This manuscript examines the clinical, ethical, and psychological implications inherent in caring for very important person (VIP) patients within cardiothoracic surgery. 
 
When a VIP patient presents for care, there is a natural inclination to deviate from established institutional protocols or routine surgical workflows. Such deviations may include preferential assignment of the most senior surgeon, restricting trainee participation, limiting staff access in the name of privacy, or allocating additional institutional resources to accommodate patient expectations. While these adjustments are often motivated by respect or a desire to provide exceptional care, the authors argue that they can paradoxically compromise patient safety by disrupting team dynamics, eroding standardized processes, and introducing heightened psychological pressure that may drive inconsistency in care delivery. 
 
Overall, caring for VIP patients requires a careful balance between respecting patient preferences and maintaining equitable, evidence-based clinical care.