Loading ...

The patient on your list is not just any patient but the chief of your division. He needs surgery, and he wants you. He says he trusts your skills and expects you to go above and beyond. The request may sound flattering. It is also exactly the kind of situation that can unsettle judgment, blur boundaries, and pull care away from standard practice.

So-called VIP syndrome — also described as the recommended patient syndrome — arises when well-intentioned efforts to provide extra attention to a prominent patient inadvertently distort care. Recent literature describes the problem in celebrities, physicians, political leaders, and other well-connected patients, warning that preferential treatment can lead to unnecessary interventions and departures from routine clinical processes.

How common this problem is remains unclear, with recent reviews noting that empirical research is sparse. What the literature does show is that treating clinicians can come under unusual pressure when the patient is a fellow doctor or another person of influence.

That tension matters because equitable access is a core organizing principle of many healthcare systems, whereas the day-to-day reality of caring for a colleague, hospital donor, public figure, or senior leader can make equal treatment difficult to sustain.

A Dangerous Dynamic

In a 2022 qualitative study in JAMA Network Open, 17 of 21 physicians interviewed in Atlanta said physician-patients were able to obtain privileges generally unavailable to other patients, even though interviewees did not report changing formal treatment plans. More recently, a 2024 qualitative study of 26 general practitioners in Australia found that treating doctor-patients can alter consultation dynamics around testing, sensitive topics, and decision-making, while also provoking anxiety, self-consciousness, and concern about being judged by a colleague.

The central concern is whether a patient’s status changes clinical decision-making, communication, or access in ways that pull care away from other patients or from standard practice.

“Care delivery should follow the usual clinical hierarchy, with a clearly designated attending physician leading the case and junior team members maintaining routine monitoring and communication,” Hashem A. Abu Serhan, MBBS, MD, an ophthalmologist at Hamad Medical Corporation in Doha, Qatar, told Medscape News Global. “It’s essential that the attending physician maintains leadership, reinforces adherence to institutional policies, safeguards patient confidentiality, and sets clear expectations that the care provided will be identical to that of any other patient with the same condition.”

VIP Care From Both Sides

From the patient’s side, the impulse is understandable. A physician who becomes a patient, or who is seeking care for a relative, often knows exactly whom to call and how to accelerate access. In fragmented systems, those advantages can cut through bureaucracy. But the literature suggests that the same insider status that smooths access can also complicate care because both parties enter the encounter with overlapping professional identities and assumptions.

Some accommodations may be appropriate. A public figure, for example, may reasonably need heightened attention to confidentiality. Privacy protections, however, are different from special clinical handling.

“Managing VIP patients requires striking a balance between excellent clinical standards and personalized, discreet service,” Nicola Zingaretti, MD, PhD, consultant plastic surgeon at SOC Clinica di Chirurgia Plastica at Azienda Sanitaria Universitaria Friuli Centrale and associate professor of plastic, reconstructive, and aesthetic surgery at the University of Udine, both in Udine, Italy, told Medscape News Global.

He said doctors who are treating VIPs need to set limits and preserve the normal balance of clinical authority while remaining objective and empathetic.

“It’s essential to offer the utmost privacy, appointment flexibility, and a comfortable environment while strictly upholding rigorous medical integrity,” said Zingaretti. “It’s equally important to maintain a high level of professionalism and empathy.”

How VIP Status Can Distort Standard Care

In the 2022 JAMA Network Open study, nearly half of the interviewed physicians said physician-patients tried to dictate aspects of their care. Interviewees described requests for extra visits, involvement of senior specialists in routine matters, and second opinions from within the same team. Despite the small number of people interviewed for this study, it does demonstrate the mechanism by which status can disrupt ordinary care.

Higher expectations by VIP patients can also quickly spill over into clinicians’ day-to-day lives.

“A highly connected VIP patient was given the personal phone number of my colleague, the treating physician,” explained Serhan. “While intended as a gesture of attentiveness, this led to frequent calls outside working hours, significantly disrupting the physician’s personal life and blurring professional boundaries. This experience highlighted how deviations from standard communication channels, even with good intentions, can negatively affect both physician well-being and the quality of care.”

VIP patients can also have unrealistic expectations. “I frequently encounter VIP patients who expect their wound healing or postoperative recovery to proceed faster than that of other patients,” said Zingaretti.

Clinicians also describe pressure to overinvestigate when the patient is a colleague or other high-status figure.

“Unnecessary investigation is often masqueraded as ‘more is better,’” Ching Soong Khoo, MD, professor of neurology at the National University of Malaysia in Bangi and consultant physician and neurologist at Hospital Canselor Tuanku Muhriz in Kuala Lumpur, both in Malaysia, told Medscape News Global. “Contrary to this conventional belief, this may do more harm. For example, by exposing an individual with no indications to radiation injury by doing a CT scan; by causing emotional stress and fear after detection of slightly elevated blood levels, false positives, or mildly raised cancer markers in an asymptomatic patient; or by inappropriate escalation of an antibiotic to a more broad-spectrum class drug, resulting in antibiotic resistance.”

There’s also a risk for overtreatment. “I saw an elderly patient whose daughter was my colleague and a consultant dermatologist,” said Khoo. “He had experienced a recurrent syncopal attack, with a heart rate of 40-50 beats/min. A cardiologist first saw him and advised a pacemaker, but she brought him to see me for a second opinion. After my unbiased clinical assessment, I believed he actually had vestibular neuritis followed by vasovagal syncope. He recuperated completely after treatment with betahistine, without a pacemaker implantation.”

Boundary strain can be a consistent risk in these cases. In the 2024 Australian study, general practitioners described feeling pressure to perform well in front of colleagues, uncertainty about how much medical detail to explain, and discomfort discussing sensitive issues with doctor-patients.

“Physicians must maintain professional boundaries and avoid deviations from clinical guidelines, even in the presence of external pressures from administration, colleagues, or patient families,” said Hema Siri Kottu, MBBS, MS, MCh, senior resident at the All India Institute of Medical Sciences in New Delhi, India, who co-authored a 2025 review on VIP management in surgical oncology. “Clear communication is key — patients should feel heard, but decisions must remain grounded in medical necessity.”

The same applies at the team level.

“Remind everyone to stick to their protocols,” Amir-Reza Hosseinpour, MD, PhD, chief of pediatric and congenital cardiothoracic surgery at the University Hospital of Vaud in Lausanne, Switzerland, told Medscape News Global. “Don’t give in to pressure and intimidation from patients and their family members who are friends of your boss or who give money to the hospital.” If issues result, he said, bring them to a supervisor and be honest about how a VIP’s behavior is affecting care.

What System Changes Could Help?

Hospitals cannot remove status from medicine, but they can reduce the opportunities for status to distort care.

Practical approaches include having:

• Clear attending responsibility
• Protocol-based testing and treatment
• Protected confidentiality
• Limits on direct access outside usual channels
• Explicit institutional policies stating that VIP patients receive the same clinical care as any other patient with the same condition

“We’ve seen that when patients — regardless of their status — trust the treating team and adhere to standard protocols, outcomes were significantly better, with timely recovery and discharge,” said Kottu. “This reinforces that equitable, protocol-driven care benefits all patients.”

Hospitals should also require patient and family meetings, including for VIPs, in which equal-care terms are clearly communicated. “During the meeting, the VIP should be offered unbiased professional management plans, which remind all involved about the potential risks of unnecessary testing, and offered reassurance that the right care will be delivered,” said Khoo.

Additional guardrails can also be put in place. “Institutions also play a crucial role by implementing transparent systems for resource allocation, ensuring that staffing, equipment, and access to services are determined solely by clinical need,” said Serhan. “Additionally, healthcare systems should address chairperson’s syndrome — the idea that VIP patients request senior figures assuming superior care — by reinforcing that the most appropriate clinician, not necessarily the most senior, is responsible for patient management. Establishing institutional oversight, such as ethics committees or review boards, can help ensure accountability and monitor for preferential treatment.”

The central lesson is that clinicians across settings repeatedly describe the same pattern: Status changes behavior, and changed behavior can destabilize good care. For healthcare institutions committed to equity, the answer is not special pathways for special people, but stronger systems that make ordinary, evidence-based care easier to preserve under pressure.

“Clinicians should be well-versed in handling this issue,” Khoo said. “Remember: First, do no harm is always our fundamental guiding principle in our daily clinical practice.”

Serhan, Zingaretti, Kottu, Hosseinpour, and Khoo reported having no relevant financial relationships.