New Delhi: ‘VIP culture’ in hospitals can compromise patient safety and equitable access to care, with pressure to accommodate influential patients sometimes leading to medical decisions that depart from standard protocols, AIIMS Delhi doctors have warned.
In an opinion paper published in Oncology Reviews, surgical oncologists Prof. M D Ray and his MCh student Dr Hema Siri Kottu describe how pressure from influential patients, their families and hospital management can lead to unnecessary investigations, surgery before adequate preparation and prolonged intensive care stays.
“Every cancer patient deserves the same standard of evidence-based care. VIP syndrome arises when a patient’s influence or connections alter clinical decisions,” Prof. Ray, professor of Surgical Oncology, told TOI.
The authors describe two cases. In the first, a 60-year-old woman with early-stage breast cancer underwent a PET-CT scan after her relatives insisted on it. The scan showed increased uptake in lymph nodes in her chest, prompting a further biopsy to check for cancer spread. The biopsy found reactive changes rather than cancer spread.
In another case, a 58-year-old woman with advanced ovarian cancer underwent surgery without adequate pre-operative preparation following pressure from hospital management. Delayed mobilisation contributed to lung complications, extending her hospital stay to 12 days, compared with the usual five days for similar surgeries, the authors reported.
“Pressure to advance surgery before adequate preparation, order unnecessary investigations or prolong ICU admission can expose a patient to avoidable harm while restricting access for others,” Prof. Ray said.
The impact can extend to hospital staff. In one case, the department head was asked to explain why a first-year surgical resident had removed a patient’s drain according to protocol after a relative objected to the resident performing the procedure. The authors said such incidents can create stress for junior doctors and staff who face scrutiny for following standard clinical practice.
The authors also reported that, in their experience at the oncology centre, three breast surgery patients could have been operated on in the time taken up by one patient whose private-ward stay was extended. They said prolonged stays and demands for extra attention can reduce patient turnover and affect the use of limited hospital resources. This was an observation from their clinical practice, not a hospital-wide estimate.
Prof. Ray said discrimination between patients in a premier hospital erodes trust, undermines staff morale and damages a positive work culture by allowing status and influence to take precedence over clinical need and equal dignity.
The authors call for transparent admission and discharge criteria, consistent clinical protocols, better communication with patients and kin, and institutional support for doctors. Patients must remain free to ask questions and seek second opinions, Prof. Ray said, but pressure to override sound medical judgement must be resisted. “Clinical urgency, not social status, should determine priority,” he said.
The paper draws on the authors’ clinical experience; it does not measure how widespread ‘VIP culture’ is in hospitals.
