Fast-tracking dermatologic care for "very important person" patients: Ethical concerns and practical approaches

Requests to expedite dermatology appointments for socially, professionally, or institutionally connected patients are common in academic medical centers. Prior literature has described "very important person syndrome" and the ethical challenges of caring for prominent patients, but less attention has been given to dermatology-specific fast-tracking through clinic scheduling, electronic messaging, on-call pathways, procedural access, and donor-related requests. These pathways raise recurring ethical concerns when influence, philanthropy, or proximity to institutional authority affects access to appointments or procedures. This contribution examined a very important person fast-tracking in dermatology through the ethical principles of justice, beneficence, nonmaleficence, and truthfulness. We argued that expedited access may be ethically defensible when based on clinical urgency, unusual complexity, or use of added clinician time that does not displace patients with greater need. Preferential access, however, becomes ethically problematic when it bypasses standard triage, weakens transparency, creates a multitiered access system, or diverts limited resources away from vulnerable patients and communities. We also addressed donor-related very important person requests, recognizing the institutional importance of philanthropy while emphasizing that financial contribution should not justify bypassing medically appropriate evaluation or equitable scheduling processes. We proposed practical safeguards for dermatologists and departments, including urgency-based triage, preservation of core clinical protocols, use of cancellation lists or added time when feasible, transparent expectations for requests, and avoidance of displaced care for higher-acuity patients.