Doctors' Group Leaves Secret Shoppers in the Waiting Room
This week, the American Medical Association took the bold step of deciding not to decide whether to endorse using "secret shoppers" to evaluate their medical practices. Rather than adopt a tepidly positive report by the group's Council on Ethical and Judicial Affairs, which had offered its qualified support provided certain conditions were met, the AMA's House of Delegates voted to refer the issue back for further study after it had heard doctors' concerns. And so physicians have missed another opportunity to embrace customer feedback, just as they've taken a hard line against online physician rating sites, which I've discussed before in this space.
Secret shoppers are by now commonplace in retail and hotel settings and are considered a valuable tool to improve customer service. They're undercover reviewers who pose as, for example, medical patients in order to assess quality of service. Medical practices have been slow to adopt their use, and the medical sector accounts for only about 2 percent of secret shopping revenue, according to the report.
In the relatively rare instances when it has been used, feedback from secret shoppers—who may be hired by group practices, hospitals, or individual physicians themselves—has helped improve patient experiences, according to the report. It has led to shorter wait times for appointments, stronger patient privacy protections, extended staff hours, and better physician-patient communication, along with more mundane improvements like adjustments to TV station programming in the waiting room and larger type on signs.
Physicians are understandably concerned that secret shoppers not in any way hinder the treatment of genuinely sick patients. The council report said that any secret shopping program should take that into account. It also stipulated that medical providers be notified before secret shoppers are sent to their offices. Information collected could not be used to punish providers, nor should feedback from the visits be solely relied on for evaluating clinical performance. If these conditions were met, the council said, then secret shoppers could be a useful tool to improve patient care.
But too many doctors balked. I wasn't in the room when the proposal was discussed, but others have reported that some doctors really got the wind up, describing using secret shoppers as "grossly unethical" and "against the grain of the doctor-patient relationship."
I don't understand this. If the conditions above are met—no surprises, no interference with sick patients, no disciplinary teeth—a secret shopper program could certainly do no harm and might actually offer useful insights to any doctor willing to listen. I'm sure I'm not the only patient who's stopped seeing a doctor because the staff was rude or the office chaotic. A secret shopper could give doctors a heads up about these patient-unfriendly problems and maybe stop some real patients from walking out the door. You'd think doctors would see some benefit in that.
What do you think? Should secret shoppers be allowed in doctors' offices?
Tags: doctors | medical quality | ethics
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Reader Comments
Running out of options to protect patients
I have no problem with the idea of "secret shopper." What on Earth is the medical community afraid of? If there was more transparency in the delivery of medical care and if the state disciplinary commissions would discipline doctors who make errors, then there would be fewer medical malpractice actions and no need for covert monitoring of medical practices.
I underwent unnecessary orthopedic surgeries by an Illinois doctor (Carle Clinic Association in Urbana, Illinois) who cared more about money than medical care. (A Carle Clinic, the doctors own the HMO - hmmm, conflict of interest? Tough to expect a Carle Clinic physician to refer to outside clinic when they are "stumped" if the patient is a member of the HMO owned by the physician!)!
I have spent the last eight years having a surgeon at Duke University Medical repair and correct the damage caused by the Illinois surgeon. I am looking at surgery number 8 and I cannot walk without pain. In addition, I struggled with major depression during the period when I was treated by the Illinois surgeon.
I asked the Illinois Department of Professional Responsibility to investigate the doctor. But absolutely no investigation was undertaken. I have since learned that the Illinois Medical Society is a major contributor to the DPR.
Even though the Illinois surgeon stated (under oath) that he does not know why he performed the surgery and further states (under oath) that I talked him into doing the surgery. The surgeon also stated (under oath) that he suspects that my instability when walking (since the surgeries) is a function of my "alcohol abuse." Of course there is no evidence whatsoever of my having an alcohol problem. I very rarely drink.
I never wanted to sue any doctor. I wanted the doctor to take responsibility and be held accountable. I did not want any other patient to be hurt. Perhaps all it would have taken is the surgeon to be better educated on the procedure and indications for when to perform the procedures to tighten lateral ligaments in the ankles. Instead, the surgeon insults me (the patient) and blames me.
My Duke surgeon "does not want to get involved" in testifying against the Illinois surgeon. The Duke surgeon proclaims that he went to medical school and he just wants to practice medicine.
That is all fine and well that the physicians want to protect one another. And apparently we can trust the states will investigate and discipline doctors. But there has to be some way to protect the public.
A "secret shopper" would be a great way for the physicians to get the clue that they work for us - the public.
Can you guys imagine how much worse the delivery of medical care will be if this country is subjected to universal medical care?
Sounds like a student afraid of what the grade will be on his reportcard.
Doctors are way to insulated and protected as it is. To find a good one, you have to hope that one of your friends or co-workers has had a good or bad experience with whomever you are planning to see. Doctors don't want to be rated because they are afraid their patients may have a different view of what they provide than they do. Doctors have for decades shielded other bad doctors from removal out of fear of reprisals and with no regard of what havoc these 'bad apples' are unleashing on their patients. Just try to find a doctor that will give you an honest opinion of a colleague.... you will find a living, breathing dodo first... or TRex stomping up your neighborhood street. They consider themselves in a class above their patients for the most part and want patients to have what they are willing to give them.... and charge handsomely for it. I say, "Bring on the Secret Shoppers!" The more they want to resist, the more I want to find out what they are hiding.
No place for pretense
The pretense of an undercover patient runs counter to the open and honest relationship that should exist between patients and physicians. A systematic evaluation should rely on feedback from real patients
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