Caring for 'Very Important Patients'--Ethical Dilemmas and Suggestions for Practical Management.

The care of Very Important Patients (VIPs) is different from other patients because they may receive greater access, attention, and resources from health care staff. Although the term VIP is used regularly in the medical literature and is implicitly understood, in practice it constitutes a wide and heterogeneous group of patients that have a strong effect on health care providers. We define a VIP as a very influential patient whose individual attributes and characteristics (eg, social status, occupation, position), coupled with their behavior, have the potential to significantly influence a clinician's judgment or behavior.

Nonurgent use of the emergency department.

Emergency department (ED) overcrowding by low-acuity patients is a recognized problem. There is little in the literature on why patients with minor problems and an established primary care physician (PCP) present to the ED. Two hundred forty low-acuity patients with a PCP were surveyed regarding their reasons for presenting at a University of Colorado ED.