Rolling out the red carpet at movie premieres, awards shows, and other events is considered the norm, but Very Important Person (VIP)-style treatment doesnโt always stop there. Many of the rich and famous have come to expect, if not demand, such white-gloved attention wherever they goโincluding the emergency department, doctorโs office, urgent care clinic, or surgical center.
In medicine, this phenomenon is known as VIP syndrome, and it occurs when a famous person is given special or different treatment because they are famous.
Many top cosmetic doctors do offer VIP exits and special waiting areas for clients who donโt want to be seen because that may create a scene (especially if theyโre waiting for their Botox or are all bandaged up following a facelift). Such amenities are usually considered a major perk for certain patients. Some of these exits and waiting area are separate but equal. Others are merely separate, but they are just the tip of the iceberg when it comes to VIP syndrome in plastic surgery.
Sure, the initial rule-bending may seem like a minor infringement at the timeโsay, taking the stitches out or signing off on air travel earlier than intended to compensate for an awards show or tour schedule. Other times, a celebrity may have more tests and procedures largely because of the attention that they command. Too much testing can lead to unnecessary follow-up procedures, which have risks all their own. Some celebrities may demand the department chairperson perform the procedure even if he or she is halfway to retirement, and others may ask that the surgery take place someplace more secluded or convenient than an accredited surgical facility.
In these scenarios, the โcelebrityโ may receive something other than the standard of care. If anything goes wrong, differently or just not according to plan, these decisions will be scrutinized by hospital administrators, legal eagles, handlers, and the omnipresent media.
โIf you deviate from standard protocols for a VIP, you increase the chances of an adverse event,โ explains ethicist Arthur Leonard Caplan, PhD, the Drs William F. and Virginia Connolly Mitty Professor and the founding director of the Division of Medical Ethics in NYU Langone Medical Centerโs Department of Population Health in New York City. โIf you get one bad outcome, you get in troubleโyou are off protocol, and it is hard to defend deviating from standard protocols for a VIP.โ
When VIP Equals RIP
It happens. Think Michael Jackson. The โKing of Popโ died from an overdose of medicines prescribed by his personal physician, who was later accused of involuntary manslaughter.
โThere is no question that judgment gets clouded whenever a physician is starstruck,โ says M. Mark Mofid, MD, FACS, a plastic surgeon in La Jolla, Calif, and a member of the PSP editorial advisory board. โIโve personally had a few patients who would have made the news had anything gone awry.โ
Many plastic surgeonsโespecially those who set up shop in such celebrity-studded areas as Los Angeles and New York Cityโcan likely say the same.
Recent media reports have suggested that comedienne Joan Riversโ untimely demise at the age of 81 may have been a case of VIP syndrome. Rivers reportedly went into cardiac arrest when her personal ear, nose, and throat physician performed an unscheduled throat biopsy. (Said surgeon may or may not have taken a selfie with the anesthetized Rivers.) The doctor was not on staff at the clinic where Rivers underwent outpatient upper endoscopy, but she was on hand.
โThe ENT should have just done a tracheostomy when the oxygen saturations were dropping, but she probably freaked out that she was about to do an emergency trach on a VIP and that it would be a catastrophic complication of a routine procedure,โ Mofid speculates. โInstead, the patient died.โ
A gangster or gunshot wound victim in your average trauma emergency department would have gotten better care, he says. (Mofid did not treat Joan Rivers, and exactly what happened to the icon is still unraveling.)
โFortunately, Iโm not so in tune with popular culture, so I donโt really get just how famous they are until after surgery,โ Mofid says. โWhen I operated on them, they were sort of just average people to me since I didnโt know any better,โ he says.
This pop culture cluelessness is definitely a gift. โIโve had a few other model/actress types, but since I donโt watch TV, they just seem like really attractive people and again, until my patients that sit next to them in the waiting area ask me about them.โ
Treating celebrities absolutely often comes with its own set of road rules, says Joe Niamtu III, DMD, a Midlothian, Virginia-based cosmetic facial surgeon. โThere are many things they donโt want, such as any pictures taken, normal office hours, and public entrances,โ he says.
Also, they frequently come and go with an entourage, which further complicates everything. โThey may present with their own consents that the entire office staff needs to sign as confidentiality.โ Privacy matters take on a whole other level as well when dealing with celebrity clientele.
And yes, sometimes they do get a different level of care, and that can affect their diagnosis and treatment, Niamtu says.
โI think that every surgeon has the ethical obligation to treat all patients equally, but in reality, it is human nature to want to overperform for special patients,โ he says. โMany of us treat special needs patients. I am referring to those patients with physical or mental disabilities. These patients require special care, and you have to change the way you do things when treating them.โ
[sidebar float=”right” width=”250″]VIP syndrome occurs when a famous person is given special or different treatment because they are famous.[/sidebar]
VIPs are another type of special needs patient, he says. โIf you treat them, you have to provide privacy, be ready to deal with โtheir people,โ and be more flexible and available.
โThe negative part comes when a surgeon changes his or her normal regimen. They may want to forego some tests or procedures, or add more to be more thorough,โ he says. โThey may not want to bring in consults that they normally would, and follow-up can be hard as these people donโt want to hang around.โ In the world of VIP plastic surgery, some requests are more easily complied with than others.
โIโve had patients whoโve called for consultations and demanded to be put ahead of everyone else on the waiting list because he or she considered himself or herself a VIP,โ says Anthony Youn, MD, FACS, a plastic surgeon in Detroit. โIโve had celebrity patients request that I not share their entire medical history with the anesthesiologist because they feared the information would become public knowledge. And Iโve had VIP patients request consultations and treatments at hours when my support staff arenโt around, as a way to provide more privacy.โ
Gold-Plated Care
The initial request may be unfair, but the latter two scenarios can cause a less safe atmosphere for surgery, he says. When considering treating a VIP, ?ask yourself if you can provide the care without disrupting your schedule, your staff, or your surgical plan, says New ?York facial plastic surgeon Steven Pearlman, MD.
If you can, go for it, he says.
โTo treat a celebrity means that you also have to be able to say no to a celebrity at any point, and that can be easier said than done,โ he says. Even surgeons can get starstruck at the thought of being chosen by a rock star or Academy Award-wining actress who could have picked any doctor in any part of the world.
โYou have to make sure your ego is in check,โ Pearlman says. โDonโt stretch indications, donโt compromise care, and donโt take shortcutsโeven if you think you are doing this celebrity a favorโbecause you may be causing much bigger problems for you and the patient.โ
Niamtu agrees: โIf you get starstruck, it clouds your clinical vision.โ
Denise Mann is the editor of Plastic Surgery Practice. She can be reached at [email protected].