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August 20, 2020

Observations on Ophthalmic Care and Surgery for Very Important People

Author Affiliations
  • 1Department of Ophthalmology, Weill Cornell Medical College, NewYork–Presbyterian Hospital, New York
JAMA Ophthalmol. 2020;138(10):1015-1016. doi:10.1001/jamaophthalmol.2020.2971

Regardless of practice setting, experience, or expertise, most ophthalmologists will be asked to care for a very important person. This individual may be a prominent athlete, musician, movie or television personality, artist, political leader, wealthy individual, philanthropist, or even a family member or medical colleague. Whether the prospect of caring for a very important person engenders enthusiasm or dread, it is certain to provoke strong feelings not only in the treating ophthalmologist but also in their professional associates and trainees, office and hospital staffs, administrators, and virtually all support personnel. This places everyone, most pointedly the patient, at risk of entrapment in a condition called the VIP syndrome. This unfortunate syndrome has been quite well characterized since an early, possibly initial description in 1964.1-3 It begins insidiously from such understandable intentions, such as (1) sparing the very important person pain or inconvenience, (2) minimizing the mention of (or avoiding blame for causing) a poor outcome, or (3) deviating from standard practice for a host of reasons. If unrecognized and unaddressed, these influences can concatenate and result in substandard, chaotic, and even dangerous care. Numerous accounts, including several written after the assassination attempt on US president Ronald Reagan in 1981,4 document the difficulties encountered in rendering appropriate care in the grip of the VIP syndrome. The article by Smith and Shesser5 contains an excellent discussion of many enduring issues in the care of very important people, such as security, privacy, and communication. Given the extraordinarily high value placed on sight and the corresponding profound fear of its loss, the challenges of providing effective and compassionate ophthalmic care and surgery for a very important person merit a careful look, considering new influences in our medical environment.

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1 Comment for this article
Observations on ophthalmic care and surgery for VIPs
Frank Larkin, MD | Moorfields Eye Hospital, London, UK
Thank you Dr D'Amico for this Viewpoint. It is as superbly written as it is timely.