Evaluation of Standard-of-Care Practices Among Physicians Who Treat Other Physicians

Abstract

ImportanceEthical discussions have suggested that physicians who treat other physicians may put their physician-patients at risk of receiving non–standard-of-care treatment, which may result in worse outcomes. This phenomenon occurs when a physician treats a fellow physician as a VIP (very important person), and is therefore known as VIP syndrome. It is important to assess physicians’ perceptions when treating physician-patients.ObjectiveTo determine whether the physicians treating other physicians have attitudes toward or act in ways that could place physician-patients at risk for VIP syndrome.Design, Setting, and ParticipantsThis 2-part qualitative study was conducted from December 1, 2021, to February 28, 2022. Physicians who worked at a single comprehensive cancer center with experience treating other physicians were eligible to participate. Convenience sampling was used. Emails and flyers were sent out with study information, and if interested, physicians were able to schedule an interview. Of 24 physicians responding, 3 did not have experience treating other physicians, yielding a sample of 21 (88%), which was sufficient to reach a saturation of themes. After the initial structured interview of physicians, follow-up key informant interviews were performed.ExposuresThe structured interview was developed on the basis of a literature review and focused on factors that may contribute to VIP syndrome.Main Outcomes and MeasuresParticipant responses to open-ended questions were qualitatively coded using standard multilevel semantic analysis to assess physician perceptions of treating fellow physicians. A series of Likert-scaled questions were used to identify potential contributing factors to VIP syndrome.ResultsTwenty-one physicians (11 men [52%], 11 White [52%], and 15 [71%] younger than 49 years) participated. Although no physician interviewed stated that they altered their usual treatment plans, 11 (52%) agreed that their physician-patients tried to dictate their own care, and 17 (81%) believed that their physician-patients obtained privileges, such as use of medical knowledge to participate in in-depth discussions of care, ability to obtain and use the treating physicians personal contact information, and receiving faster access to care. Eleven respondents (52%) reported increased stress, and 12 (57%) experienced more pressure not to disappoint their physician-patients.Conclusions and RelevanceThe findings of this qualitative study suggest that when physicians treat other physicians, the physician-patients may obtain privileges unavailable to patients who are not physicians. Therefore, guidelines to help physicians navigate the complex relationships between themselves and their physician-patients are needed to ensure equitable outcomes between physician and nonphysician patients.

Doctors’ experiences when treating doctor–patients: a scoping review

“… 5 , 32 , 37 , 38 First noted by Rhodes almost 40 years ago, this remains a concern in more recent literature. 23 The only quantitative study 18 found 42% of primary care doctors would order more tests and procedures, if their patient was another doctor, while a qualitative study 16 of oncology specialists found none reported differences in testing for their doctor–patients.…”

“…Treating doctors can also experience frustration with their doctor–patients, if they felt they were being manipulated into a treatment plan against their better judgement. 16 , 31 , 33 As it can be time-consuming to treat a doctor–patient, the increased workload can also result in feelings of irritation. 26 , 27 , 32 …”

“… 34 Some treating doctors reported that they provided their doctor–patient a greater degree of accessibility, including giving their personal phone number. 16 , 21 …”

“… Experiences of doctor-patients (4,20), including comparing these to ethical guidelines (22)  Differences, challenges and strategies when treating doctor-patients (14,15,19,23)  Challenges in the relationships between the treating doctor and doctor-patient -one study focused primarily on doctor-patients (21), another on the psychiatrist-patient relationship (16), a third on the palliative care setting (18)  Medical socialisation and culture: Examining the extent to which social rather than medical factors impact on a doctor's decision regarding choosing a treating doctor (17), and exploring the impact of the notion that doctors should not get sick (7).…”

“…While doctors may feel flattered to be chosen by a colleague to provide care (13,15,19,34,53), they can also find it awkward (10,15,41) and intimidating, especially providing care to a doctorpatient whose knowledge or experience is similar or greater than their own (10,25,26,44,45). They can feel less able to form independent judgements about the best treatment (8,47) and may defer to what they perceive as the doctor-patient's superior knowledge (27,40).…”