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Toni Talks about PT Today

VIP Patients

Published February 18, 2010 5:46 PM by Toni Patt
I've yet to work in a facility that didn't maintain that all patients are treated equal.  Anyone who has ever worked in health care can tell you that isn't so.  Just let a doctor or other prominent patient be admitted.  Administration will immediately fall all over itself to make sure that patient is treated like a VIP.  Administrators see this as a positive thing.  Those of us who provide the care feel differently. 

As soon as these patients realize their every demand will be met, they will ask for more.  The family dynamics are often strained which makes the situation worse.  Last week one of those special individuals was admitted to my facility.  What followed has been a horror story. 

The patient himself was not a problem.  The same couldn't be said for his family.  From his admission none of them were happy with the service or care he received.  He was intubated so I doubt he expressed an opinion.  The daughters argued with the ICU team about everything including when he would leave the unit.  Once he left the unit, his wife took out her frustration on anyone who happened to enter the room.  Her explanation was that she hadn't slept for five days and was worried about her husband.

That's interesting.  I think I can safely say the families of all of my other patients are also worried. Many of them are probably sleep deprived.  Yet, none of them behave like that.  Most are happy for any care received.   Administration became involved following the wife's first outburst.  After that, several of them made it a point to visit two or three times daily.  I wonder how they found the time given their busy schedules.

Although I avoided the situation, it didn't look like all the special treatment did any good.  His family has remained unhappy.  This morning the patient was moved back to the ICU because the family preferred that level of care.  I wonder who will be paying for that since insurance companies refuse to pay for ICU unless it is medically necessary.   Patient preference isn't medical necessity.  If it was, our ICUs would stay filled.

The problem is no one will tell these families, and sometimes patients, "no."  Administrators are so worried about what the family will think, that they lose sight of the bigger picture.  Patients are in the hospital is to get better, not to receive five-star hotel treatment.  What really irks me is the effect this has on other patients who are left waiting because so many resources are dedicated to one patient.  Not even hospital employees receive that kind of care if they are admitted.

Obviously these families feel they are entitled to such treatment.  They expect it.  I'm sure administration will eat any additional costs associated with meeting their needs.  That's the same administration telling its employees to cut costs and watch expenses. That's the same administration who refuses to comp anything on hospital or parking bills for anyone else.  You might get a few free meals.  You might get a discount at the gift shop.  Your bill won't change. 

It's a misconception to believe all patients are treated equal.  That just doesn't happen.  Everyone receives the same standard of care but some patients get more of it.  A VIP patient is never skipped for therapy.  A VIP patient gets to tell the therapist when he wants therapy and is accommodated.  In some cases VIPs even get to pick the therapist.  The CEO of a hospital I worked at several years ago had a stroke.  After he was admitted to the facility his "care team" was handpicked for the duration of his stay.  I hope I get that kind of care if I'm ever admitted as a patient.  I can hope, but I doubt it will ever happen.


Dean makes a good point with PR issues, if that is the level of VIP you are referring to.  But, it doesn't just happen with VIPs - squeaky wheels also receive inappropriate levels of care.  

I was one in a long line of therapists to see a young man who had been in a vehicle accident.  His parents were grief stricken, as one would expect.  I came in to play during year three.  His parents were certain he was responding, but there was no indication any movements were purposeful.  The mother was so demanding and persistent, telling her "no" was more trouble than it was worth.  Thousands of dollars and hours had been spent on this young man's care - in the home, in the school system, and in out patient care.  If there was a discipline that treated patients with head injuries, he was being seen by them.  

I can't imagine what it would be like to have a healthy child one moment and an invalid the next.  With all that is in me, I hope I never have to live that reality.  But I have to think that I would be better off in the long run for someone to gently speak the truth to me than to cower to my requests because they didn't have the fortitude to stand up to my rants.  So that is what I did.  I discharged the patient after explaining to the mother why.  

The very next week I had a doctor's order come across my desk to evaluate and treat him.  I respectfully declined.  The doctor didn't like it.  My supervisor didn't like it.  But they knew I was right.  They found someone else who would provide the unnecessary care.  If the patient is still living, he is probably still receiving that care today.

We can only do so much.  We can't control another's actions.  All we can do is decide what we can live with and make decisions for ourselves based on that.  My head on my pillow at night - that's the only one I have any say over.

Janey Goude February 23, 2010 1:56 AM

Intresting.  I worked in Palm Springs for a while.  Large resort styled double rooms, plush carpet, free flowers and fruits for the VIP's.  There are some facilities that will cater to them.  To tell the truth it was nice to work for some of those places. I felt like I was on vacation when I stepped through the doors.  

You are right, I doubt we will get that extensive treatment when we are in the hospital.  And Dean is right, endownments and press can play a huge role in the treatment one gets.  Imagine if Reagan was treated like the usual GSW in the E.R./O.R. or Clinton was given HEP's after the normal 3 day stay after knee surgery.    

Jason February 19, 2010 10:43 PM

Entitlement seems to be a theme with your posts as of late. I worked for a 5 star hotel (whoops, I mean hospital) in New York City when I first started practicing. Lots of celebrities, business moguls, and benefactors came across my roster. Yes, admin fell over backwards to prevent loss of endowments, bad press, or complaints to DOH. Legitimate or not, DOH must follow up in NY and that is never fun to go through.

My professional satisfaction improved greatly when I started doing homecare in central Harlem.

Maybe it is time to reconsider where you practice.

Dean Metz February 18, 2010 5:55 PM

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