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Dignitary Medicine: A Novel Area of Medical Training

“The burgeoning field of DM encompasses several disciplines and skills. We strongly recommend a structured curriculum for the field of DM, focused on dignitary wellness, executive health, and protective medicine.”[1]

By Michael Tetreault, Editor-in-Chief | Citations and Sources Listed Below To Continue Learning More about DM/DPM.

So there is an interesting development in Concierge Medicine that we want to help you learn more about.

It’s called “DIGNITARY MEDICINE” (DM) or, “DIGNITARY PROTECTIVE MEDICINE” (DPM).

DM or DPM, which ever you prefer, is not necessarily new. You could say that like Concierge Medicine, it’s decades and decades old. You probabaly could trace origins of DM back hundreds of years to the Romans if you really wanted to. Who knows?

Today however, DM is getting some new attention by a few peer-reviewed literature publications and what we could consider at CMT as “honorable mentions” or “nods” in the concierge medicine direction late.

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More specifically among some peer-reviewed publications and academic types stating that “We strongly recommend a structured curriculum for the field of DM, focused on dignitary wellness, executive health, and protective medicine.”[1]

That’s cool.

Talk about a nod in the right direction towards what Concierge Medicine is and does each and every day.

Could these “honorable mentions” be that this style of medicine technically under umbrella of Concierge Medicine as a VIP-demography style of medicine is perhaps due to Concierge Medicine’s popularity in the past decade or two?

One might guess so.

DM or DPM by some is not considered a “medical specialty” according to the peer-reviewed literature below.

It’s actually more along the lines of how we describe today “executive health” or “concierge medicine”.

Interesting, right?

Let’s go back a little ways.

On January 5, 2012, Am J Emerg Med., Roger A Band  1 , David W Callaway, Bradley A Connor, Brian P Haughton, and C Crawford Mechem published an article entitled Dignitary medicine: adapting prehospital, preventive, tactical and travel medicine to new populations.

In the Abstract, they noted … Dignitary Protection Medicine (DPM) is a new area of medical expertise that incorporates elements of virtually all medical and surgical specialties, drawing heavily from travel, tactical and expedition medicine. The fundamentals of DPM stem from the experiences of White House, State Department and other physicians who have traveled extensively with dignitaries. Furthermore, increased international travel of business executives and political dignitaries has mandated a need for proficiency in this realm. We sought to define the requisite knowledge base and skill sets that form the foundation of this new area of specialization.

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For example, in 2012, months after this peer-reviewed article was published, the Atlanta Journal Constitution (AJC) writer Bob Keef, published a story called Lawmakers get bounty of benefits.

One of the most notable statements in Keef’s AJC article was … Members of Congress get free VIP treatment at military hospitals. When Republican U.S. Rep. Lynn Westmoreland of Coweta County was suffering from kidney stones earlier this year, for instance, he was rushed to Bethesda Naval Hospital — and he probably didn’t have to wait in line at the emergency room. For a nominal fee, senators and representatives can also join the congressional gym, open only to members and former members. One of the most unusual perks may come from the Office of the Attending Physician of the United States Congress. For an annual fee of $503, House and Senate members can designate the official congressional physician to be their primary care doctor — meaning they never have to leave Capitol Hill, deal with crowded doctor’s offices or be subject to the same type of care from a doctor as the rest of us. The service is optional, however, and not that popular. Among the 435 members of the U.S. House, only 141 signed up for the service this year.

A review by Concierge Medicine Today (CMT) of recent medical journal literature as late as October of 2019 in a peer-reviewed article entitled Dignitary Medicine: A Novel Area of Medical Training by Mobarak A. Al Mulhim , Robert G. Darling, Hetaf Kamal, Amalia Voskanyan, and Gregory Ciottone notes that … Executive health refers to the general health maintenance of the dignitary, something akin to concierge medicine [23]. DM physicians provide some primary care but may also refer specific health matters to specialists in predesignated medical centers of excellence. The DM physician commonly establishes a “hotline” system by arranging immediate access to the best available specialty services and consultants around the world, with particular attention to medical record security and concierge access.

The peer-reviewed article by the same authors (citations included below), also began by describing DM as … Dignitary medicine (DM) involves the provision of healthcare to government leaders and other high-profile individuals collectively referred to as “dignitaries.” Due to the unique circumstances around their lifestyle, dignitaries often receive suboptimal healthcare. We define the requisite skills needed to practice DM based on the available literature and provide a framework for training providers in these skills. A review of the English language medical literature focussing on adult subjects was performed, searching for terms such as “dignitary medicine,” “VIP medicine,” and “protective medicine.” Literature was gathered from CINAHL, Google Scholar, PubMed, EBSCOHost, and San Bernardino County Library databases and then analyzed by experienced DM providers. A total of 23 relevant articles were eligible for review. No meta-analyses on the subject exist. We found that existing studies highlight skills in wellness, executive health, and protective medicine, which form the backbone of DM. The burgeoning field of DM encompasses several disciplines and skills. We strongly recommend a structured curriculum for the field of DM, focused on dignitary wellness, executive health, and protective medicine.

The healthcare delivery models used within the Concierge Medicine space are no stranger to innovation.

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For example, Precision Medicine exploration, educational and implementation has entered Concierge Medicine in the past few years with a warm reception from Concierge Physicians and their Patients.

The Advisory Board in 2016 published an in-depth series of articles about Concierge Medicine as well. They noted that Concierge models, which allow physicians to slow their pace and offer patients more relationship-based care, are growing. Explore five popular models and strategic, operational, and legal considerations for evaluating what’s right for your medical group.

For those who would like to access this Advisory Board research, click here. It’s titled Research: Assessing the Case for Concierge Medicine.

As an observer of innovation and in particular, what’s specifically happening within all the delivery models operating in Concierge Medicine, we at CMT are encouraged by this fruitful development within the field of Concierge Medicine. Innovation is important.

Fast forward to present day, you might recall we at CMT recently featured and interviewed two amazing Physicians familiar with caring and treating dignitaries and VIPs, even several of our past Presidents. We’ll include those interviews for you to listen to in its entirity below.

 

RELATED RESEARCH | DM | DPM | FEBRUARY 2020
A dignitary medicine curriculum developed using a modified Delphi methodology

To learn more, we encourage you to further explore these studies by your peers about DM/DPM.

Here is a helpful chart/diagram …

The burgeoning field of DM encompasses several disciplines and skills. We strongly recommend a structured curriculum for the field of DM, focused on dignitary wellness, executive health, and protective medicine.[1]

Additionally, an open source article in SJEM, or the Saudi Journal of Emergency Medicine which is an international, peer-reviewed publication made the following available (see below) by Mobarak Al Mulhim et al, 2020;1(1):032.

A look into a new evolving medical specialty, “Dignitary Medicine”

Mobarak Al Mulhim*

Correspondence to: Mobarak Al Mulhim

*Beth Israel Deaconess Medical Center – Harvard Medical School, USA.

Email: kfshed [at] gmail.com

Received: 29 December 2019 | Accepted: 30 December 2019


We believe the readers of SJEM will take great interest in our recent work on the burgeoning field of Dignitary Medicine (DM). Historically, there are significant lessons learned from medical catastrophes that affected or killed leaders from all over the world, all of which highlighted the importance of the physicians—leaders’ relation (When Illness Strike the Leaders—by Jerald Post). We always assume that leaders as VIP get the best health care, while in fact their health outcome are compromised by many factors, including the inner circle interference and their families influences, but also the lack of physician special training [1]. DM involves caring for government leaders, their family, and other high-profile individuals, generally referred to as dignitaries. Dignitaries require 24/7 access to complex care, mitigation against unique threats, such as assassination, coordination of medical care with security services and an inner circle of advisors, and greater medical record privacy than the average patient [2]. Given the complexities of managing such patients, we have proposed DM as a novel area of medical specialization and training. As a first step toward training physicians in DM, a consensus panel of experts from around the globe recently convened and using the Delphi methodology, created a framework for a curriculum that could serve as the basis for advanced training and potentially even fellowship level training (Mulhim, Darling, R, Sarin, R et al. A Dignitary Medicine Curriculum Developed Using a Modified Delphi Methodology. Publication pending).

The six domains of competencies were derived from the consensus to include:

  1. Executive health (Hospital based dignitary care)
  2. Protective medicine (Providing medical care and protection round the clock)
  3. Wellness and personalized health
  4. Physician leadership & quality
  5. Knowledge in technological advances (such as tele- monitoring & tele –medicine)
  6. Maintaining clinical skills & competencies in the original specialty & the essential medical emergencies.

We believe that specialists from emergency medicine would be, especially, well suited toward pursuing a career in DM. Additionally, general surgeons, trauma surgeons, internal medicine providers (especially with infectious and tropical disease expertise), critical care doctors and in some cases pediatricians and women’s health experts, would all bring necessary expertise to the field of DM.

We encourage the readers of the SJEM to evaluate our published work, reference 1 below, and await our second article on the subject, forthcoming in 2020.

SOURCE: http://www.sjemed.com/?mno=79844&html=1


SJEM References

  1. Al Mulhim MA, Darling RG, Kamal H, Voskanyan A, Ciottone G. Dignitary medicine: a novel area of medical training. Cureus. 2019;11(10):e5962. Published 2019 Oct 22. https://doi.org/10.7759/cureus.5962
  2. Band RA, Callaway DW, Connor BA, Haughton BP, Mechem CC. Dignitary medicine: adapting prehospital, preventive, tactical and travel medicine to new populations.. Am J Emerg Med. 2012;30(7):1274–81. https://doi.org/10.1016/j.ajem.2011.10.019

More Helpful Resources to Learn More About DM/DPM …

Review article | peer-reviewed

Dignitary Medicine: A Novel Area of Medical Training



Abstract

Dignitary medicine (DM) involves the provision of healthcare to government leaders and other high-profile individuals collectively referred to as “dignitaries.” Due to the unique circumstances around their lifestyle, dignitaries often receive suboptimal healthcare. We define the requisite skills needed to practice DM based on the available literature and provide a framework for training providers in these skills.

A review of the English language medical literature focussing on adult subjects was performed, searching for terms such as “dignitary medicine,” “VIP medicine,” and “protective medicine.” Literature was gathered from CINAHL, Google Scholar, PubMed, EBSCOHost, and San Bernardino County Library databases and then analyzed by experienced DM providers.

A total of 23 relevant articles were eligible for review. No meta-analyses on the subject exist. We found that existing studies highlight skills in wellness, executive health, and protective medicine, which form the backbone of DM.

The burgeoning field of DM encompasses several disciplines and skills. We strongly recommend a structured curriculum for the field of DM, focused on dignitary wellness, executive health, and protective medicine.

Introduction & Background

Dignitaries are a select group of high-profile politicians, royal family members, and businessmen. While similar to celebrities, athletes, and musicians, dignitaries are not only famous, but their health can impact the political and economic health of a city, nation, or even the world. As such, dignitaries have a unique set of healthcare needs, which the general public does not have [1]: they require aggressive preventive and protective medical care, 24/7 high-quality personalized healthcare, and an even greater degree of privacy than ordinary citizens. International travel, especially as part of humanitarian or political missions, can create novel exposures to infections or illnesses. Medical and transportation infrastructure may be primitive on many trips, creating logistical challenges the medical team must plan for and overcome [1]. Threats of assassination add another layer of concern for dignitaries. The average person traveling on a business trip will be well-suited to receive emergency care at a local ED; however, if the president of a nation merely arrives in an emergency department (ED) and is not properly cared for, an international calamity may ensue. Communication with the press, media, and public about the condition of a dignitary takes on an added dimension, which average patients just do not require. Furthermore, privacy is of even greater concern for dignitaries than the average patient.

READ MORE …

SOURCE: https://www.cureus.com/articles/23999-dignitary-medicine-a-novel-area-of-medical-training


Citations


Band RA, Callaway DW, Connor BA, Haughton BP, Mechem CC. Dignitary medicine: adapting prehospital, preventive, tactical and travel medicine to new populations. Am J Emerg Med. 2012 Sep;30(7):1274-81. doi: 10.1016/j.ajem.2011.10.019. Epub 2012 Jan 5. PMID: 22226476.

Al Mulhim M A, Darling R G, Kamal H, et al. (October 22, 2019) Dignitary Medicine: A Novel Area of Medical Training. Cureus 11(10): e5962. doi:10.7759/cureus.5962

SOURCE: https://www.cureus.com/articles/23999-dignitary-medicine-a-novel-area-of-medical-training


Band RA, Callaway DW, Connor BA, Haughton BP, Mechem CC. Dignitary medicine: adapting prehospital, preventive, tactical and travel medicine to new populations. Am J Emerg Med. 2012 Sep;30(7):1274-81. doi: 10.1016/j.ajem.2011.10.019. Epub 2012 Jan 5. PMID: 22226476.

TY – JOUR
AU – Band, Roger
AU – Callaway, David
AU – Connor, Bradley
AU – Haughton, Brian
AU – Mechem, C
PY – 2012/01/05
SP – 1274
EP – 81
T1 – Dignitary medicine: Adapting prehospital, preventive, tactical and travel medicine to new populations
VL – 30
DO – 10.1016/j.ajem.2011.10.019
JO – The American journal of emergency medicine
ER –

SOURCE: https://www.researchgate.net/publication/221730386_Dignitary_medicine_Adapting_prehospital_preventive_tactical_and_travel_medicine_to_new_populations


https://eurekamag.com/research/069/580/069580837.php


https://www.advisory.com/Topics/Classic/2016/01/Assessing-the-Case-for-Concierge-Medicine

 

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