VIPs don't have to wait hours on end for an X-ray or MRI, and they are given extra amenities and pampering care, but for these high profile patients, receiving high-quality medical treatment often becomes an enormous challenge.

From national and foreign dignitaries to athletes and politicians, there are some common observations that have heightened awareness within the medical community about the issues and concerns surrounding the treatment of VIPs.

Good health: A high price to pay for fame
Unfortunately, the most evident problem for VIPs is the vested interests of others, including advisors, family members, the media and even their physician, which can cause delays in the treatment or impede important medical decision-making processes. Oftentimes, the political agendas of others are not always in the best interest of the patient.

The pressure to perform in the media spotlight
It is a world-recognized fact that a patient's medical care may be influenced, and in some cases hindered, because of their national or international status. For example, the rational medical treatment recommended for a customary patient may not be as readily provided to a VIP. This is especially true if there is a high risk of mortality or an unfavorable outcome that could generate negative publicity around the physician. Obviously, no one wants to be responsible for the death of a patient, especially a high-ranking political figure or celebrity. Therefore, high-risk treatment may be avoided even if it is, in fact, the best option.

Another scenario may involve a VIP who is a "borderline" candidate for a surgical procedure. Even though his or her medical condition may not warrant immediate treatment, some health care providers may be overly aggressive and operate prematurely to bring a higher level of attention to their affiliation with that patient. Subsequently, these patients are also likely to undergo more tests and treatments than actually needed.

Because confidentiality and security are key elements with many patients, secretive measures are often taken for their safety. This is especially true for patients surrounded by controversy or notoriety, which may also require dodging television cameras and even traveling to another country to perform a procedure.

Redefining VIP
Regardless of the added pressure, it's no secret that most physicians eagerly embrace the opportunity to be associated with treating a VIP. While some may enjoy the glamour of the media publicity, most just strive for the personal gratification and success of the case.

From a medical standpoint, all patients, including VIPs, deserve the best care and should be treated the same as any other patient. The level of personal attention from the physician may need to be greater to meet the VIP patient's expectations, but the fundamental medical process should be unattended.

Tips to remember when treating or dealing with high profile patients

• The patient is always first. Everything else is secondary, including the surrounding publicity.
• Confidentiality. By law, all patients have a right to complete confidentiality. Be sensitive to what is said to the media and what the patient wants you to say to the media. Also, some celebrity patients request to be treated anonymously under an assumed name. Check with hospital administration or the public relations department if you have questions.
• Practice absolute discretion and respect. If the patient requests that nothing be said to the media, then that's it. Honor their request. Also, avoid gossip with friends, family or colleagues regarding VIPs.
• Maintain your professional integrity and personal responsibility. Regardless of media attention or its potential negative backlash, keep in mind the importance of maintaining high medical standards that are in the best interest of the patient.
• Be the patient advocate. Avoid delays and stand your ground about recommended treatment for critically ill patients. However, be patient and understanding about the complex social circumstances surrounding the patient. A disagreement with physician advisors or family members may unfairly interfere with the timely and pro-active treatment of the patient.
• Be diplomatic. Again, stick to your guns about your medical treatment advice, dismissing the personal agendas of others. When making recommendations for a high-profile patient, there may be an advisory board or entourage to contend with that disagrees because of their anxiety, lack of understanding, competing agendas or because opinions given by other physicians.
• Work closely with hospital administration. Although most major medical centers are accustomed to accommodating VIPs, it is a good idea to confirm any special requests or security needs with the hospital administrator and appropriate department directors. This ensures all hospital staff members will be prepared to handle everything smoothly and efficiently.
• Be financially fair and ethical. Fortunately for hospitals and physicians alike, many prominent and out-of-country patients pay in cash. Don't take advantage of this, even if the patient has substantial means. Most of these individuals are very business savvy, and chances are, they will question every item on their bill like any other patient. More than most patients, they will appreciate this simple display of your integrity.

Regardless of a patient's status, remember that underneath all the hoopla, these patients are just ordinary people trying to get restored to good health.

Gerald M. Lawrie, M.D., FACS, is a founding partner of Texas Surgical Associates, a medical group of cardiovascular surgeons in Houston, Texas. Internationally recognized, Lawrie was a principal member of Dr. Michael DeBakey's original team that has participated in the treatment of such VIPs as the Shah of Iran, the King of Belgium, the President of Turkey and Boris Yeltsin.