitis cannot be ruled out and admits Junior VIP to the hospital, explaining to JVIP that we don’t want to miss anything but we also don’t want to do an unnecessary surgery for what may turn out to be a viral illness. Therefore, we will admit, obtain further labs, provide fluids, keep him from eating, and observe his condition during the day. If he improves, there will be no need for surgery.
If he gets worse, we will take him immediately to the operating room. JVIP agrees to this plan, but soon becomes agitated in the ER. “When am I going to get my room,” he complains to the ER nurse, followed by, “It smells in here. Did someone crap their pants?” followed by “There are drunks in here, get me out of here right now!” The ER nurse, then the ER physician, as well as the residents, explain that the hospital is very full, but they are working as fast as they can to obtain an available bed as soon as possible. JVIP tells them to hurry, and make sure it’s a private room. But after one more hour of being in the ER, JVIP decides he can’t stand it any more, and checks out Against Medical Advice.
Being a (Junior) VIP, he is incensed by his “shabby” treatment, and uses his connections to contact the local newspaper outlet, the local television news outlet, the mayor’s office, and several prominent friends who are tight with the hospital board members. The attending surgeon, who saw the patient two hours ago, and is now in the OR where he plans to finish his first case of the day and then check on JVIP to see how he is doing, gets a phone call from the CEO of the hospital, demanding that he break scrub to discuss this “unacceptable” matter. This, within five minutes of receiving a phone call from the surgical resident explaining that the patient has checked out AMA, another phone call from the local television news asking for a comment on a story they are doing about Delays In Diagnosis For Severe Medical Conditions, another phone call from a physician colleague in the hospital who wants to know what happened with her friend JVIP and why he didn’t get treated, and a phone call from JVIP’s lawyer. Two more phone calls from the Chair of Surgery—all this while the attending surgeon is trying to operate—and it is established that JVIP will be returning to the hospital, will go directly to PreOp and be taken immediately to surgery. No more tests, no observation, no more “flimflam” is the word from above.
Article comments
1 - Terry
Dr. Tim,
I agree. Some of the worst "victims" of VIP Syndrome are not just the celebrities who have "their people" try to muscle worthless tests and treatments out of us but also patients whose "people" are friends and relatives in the medical field. How often have you had a patient who insists you discuss their case with their best friend from high school (cousin, neighbor, etc) who is a Respiratory Therapist (Lab Tech, EMT,Psych Nurse, etc) before you initiate any care? Most tend to be fairly reasonable but it seems as their level of education and training increases the level of interference rises proportionally. There is nothing worst than talking to a Non-Surgeon physician who lives 2000 miles away and explaining why we don't need another CT scan or MRI to make a diagnosis of acute appendicitis.
2 - Dr. Tim
Terry you must be a doc yourself, or somehow connected to medicine. In my experience, though, their knowledge base is only loosely connected to their Interference Factor, but directly connected to their Ego Factor. Big Easily Bruised Ego = Big Pain In the Butt. My favorite was a dentist who wanted to observe us work on his wife during a trauma code, which was fine, we often let family in, but he kept trying to run the code himsel. I finally had the nurse (now my fiancee) throw him out of the room. But I agree that the further away they are the more they want to run the show, especially with end of life decisions. Worst of all, though, are the parents of small childern, which is why I'm not a pediatric surgeon.
3 - TheNewGuy
Every ER docs has stories like these.
I had one patient with an ongoing anterior-wall MI insist on my discussing her care with her brother-in-law (also an ER doc) before she'd let us treat her. She was threatening to go AMA if we didn't.
Time is muscle, but oh well... if that's it took to get her cared for, I was willing to do it.
The ER doc brother-in-law must not have liked her, because he insisted on playing 20-questions and pimping me on the phone: "what's the EKG show" "are you sure?" "any enzyme elevations?" "what's your training" etc, etc. I finally cut him off, and advised him that what I really needed was for him to talk her out of leaving AMA. He said "Oh..." and we got her to the cath lab.
The kicker? She didn't want to pay her hospital bill, so she threatened to sue me later for delaying her care. No problem lady... think nothing of it... you're welcome.
4 - Dr. Tim
New Guy you cracked me up! Your example is so sad and so true to life. What else can we do except laugh? Speaking of laughing so hard I wanted to cry, there was an article in Sunday's Boston Globe Magazine about Shaken Baby Syndrome, which of course has its doubters. (Is there some special school that these people go to, where they are taught that the Holocaust didn't happen, global warming doesn't exist, and there is no such thing as disease?) One of these clowns is Dr. Leestma, a neuropathologist and hired gun who is frequently retained by the defense in SBS cases to cast doubt on whether the unfortunate baby was actually a victim of child abuse, or if all those broken ribs and retinal hemorrhages just happened by accident. Here's a direct quote: "We tend to be a little sloppy in medicine with diagnosis and treatment, but the law demands a more rigorous approach." The LAW demands a more rigorous approach! I just about fell out of my chair laughing. A rigorous approach! As was seen, for example, in the OJ case, or Jon Benet Ramsey, or any of a thousand jury decisions that find for the plaintiff in medical malpractice cases not because of any wrongdoing but because the jury felt sorry for the plaintiff? My side aches just thinking about it. But it's either laugh it off and get on with saving lives or sit in a corner and cry.