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1/ THREAD: VIP Patients
We can& #39;t let patients buy special treatment. It privileges the white & wealthy.
In residency, when I wouldn& #39;t provide unwarranted treatment, a “VIP" patient brought me to tears, yelling and asking where I went to med school.
#TipsForNewDocs
#medtwitter
We can& #39;t let patients buy special treatment. It privileges the white & wealthy.
In residency, when I wouldn& #39;t provide unwarranted treatment, a “VIP" patient brought me to tears, yelling and asking where I went to med school.
#TipsForNewDocs
#medtwitter
2/
Every hospital I’ve worked or trained in has a special floor where patients can spend thousands of dollars to get “better” treatment.
They are given rooms with wooden panelling, gourmet meals, and attentive nursing care.
https://www.nytimes.com/2015/10/26/opinion/hospitals-red-blanket-problem.html?_r=0
https://www.nytimes.com/2015/10/2... href="https://twitter.com/ShoaClarke">@ShoaClarke
Every hospital I’ve worked or trained in has a special floor where patients can spend thousands of dollars to get “better” treatment.
They are given rooms with wooden panelling, gourmet meals, and attentive nursing care.
https://www.nytimes.com/2015/10/26/opinion/hospitals-red-blanket-problem.html?_r=0
3/
Allocate your time based on patients’ clinical severity, NOT their social standing.
Don& #39;t give VIPs any more of your time or brain space than other similarly sick patients. It is inequitable and unethical to do so.
Allocate your time based on patients’ clinical severity, NOT their social standing.
Don& #39;t give VIPs any more of your time or brain space than other similarly sick patients. It is inequitable and unethical to do so.
4/
Never suffer alone!
If asked to spend longer than average or provide care that doesn’t feel “right”:
1. stay calm
2. say that you feel uncomfortable, ask to leave the room
3. escalate - either to your attending, hospital leadership, or the ethics committee
Never suffer alone!
If asked to spend longer than average or provide care that doesn’t feel “right”:
1. stay calm
2. say that you feel uncomfortable, ask to leave the room
3. escalate - either to your attending, hospital leadership, or the ethics committee
5/
For patients that are philanthropic donors, distinguish between their donations and your doctor-patient relationship.
“Your donations are valuable to our institution. I want you to know that I won’t let that interfere with the care I provide for you."
For patients that are philanthropic donors, distinguish between their donations and your doctor-patient relationship.
“Your donations are valuable to our institution. I want you to know that I won’t let that interfere with the care I provide for you."
5/
As a doctor with a heart condition, I often expect special treatment as a courtesy.
But, research shows that VIPs can receive *worse* treatment because they expect tests and medications that differ from standard of care. https://www.wbur.org/commonhealth/2017/03/20/study-looks-at-the-special-pressure-of-treating-a-vip-very-important-patient">https://www.wbur.org/commonhea...
As a doctor with a heart condition, I often expect special treatment as a courtesy.
But, research shows that VIPs can receive *worse* treatment because they expect tests and medications that differ from standard of care. https://www.wbur.org/commonhealth/2017/03/20/study-looks-at-the-special-pressure-of-treating-a-vip-very-important-patient">https://www.wbur.org/commonhea...
6/
For patients who like to be involved (including docs), be very transparent.
I like to open their records in front of them and go over them together.
I ask: "Is there anything you want to make sure we don’t miss?”
For patients who like to be involved (including docs), be very transparent.
I like to open their records in front of them and go over them together.
I ask: "Is there anything you want to make sure we don’t miss?”
7/
We know that disparities in hospitals already exist that disproportionately hurt BIPOC -- even without rich, white peoples’ abilities to buy different standards.
https://www.ahajournals.org/doi/abs/10.1161/CIRCHEARTFAILURE.119.006214
https://www.ahajournals.org/doi/abs/1... href="https://twitter.com/eberly_lauren">@eberly_lauren
@AaronRichterman
@michellemorse
We know that disparities in hospitals already exist that disproportionately hurt BIPOC -- even without rich, white peoples’ abilities to buy different standards.
https://www.ahajournals.org/doi/abs/10.1161/CIRCHEARTFAILURE.119.006214
@AaronRichterman
@michellemorse
8/
Health disparity researchers @BrighamWomens showed that if you were Black or LatinX & presented with heart failure, you were more likely to be admitted to our fancy cardiology wing, where you had better treatment and heart failure outcomes than on a general medicine service.
Health disparity researchers @BrighamWomens showed that if you were Black or LatinX & presented with heart failure, you were more likely to be admitted to our fancy cardiology wing, where you had better treatment and heart failure outcomes than on a general medicine service.
9/
Knowing about baseline disparities, how can we, in good conscience, allow rich white people to buy their way into *explicit* bias that favors them?
Knowing about baseline disparities, how can we, in good conscience, allow rich white people to buy their way into *explicit* bias that favors them?
10/
Additional References:
https://www.amjmed.com/article/S0002-9343(15)01010-4/abstract
https://www.amjmed.com/article/S... href=" https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108766
https://jamanetwork.com/journals/... href="https://twitter.com/pedsmd2b">@pedsmd2b
@gradydoctor
@tony_breu
@colleenmfarrell
@COREIMpodcast
@drlouiseivers
@aaronLberkowitz
@DrwilfredoM
Additional References:
https://www.amjmed.com/article/S0002-9343(15)01010-4/abstract
@gradydoctor
@tony_breu
@colleenmfarrell
@COREIMpodcast
@drlouiseivers
@aaronLberkowitz
@DrwilfredoM
