The Treatment of VIP Patients in Academic Teaching Settings: Applying the “Difficult Patient Framework” to Guide Therapeutic Response

Every day, thousands of resident physicians across the nation go to work in academic teaching settings where they are asked to provide sound clinical care to their patients while maintaining rigorous ethical standards. Although academic teaching hospitals may deliver psychiatric care to largely underserved patient populations, the treatment of very important persons (VIPs), or so-called VIP patients, is a quiet reality of medical treatment in general and occurs in academic training settings as well. In fact, academic teaching hospitals, which often carry prestigious reputations of employing the top physicians and offering cuttingedge medical care, may be particular sites of attraction for VIP patients who are seeking “the best” medical treatment. It is difficult to find a commonly agreed upon definition for VIP patients as the concept has minimal representation in the medical and psychiatric literature. For the purposes of this paper, VIP patients will refer to patients with perceived or legitimate power derived from various sources including higher social status, wealth, government or political rank, and/or beauty. Several VIP patients commonly encountered in medical settings include celebrities, political figures, prominent members of the community, or other physicians. The care of VIP patients in academic teaching settings is complex as it invites significant clinical and ethical problems for both patients and medical trainees. Unfortunately, there is little to no formalized teaching or standardized protocols to guide resident physicians in their treatment of VIP patients. Here, we suggest that the “difficult patient framework” as described by Roberts and Dyer [1] may be utilized in order to help conceptualize VIP patients and subsequently guide the therapeutic response. Furthermore, we encourage explicit discussion with medical trainees about the rationale for this treatment approach to avoid sending unintended though ethically problematic messages.