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Steer clear of VIP disease

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Marlon Brando, pictured in “The Godfather,” was known for being tough to work with, and for being a difficult patient. (Courtesy Paramount Pictures)

Varying medical protocols because someone is extra-special can lead to problems.

If you are extra-special, I suggest you request plain vanilla care —and expect the best outcome to occur. Here is why.

VIPs come in all forms: superstar athletes, politicians, CEOs, social media notables and rock stars, musicians whose songs we all know.

If they are humble and are treated at the level of excellence that we all expect, things go well. If they are arrogant, or if the staff is in awe, the problems begin early.

Here are few of the potential errors that you, the VIP, might make.

It starts with the first call to the office. If you are in a rush to get in immediately, you often fail to fill out all the forms necessary for us to understand your past medical background, allergies, or other risk factors for medical and surgical care.

You will push to be seen right away, even on a day that is not a normal patient exam day for us. If we acquiesce, the diagnostic testing team may not be available — and the full complement of physical therapists may already be booked out. Thus, you won’t benefit from the PT assessment and instruction. We use physical therapists to help patients avoid surgery or to get the most out of any surgical procedure. And the PTs often see issues the surgeon may not see. This collaboration leads to the highest quality care. You risk missing out on that when you skip the full evaluation.

You may not book enough time for a pre-op conversation, the lengthy physical exam and review of imaging studies—not to mention time for any additional MRIs or X-rays. Normal appointments with our clinic take from two to four hours.

Squeezing us in between your other obligations just doesn’t cut it, assuming you want truly insightful diagnostic analysis.

Once scheduled for surgery, you forget the instructions on pain medications, blood clot prevention and bowel management. You get constipated and woozy on unnecessary narcotics. You request extra opioids and, thanks to your extra doses of charm, you receive them … and the problems associated with opioids multiply. You sleep wearing a brace that you were supposed to take off. You can’t remember how to use the ice machine, which helps keep your knee cold and reduces pain.

The surgical and rehab team does not get enough time to get to know you personally, so the little changes that we usually make to customize your surgery and rehab program get skipped. And you don’t book enough days in PT after surgery, forgetting that it takes months to fully heal. You forget that we are encouraging you to be an athlete in training, rather than a patient in rehab — a mindset that involves training your entire body while your injured joint is healing.

You jump on a plane to attend an “important” business meeting the week after surgery, which increases your blood clot risk, your swelling and your stiffness.

Due to your busy schedule, you want PT at home rather than in the clinic. While you are out of a trainer’s eyesight, the little problems that pop up turn into big problems that may have been avoidable.

You accelerate the post-op protocols on your own, due to the delusions of invincibility that made you a VIP in the first place. This acceleration sometimes works out great — and other times leads to procedure failure. But you would never acknowledge that it’s your error.

The nursing team, meanwhile, has a hard time following up with you, as you insist they go through your assistant to answer every question.

So even you—the VIP—are much better off being one of the very important patients in our practice, and not the standout. Plain vanilla is sometimes the perfect flavor.

Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.

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