Undercover patients keep an eye on docs
There’s a storm brewing in the medical community, and it should give you a rare glimpse into the often-closed world of the business of medicine. I’ve long been critical of the aloof and imperious attitude of many of my colleagues. I think that many of the old-line doctors are shaken by the increasing numbers of what they believe are “over-informed” patients who enter examining rooms clutching reports and studies printed out from the Internet. Some doctors are feeling that their authority and knowledge are being questioned.
But me? I love a shake up, and I think the fact that the Internet has finally empowered patients is a very good thing. For the longest time, doctors were treated as all-knowing auricles who dispensed all the answers. But doctors are as human and as fallible as their patients. And it’s sad to say that there are many doctors who lose sight of this.
So you can imagine the outrage throughout the ranks of the medical old guard when the ethics council of the American Medical Association (AMA) proposed that AMA endorse the practice of using “undercover patients.” And yes, an undercover patient is just what it sounds like: someone who is faking an illness to grade a doctor on the level of health care he’s providing – and on how he is providing it. More and more, health clinics and hospitals have been using this method as a way to evaluate the performances of doctors and their staffs.
Let’s just say that some doctors don’t love this idea – and that’s putting it mildly. One of the more vocal opponents of the undercover patient method is Dr. Richard Frederick of the University of Illinois College of Medicine. Fredrick has called this practice “official deceit,” and thinks that it’s an irresponsible method of quality control that has no place in medicine.
Frederick wonders about a scenario where a sham patient enters an already overcrowded emergency room faking chest pains. “How could the hospital administration defend this exercise to someone who suffers an adverse outcome while waiting his turn behind the person who is only pretending to be sick?”
It’s a good point, of course. And that’s why the AMA’s ethics council already built clauses into their proposal that would prevent fake patients from interfering with or delaying the treatment of real patients. But personally I believe that the opposition to the undercover patient program has more to do with the fact that most doctors don’t like the idea of being questioned or graded on how they do their jobs.
I find it galling that some of my colleagues have taken this position. Especially because, if they’d bothered to look at the AMA ethics council’s proposal, they’d see that it’s almost entirely toothless. For example, the proposal recommends that doctors be forewarned that undercover patients could be coming in – which entirely defeats the purpose of having undercover patients in the first place. How can a pop quiz work as a pop quiz if you’re told it’s coming?
What’s more, the proposal also ensures that bad reviews by undercover patients aren’t used to punish doctors. What?! Let me go back to the pop quiz analogy once more: if you’re told that you’ll be having a pop quiz, and then told that the grade you get on the it won’t count toward your gradewell then, isn’t the whole exercise kind of pointless?
If this is the case, I can’t imagine why any doctor could possibly be against the idea undercover patients. Still, some doctors say that there’s a benefit. After all, well-directed criticism can help anyone improve. Yes, even doctors.
