Psychiatric Annals

Editorial 

The Dangers of ‘VIP’ Treatment

Jan Fawcett, MD

Abstract

We begin 2012 by focusing on the challenges inherent in treating the “VIP” in psychiatric practice.

The VIP (very important person) patient’s potential impact upon a medical facility is rarely addressed by the literature; yet, because everything from the patient’s clinical outcome, to the facility’s standing in the local community, to the facility’s ability to raise funds, can be affected, it is a topic well worth reviewing.

Guest edited by Stephen H. Dinwiddie, MD, the papers presented here examine the ethical, medical, and practical implications of conferring special status on certain patients.

Dr. Dinwiddie and colleagues offer practical insight to clinicians who may at times be called upon to care for a celebrity or politician who demands to be shielded from public scrutiny; a very wealthy person accustomed to privilege; or a colleague who second guesses our medical management of his or her condition.

This month’s issue exemplifies our intention with all issues of Psychiatric Annals: to provide relevant information that clinicians can put to use immediately.

As I write this, I am sitting on a balcony overlooking the white-capped Pacific, palm trees swaying in the wind. I am in Kona, Hawaii, attending the 50th annual meeting of the American College of Neuropsychopharmacology. In this relaxed setting, I am reminded of the question I typically ask myself four times a year — on my birthday, during the academic New Year (July 1), the Jewish New Year (Rosh Hashana), and the secular New Year: How do I want to spend my precious consciousness this year? None of us is guaranteed any period of consciousness; I want to experience every second of what I do have with maximum intensity.

I want to know what will bring me the most meaning. I am seeking how best to apportion my time spent doing the things I love best: helping “hopeless” patients forge a creative life; finding ways to improve my clinical practice; teaching psychiatric trainees how to practice more effectively; and writing fiction.

I just finished writing my first novel, Living Forever, and want to write more about consciousness, exploring what else I can do to intensify my experience of it. Should I pursue the nature of Mu? After “playing around” with Zazen meditation for the past 20 years — should I get serious about it? That’s a major commitment.

As a rank beginner, I have occasionally experienced a hint of the deep feeling of peace resulting from Zazen (getting to “no-thought”). Typically, I have been wary of gurus; I have never trusted another frail human being to influence me spiritually, except by example. This is something for me to seriously think about. I will at least continue to read Philip Kapleau’s The Three Pillars of Zen.

What are you going to do in 2012 to experience the wonder of the consciousness you have been given? A meaningful New Year to you and yours.…

We begin 2012 by focusing on the challenges inherent in treating the “VIP” in psychiatric practice.

The VIP (very important person) patient’s potential impact upon a medical facility is rarely addressed by the literature; yet, because everything from the patient’s clinical outcome, to the facility’s standing in the local community, to the facility’s ability to raise funds, can be affected, it is a topic well worth reviewing.

Guest edited by Stephen H. Dinwiddie, MD, the papers presented here examine the ethical, medical, and practical implications of conferring special status on certain patients.

Dr. Dinwiddie and colleagues offer practical insight to clinicians who may at times be called upon to care for a celebrity or politician who demands to be shielded from public scrutiny; a very wealthy person accustomed to privilege; or a colleague who second guesses our medical management of his or her condition.

This month’s issue exemplifies our intention with all issues of Psychiatric Annals: to provide relevant information that clinicians can put to use immediately.

A New Year of Consciousness

As I write this, I am sitting on a balcony overlooking the white-capped Pacific, palm trees swaying in the wind. I am in Kona, Hawaii, attending the 50th annual meeting of the American College of Neuropsychopharmacology. In this relaxed setting, I am reminded of the question I typically ask myself four times a year — on my birthday, during the academic New Year (July 1), the Jewish New Year (Rosh Hashana), and the secular New Year: How do I want to spend my precious consciousness this year? None of us is guaranteed any period of consciousness; I want to experience every second of what I do have with maximum intensity.

I want to know what will bring me the most meaning. I am seeking how best to apportion my time spent doing the things I love best: helping “hopeless” patients forge a creative life; finding ways to improve my clinical practice; teaching psychiatric trainees how to practice more effectively; and writing fiction.

I just finished writing my first novel, Living Forever, and want to write more about consciousness, exploring what else I can do to intensify my experience of it. Should I pursue the nature of Mu? After “playing around” with Zazen meditation for the past 20 years — should I get serious about it? That’s a major commitment.

As a rank beginner, I have occasionally experienced a hint of the deep feeling of peace resulting from Zazen (getting to “no-thought”). Typically, I have been wary of gurus; I have never trusted another frail human being to influence me spiritually, except by example. This is something for me to seriously think about. I will at least continue to read Philip Kapleau’s The Three Pillars of Zen.

What are you going to do in 2012 to experience the wonder of the consciousness you have been given? A meaningful New Year to you and yours.

10.3928/00485713-20111229-01

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