Spies Like Us: Physicians and Undercover Patients

AMA delegates this week pondered an ethics council recommendation to endorse the practice of secret or mystery shoppers—undercover patients hired by a hospital or physician group to pretend they are patients and report back on their experience.

Physicians who oppose the measure fret that the "fake" patients will interfere with the treatment of real patients. They worry that they might be disciplined if they happen to make one small misstep. They say mystery shoppers aren't a good way to measure quality.

But I don't think these or any other arguments hold water.

For starters, the ethics council proposal as written already addresses many of opponents' concerns:

• Mystery shoppers should never go through with an inspection if it would interfere with the treatment of emergency patients. (In fact, many mystery shopping firms use people who need tests or procedures anyway.)
• Healthcare organizations should inform doctors that they will be using mystery shoppers, though not announce the exact time of the visit.
• Physicians and others who come into contact with mystery shoppers should not be disciplined for any issues that arise, but rather be counseled on how to improve based on the feedback.

But more importantly, think about the message physicians who oppose mystery shopping are sending to your patients: that they'll only behave if they know they're being watched. It might not be true, but do you really want your patients to think that physicians will only be on time or explain delays, wash their hands, be thorough in their examinations, explain treatments, tests, and procedures, and make sure to answer patients' questions if they think the patient might be a mystery shopper?

The American Medical Association ethics council's mystery shopper report points out what should now be obvious to every healthcare marketer and leader. "As healthcare becomes a more competitive marketplace in which ‘healthcare consumers' (patients) comparison shop for healthcare services, individual physicians and hospitals are realizing that patient perception is key to maintaining and growing practices," the report states.

In consumers' minds, perception is reality.

Take for example a doctor who washes her hands before entering the exam room. She doesn't see a problem—until the mystery shopper reports back that she didn't wash her hands. A simple adjustment to her usual routine—washing her hands in front of her patients—can change patients' perception of her.

In its report, the ethics council cites the many potential benefits of mystery shopping. For example, information from secret shoppers has led to improved patient flow and wait times and warnings about potential breaches of patient privacy. Business improvements might include more effective hours of operation, better customer service, a more pleasant waiting room, larger type on signs, and even nicer telephone exchanges between staff and patients.

"In addition to using secret shoppers to identify opportunities for improvement, information can be used to reinforce desired practices. Some healthcare facilities, for example, reward employees who receive positive feedback from secret shoppers with a range of incentives from cash, to better parking spaces, to engraving their name on a wall plaque."

I have another idea: Let's start treating every patient as if he or she is a mystery shopper.