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Editorial Spotlight | September 2020

Operating on VIPs

There are nuances, but objectivity is of the utmost importance.

I work in a cutting-edge, well-established, and well-respected tertiary care ophthalmic hospital with many innovations, eminent teams, and well-laid protocols to its credit. It is therefore not surprising that many distinguished personalities from different walks of life ranging from artists and movie stars to politicians and leading business personalities come to me for their treatment.

One case that will always stand out to me is a member of a royal family from another country. The patient was referred to me by a colleague for bilateral complex anterior segment reconstruction. The cornea, iris, lens, and anterior chamber were all involved, and this patient had glaucoma. I operated on both eyes, and the patient has done well. My personal approach while operating on any very important person (VIP) includes a few important points.

No. 1: Remain Objective

Don’t get caught up in the aura that comes along with treating a big VIP. It is best to talk to VIPs exactly as you would any other patient. Remain professional, and don’t be overwhelmed. Differences in protocol may be required for a VIP patient, but nothing should be different in the sense of how you explain the surgery. This information is why they’ve come to see you. VIP patients want to know about their disease and the options available to them. They want your frank opinion about the pros and cons of each treatment option. Most important is to focus on the disease and explain just as you would to any other patient how you’re going to proceed.

No. 2: Recognize That Differences Do Exist

In the case of a royal, a lot of security is involved—in the forms of government and personal security. The members of a royal family are accompanied by an entourage everywhere they go, including to the hospital. Their personal doctor is also often part of the conversation, which sometimes makes it easier because I can now explain medical terms to a colleague. The hospital administration will handle most aspects of VIP care, so you will not be directly involved in the security issues, for example. Privacy is important for all patients but especially for VIP patients.

All of these additional provisions can cause some inconvenience for other patients who are in the hospital at the same time; appropriate administrative handling, therefore, becomes important.

One possible upside is that, when other patients see that a VIP has put their trust in you, they feel more confident about their own choice to entrust you and your facility with their care.

No. 3: Plan With Care and Have a Backup

Carefully plan not just every step of surgery but also your instruments, devices, and backup plans. Remain cool, calm, and focused on the case. Always have a backup plan and backup instruments. And prepare for every eventuality.

Discussing with colleagues and other subspecialists is often invaluable, and I am lucky to have a great team of colleagues and friends. I am also fortunate to have great mentors in the form of internationally renowned ophthalmologists, including Amar Agarwal, MS, FRCS, FRCOphth, and Athiya Agarwal, MD, upon who I can always rely for medical, surgical, academic, and moral help and guidance in making the right decisions.


In essence, all of the good practices that you’ve learned and that you generally use on a day-to-day basis apply to VIP patients.

Soosan Jacob, MS, FRCS, DNB
  • Director and Chief, Dr. Agarwal’s Refractive and Cornea Foundation and Senior Consultant, Cataract and Glaucoma Services, Dr. Agarwal’s Eye Hospital, Chennai, India
  • Member, CRST Europe Global Advisory Board
  • dr_soosanj@hotmail.com
  • Financial disclosure: None