Let’s take a pediatrics patient as an example. She has a rare genetic disorder, heart problems, is G-tube dependent, and home-bound. The child is also on countless medications and requires 24-hour nursing. The family is rich and pays 100 percent of the child’s medical care. Parents want what’s best for their children, right? I mean, their child’s care is 100 percent private pay, so obviously, yes? Yes, but to the detriment of everyone involved. Doctors, nurses, therapists, and even hospital admin and leadership are expected to bend over backward for the family and meet every request and demand they ask. Everyone involved is fearful, and evidence-based medicine is often thrown out of the window. Conversations are being had between the family and individual doctors that are undocumented, resulting in doctors not knowing what other providers are planning for the child. Eventual disagreements happen that can eventually erode the managing team’s cohesiveness. “I appreciate your help with my child so far, but I’m letting you go.” A mom doesn’t like her child’s current PCP because of something said? Gone, the next PCP is up to bat. The parents want only specific doctors and nurses they get along with, and they will fire anyone they don’t like. Do the parents demand private phone numbers? It happens all the time, and doctors are reluctant to share them for obvious concerns of privacy and the parents not respecting their time outside of the hospital. But, the dad says, “What if my son has an emergency? Who do I call?” There is something called the ER, something everyone goes to in an emergency. “OK, but I want my child to have X, Y, and Z done because I read that these will all help my child.” Labs, imaging, and anything else a provider can order are done when the family asks for it. You would think that patient-centered care and doing what’s best for the patient is best practice. Obviously, not in the parents’ eyes. The parents are driving the bus from the beginning to the end, and wanting everything under the sun done for their child is most often not what the child even needs. It can cause more harm than good. Doing whatever the parents want for their child leads to iatrogenic consequences, leading to further interventions to address these consequences. It becomes a vicious cycle that starts because the parents use their wealth and stature to make demands. This is not how you practice medicine. I’ve never believed that someone’s medical care should change just because of their ability to pay. Or if they are a celebrity. Every patient should be treated equally and receive the best medical care possible, evidence-based and necessary. VIP medicine is not only abroad but is practiced at hospitals across the United States. VIP medicine is bad medicine. There’s no way around it. Source
