Although physicians may feel pressured to see VIPs for various reasons—especially for fear of the consequences if a powerful person (or their advocate) is not satisfied with the appointment offered—it is ultimately the responsibility of the physician to recognize their time as a limited, valuable healthcare resource that ought to be distributed on the basis of need. How, then, should a rheumatologist triage requests for VIP consults?
Physicians are often asked to see VIPs expeditiously for non-urgent issues. This may displace access to timely healthcare evaluation from another patient in need of more urgent medical attention.
A Way Forward
In a case such as the one described above for which there may be little benefit in a second opinion and almost certainly no need for an urgent appointment, it may be appropriate to have a discussion with the patient’s father (the hospital administrator) regarding the reasons you feel you need to see other patients more urgently than his daughter.
As a default, physicians should strive to treat the VIP like any other patient. The effects of VIP syndrome—the risk of over-testing and over-treating—are well documented.4
Several authors have explored the use of prioritization tools, such as patient questionnaires, referring physician reports and autoantibody testing, to stratify new referrals by potential urgency.5,6 Such strategies attempt to offer a more objective means of determining the potential urgency for care over a traditional first-come, first-served approach.
How do you handle requests for VIP consults? Do you have a good way to triage multiple requests for urgent patient consultation? Let us know.
Karen Stellpflug, MD, is a rheumatologist at EmergeOrtho, a multispecialty group practice in North Carolina.
References
- American College of Rheumatology. Access to care position statement. 2013 Aug.
- Monti S, Montecucco C, Bugatti S, et al. Rheumatoid arthritis treatment: The earlier the better to prevent joint damage. RMD Open. 2015 Aug 15;1(Suppl 1):e000057.
- Snyder L; American College of Physicians Ethics, Professionalism, and Human Rights Committee. Ann Intern Med. 2012 Jan 3;156:73–104.
- Farrell TW, Ozbolt JA, Silvia J, et al. Caring for colleagues, VIPs, friends, and family members. Am Fam Phys. 2013 June 1;87(11):793–795.
- Villeneuve E, Nam JL, Bell MJ, et al. A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis. Ann Rheum Dis. 2013 Jan;72(1):13–22.
- Cummins LL, Vangaveti V, Roberts LJ. Rheumatoid arthritis referrals and rheumatologist scarcity: A prioritization tool. Arthritis Care Res (Hoboken). 2015 Mar;67(3):326–331.
Acknowledgment: The author would like to acknowledge the input of Robert H. Shmerling, MD who provided input and guidance in writing and editing this column.
