By Aditi Mishra

Doctors at the All India Institute of Medical Sciences (AIIMS) in Delhi have warned VIP culture can compromise patient safety and cause inequalities in healthcare. The pressure from powerful patients, families and hospital staff can cause doctors to make decisions outside of normal medical guidelines. Their opinion paper published in the journal Oncology Reviews discusses how there can be unnecessary investigations, surgeries and prolonged ICU stays due to pressure from powerful patients. This was based on their clinical experiences from working in surgical oncology.

VIP syndrome happens when patients with high social status, influence or personal connections can cause changes to their medical treatment. This can include wanting to be treated quicker, getting extra attention and unnecessary investigations. This pressure can come from powerful patients but can also come from family members and hospital staff. This can also happen when treating other medical professionals and their families. It creates an issue where patients can be treated based on their influence. Every patient should be offered evidence-based treatment regardless of their status or connections.

The doctors describe one scenario where a 58-year-old female with late-stage ovarian cancer had surgery done without proper preparation due to hospital staff pressure. She also had a prolonged stay in the ICU. This meant she did not mobilize as quickly as she should have after surgery and developed a basal atelectasis. This is a complication where a section of the lungs fails to fully inflate. She then developed further lung complications. Overall, she had a prolonged stay of 12 days in hospital compared to around 5 days for similar surgeries. By performing surgery without managing any risk factors in the patient, such as uncontrolled diabetes or recent smoking, complications can increase. Prolonged stays in ICU can cause unnecessary complications.

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This opinion paper outlines a patient who was a 60-year-old female with early breast cancer. Her family wanted a PET-CT scan done despite concerns that it was unnecessary. This resulted in increased activity in the lymph nodes in her chest. This meant she had another biopsy to determine if the cancer had spread. The biopsy showed reactive changes. Unnecessary investigations can cause more procedures and therefore cause delays. In some instances, this can cause the disease to progress. Patients can become more difficult to gain trust from if they have used unreliable sources online for medical advice or come into hospital with set treatment plans. Patients may also not provide important medical history.

VIP treatment can cause issues for other patients. Hospitals have limited beds, theatre time, and staff. The doctors from AIIMS explain that in their experience at an oncology centre, 3 patients could have had surgery during the time that one patient was staying in a private ward unnecessarily. This was a learning from their experiences and not an overall number for the hospital. Prolonged stays and constant requests to see senior doctors can cause beds to be unavailable. Patients waiting to have surgery or treatment can be impacted, and staff will have less time for other patients. Medical treatment should be given based on clinical urgency and not based on status or influence.

VIP culture can cause issues for doctors. A first-year surgical resident performed a drain removal as per usual practice. However, a family member complained, and the Head of Department had to explain why the resident performed the procedure. This can create unnecessary stress on junior doctors. This can impact staff confidence and cause increased stress in the workplace. Doctors may struggle to make their own clinical decisions. The paper outlines scenarios where families of medical professionals have wanted extra treatment.

Clear policies should be in place to ensure decisions are made based on clinical needs. These include:

• Clear admissions and discharges – Patients should be admitted and discharged based on their medical needs.

• Evidence-based decisions – Investigations, surgery, and ICU should be done based on medical guidelines.

• Improved communication – Doctors should explain decisions made to patients and families.

• Fair distribution of resources – Beds, staff, and theatre should be distributed fairly based on patients' needs and urgency.

• Support for healthcare workers – Hospitals should support doctors who are following clear protocols.

They should not feel pressured into making decisions that are not medically justified. Patients have the right to ask questions, understand their treatment, and get second opinions. However, this can cause pressure. Hospitals should keep records of these cases and discuss them internally. Policies should be in place to ensure consistency. Reasonable exceptions may be acceptable if they don’t impact the quality of care. This paper shows the importance of protecting patient safety, clinical decisions, and fair healthcare. However, this is based on clinical experiences and does not give a clear understanding of how common VIP culture is within Indian hospitals.

(Rh/AM)