ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
VIP treatment exists in emergency departments, whether it is formalized or quietly embedded through professional courtesy, donor status, or a phone call ahead. The real clinical and ethical tension is equity: when special handling protects care and operations, and when it distorts triage, flow, and staff boundaries.
VIP Treatment Ethics and Operations
- Formal versus informal systems: VIP pathways are rarely just a single secret room; they often appear as unofficial prioritization for staff family, donors, EMS, police, or well-connected patients, raising the same equity problem either way.
- Equity over access: The central issue is not courtesy itself but whether special treatment changes triage, rooming, or disposition for reasons other than medical need, a distinction worth hearing in the episode.
- Service recovery use: Selective fast-tracking can be defensible as service recovery when it prevents a disruptive waiting-room spiral, but that is different from letting money, fame, or pressure skip the line.
- Professional courtesy limits: Most claimed VIP status is informal and proximity-based rather than institutional, which is why departments need a clear sense of who, if anyone, gets exceptions and when those exceptions stop.
- Boundary setting moments: VIP treatment becomes inappropriate when a patient is abusive to ED staff or when accommodations begin to impair departmental flow and other patients' care; we get into the wording in the chapter.
- VIP care for everyone: A scalable alternative is a universal VIP experience: practice evidence-based medicine, make a clear recommendation, and ask what the patient expects from the visit to align care without favoritism.
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Faculty
- Andy Little, DO
Dr. Andy Little is an emergency medicine physician and educator. He earned his medical degree from the Ohio University Heritage College of Osteopathic Medicine and completed his emergency medicine residency at OhioHealth Doctors Hospital Emergency Medicine Residency, where he served as Chief Resident. He has received multiple national awards, including recognition from the American Osteopathic Association, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents' Association.
- Drew Kalnow, DO
Dr. Drew Kalnow is an emergency medicine physician and educator based in Columbus, Ohio. He completed his emergency medicine training at OhioHealth Doctors Hospital Emergency Medicine Residency. Dr. Kalnow is passionate about advancing emergency medicine through high-quality education, with a particular focus on simulation, learning theory, and innovative teaching.
- Matthew DeLaney, MD, FACEP, FAAEM
Dr. Matthew DeLaney is an emergency medicine physician and educator based in Birmingham, Alabama. A native of Mobile, he earned his medical degree from the University of South Alabama and completed his emergency medicine residency at Maine Medical Center.Dr. DeLaney has experience in both community and academic emergency medicine and is known for his commitment to teaching and medical education. He lives in Birmingham with his wife, Erin, who is also a physician, and their two daughters.
