Doctors' Group Leaves Secret Shoppers in the Waiting Room

AMA members question allowing undercover reviewers to probe patient care.

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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?