Earlier this week one of my best friends from medical school, Dr. Shoa Clarke (or Shoa Beans to me :P) published an op-ed in the NYTimes titled “How Hospitals Coddle the Rich.” In the article he describes how many hospitals throughout the country offer VIP services to the wealthy and how that may be detrimental to other patients not offered the same courtesy but also the VIP patients themselves. It’s a thought provoking article that makes you wonder, instead of money buying happiness, can extra money really buy you better healthcare?
As a medical student at Stanford I don’t recall personally taking care of any red blanket patients, but I definitely heard of them. Red blankets were given to patients who were deemed “VIP,” examples being big donors to the hospital, a faculty member’s family member, or a very wealthy individual. These patients were often given bigger hospital rooms with windows and no roommate. At other hospitals like the one Shoa is training at in Boston, patients could pay more to have amenities like bathrobes, better dining options, and a business center. This may not seem fair, but in my opinion, this is how the business of practicing medicine ends up playing out, with or without a signifier like a red blanket.
What gives me pause about the practice is the thought that other patients who aren’t VIP’s are getting worse care because of it. In my experience, I have not seen this happen, from the level of nursing all the way up to the attending physicians. Sure, the VIP patient may get a little bit of extra time to discuss their case with the doctors, but the teams of doctors I’ve worked with do not then cut time short with other patients. I believe that inherent in every physician is a desire to heal and care for patients (some may say I’m naïve) and that means not discriminating against someone because of their financial status. Granted, I trained intern year at a county hospital where many patients were uninsured, but I also spent time at Stanford which saw its fair share of patients from both ends of the financial spectrum.
A really interesting point Shoa brings up is the thought that VIP patients actually get worse care because of their status. He mentions a study with a fascinating finding that goes contrary to what you’d think about satisfied patients. This JAMA study published in 2012 showed that higher patient satisfaction was associated with greater rates of hospital admissions, higher healthcare and medication expenditures, and even increased death! The reason lies in patients requesting more services, sometimes even invasive ones, that are not medically indicated, and when physicians give in to these demands, bad outcomes can happen. This makes me think of my own field, dermatology, or other fields like plastic surgery, where there is a huge patient population coming in for elective cosmetic services that they pay out of pocket for. At some point, do doctors draw the line at what is too much Botox or yet another facelift procedure?
So what do I think? For additional amenities such as nicer hospital rooms, better food, nicer gowns, etc. I understand that hospitals which are struggling to make money can charge more for better service. But when it comes to decisions that can impact someone’s medical care directly, I think physicians have to be fair. That means not treating other non-VIP patients with any less time and attention and on the other end, to not give in to unnecessary and potentially dangerous demands of VIP patients. At the end of the day, we need to do what we’ve always been meant to do: practice sound medicine. Period.