This is not to say that patients shouldn’t be advocates for their own health, of course they should. They should ask questions, and read all about their diseases, and get second opinions (or third and fourth opinions if they're not satisfied). But anyone who thinks that pulling rank is going to improve care should conduct the following experiment: The next time you get on an airplane, first go to the air traffic control tower and fire everyone in there, since you know so much; then fire the aircraft mechanics and service the plane yourself; then fire the pilot and fly the plane yourself. And afterwards, if you survive the crash, consider not making those same mistakes when you get sick.
We may not be as well-connected as politicians, or as famous as celebrities, or as rich as lawyers, but we do know about health, and we do try to do our best for our patients' health – even for those patients who do everything they can to prevent us from helping.
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.
5 - xyz
We also come across a number of VIP syndromes in our healthcare system. What's the best way to deal with them still alludes us.