Letter to the Editor: December 2023

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Challenges of Caring for Colleagues and VIPs in Dermatology

Dear Editor:

Physicians have an innate drive to help others. When the patient is a family member, close friend, or colleague, professional boundaries can become blurred. Patients who have close physician relationships often receive benefits that include hassle-free scheduling without needing referrals, reduced wait times for appointments, and quality care from a trusted professional. However, there have been reported instances by healthcare workers who have put the needs of colleagues or “very important persons” (VIPs) before the health of other patients, including bypassing emergency room wait times and jumping imaging study queues.1 Frequently leveraging these connections can cause undue harm and increased stress to the patient and provider. 

Patients naturally appreciate ease of scheduling and expedited appointments. New patient dermatology appointments can extend nearly six months out, yet physicians and VIPs often receive above-standard care at places where they have personal and financial relationships, unaware that this could lead to severe consequences and fallout. An evaluation by a physician who may be biased can muddy the diagnosis or identification of potential treatment options and is less likely to elicit a proper history, conduct a thorough physical examination, or adequately document in the medical record.2 Furthermore, malpractice lawsuits and revocation of a physician’s medical license are potential repercussions if physician negligence was discovered or injury was caused. 

Physicians who care for VIPs can unintentionally violate the principles of medical ethics. There is pressure to provide unnecessary care that may not be medically indicated in fear of professional retaliation.3 A physician who negatively impacts their patient’s health, even if unintentionally, violates the principle of nonmaleficence, and while there are many low-risk procedures in dermatology, medical errors can occur even in the most straightforward procedures. Informed consent should always be formally sought, along with an appropriate description of the risks and benefits.4 A survey of staff who treated fellow healthcare workers found increased levels of stress and an overestimation of their colleague’s knowledge.5 Inadequate explanations from healthcare workers about medication instructions or treatment complication risks puts patients at elevated risk for malpractice. Moreover, this might violate patient autonomy if they are unaware of the specific care being provided. Separately, prioritizing the health of colleagues and VIPs can impact the wellbeing of individuals who come from lower socioeconomic or educational backgrounds. Beneficence and justice are diminished, and healthcare inequities are exacerbated as those who can afford a professional network appear to be prioritized. Disadvantaged populations already experience extended wait times and are thus more likely to have advanced clinical presentations.2  

Setting boundaries with friends and coworkers is critical, especially when prescribing medications. According to one survey, 83 percent of physicians had reportedly prescribed medications to family members.6 Patients might feel obligated to comply despite being against the recommended treatment.2 Self-prescribing is strongly cautioned against and will largely depend on state laws. In the United States (US), some insurance companies, including Medicare, prohibit payments when a physician provides services to a family member.

While treating family members and healthcare workers can be gratifying, physicians must fully comprehend the risks and benefits that follow. Communicating one’s professional boundaries will ensure that proper documentation is obtained and clinical judgment will not be skewed by emotions. Despite possible disappointment, declining to prescribe medications and performing procedures on colleagues or VIPs yields the most optimal outcomes. 

With regard,

Madeline Brown, BS, and Albert E. Zhou, MD, PhD

Affiliations. Both authors are with University of Maryland School of Medicine in Baltimore, Maryland.

Contributions. MB: Manuscript writing and revisions to scientific content of the manuscript. AEZ: Case identification, manuscript writing, and revisions to scientific content of the manuscript.

Funding. No funding was provided for this article.

Disclosures. The authors report no conflicts of interest relevant to the content of this article.

References

  1. Kliff S, Silver-Greenberg J. ‘Major trustee, please prioritize’: how NYU’s ER favors the rich. The New York Times. 22 Dec 2022. https://www.nytimes.com/2022/12/22/health/nyu-langone-emergency-room-vip.html. Accessed 12 Feb 2023.
  2. Bercovitch L, Perlis CS, Stoff BK, Gant-Kels JM, eds. Dermatoethics: Contemporary Ethics and Professionalism in Dermatology, 2nd edition. Springer; 2021.
  3. Allen-Dicker J, Auerbach A, Herzig SJ. Perceived safety and value of inpatient “very important person” services. J Hosp Med. 2017;12(3):177–179. 
  4. Jones JW, McCullough LB, Richman BW. The ethics of operating on a family member. J Vasc Surg. 2005;42(5):1033–1035.
  5. Svantesson M, Carlsson E, Prenkert M, Anderzén-Carlsson A. ‘Just so you know, the patient is staff’: healthcare professionals’ perceptions of caring for healthcare professional–patients. BMJ Open. 2016;6(1):e008507. 
  6. Korenman SG, Bramstedt KA. Your spouse/partner gets a skin infection and needs antibiotics: is it ethical for you to prescribe for them? West J Med. 2000;173(6):364.  

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Letters to the Editor: June 2024
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