Secret Shopper Patients for Doctor’s Office Scrutiny
You’ve heard of mystery shoppers, I’m sure. They conduct business transactions or pretend to browse/window shop in certain stores in order to evaluate, in secret, the customer service skills of employees.
As Well’s Tara Parker-Pope explains, the American Medical Association was considering whether to support fake undercover patients in waiting rooms as a way to ensure good customer service from hospital and doctor’s office staff. It’s put the plan on hold for now, but apparently some hospitals already use “secret shoppers,” as reported by the Boston Globe a year ago.
These reviewers don’t have access to the actual doctor’s care. They basically sit in the waiting room and watch how the front desk staff treats patients, how long wait times are, and how they handle phone calls.
Sounds good, right?
Medical care is a service we pay for, and we should expect courteousness and prompt service just like in any other industry. By *prompt* I mean *as prompt as possible,* of course. One big difference between this industry and most others is the high potential for unexpected emergencies, and I think most patients–though not all–understand the occasional, unavoidable 30-minute wait.
Some doctors don’t really like this idea, though, and made that opinion perfectly clear at a recent AMA meeting. The Chicago Tribune says,
But AMA members told the panel that they did not trust the secret shopper concept, saying such patients could get in the way of needed medical care for real patients. In addition, doctors say, information gathered could be used to cut payments to doctors or used by trial lawyers as a way to damage physicians in court.
“It is grossly unethical,” said Dr. Howard Chodash, an associate professor of gastroenterology at Southern Illinois University Medical School and an AMA delegate representing the Illinois State Medical Society.
Maybe I’m missing something here. How would quiet, unobtrusive note-taking in the waiting room hinder care for actual patients? If the reviewers practice observation only, then they’re not interacting with the hospital or office staff at all, and their presence should be no more disruptive than the plastic ficus tree in the corner. Unless–I dunno–maybe there’s a case for a particularly busy office needing that extra chair.
As far as the data’s potential in court or against the doctor’s bottom line goes, I can’t see how any medical institution or office that practices respectful patient service would have to worry about either.
Plus, the service can address some serious problems with front office care. Consider this scenario from the earlier Boston Globe story:
In a January report, a mystery shopper described what happened when a man in a wheelchair asked whether his prescription was ready. The receptionist in an outpatient waiting room asked for his Social Security number, the shopper wrote, then “halfway through she interrupted him and asked him to repeat it louder,” which he did. A patient on the other side of the room heard the exchange and commented, “There goes patient privacy.”
Patients tend to be worried, scared, and nervous when they visit a doctor for all but the most routine visits. Add in patient loyalty to a specific doctor and the times when appointments are either impossible to reschedule or it’s medically necessary not to reschedule them, and what you’ve got is a waiting room full of people at the mercy of the staff. I’d argue the medical industry needs secret shoppers more than any other business because of the emotional factor.
And on a positive note, the undercover patients point out excellent service, too, and that can result in bonuses and other compensation for employees.
Way, way down at the bottom of that Boston Globe article is a larger point:
“Is it a little devious, a little misleading to staff, and how would they react?” said Dr. Michael Gustafson, vice president for clinical excellence. He also pointed out that shoppers don’t capture what happens once the patient gets “behind the office door, and that’s the most important part of the experience.”
I’d love to see some kind of review process for the doctor-patient relationship, one that evaluates whether the physician talks down to the patient, rushes through the appointment, seems willing to listen to patient ideas, and answers questions thoroughly. And using undercover patients for thatsort of review really does seem unethical, although I don’t see why offices couldn’t stock comment cards for doctor performance, and patients could later mail them in anonymously.
But I don’t agree with Dr. Gustafson. The crucial aspect of the actual doctor consultation doesn’t negate the need for a positive waiting room experience, since the wait itself can set the tone for the entire visit.
I like this quote from a recent interview with Dr. Rex Greene of the AMA Council on Ethical and Judicial Affairs:
We are running a service business, and we are not as focused on that as we should be.