American Medical Association members say 'secret shoppers' should not be used to gauge quality at physicians' offices

Jun 17 2008

Using "secret shoppers" to evaluate the way physicians manage relationships with patients could get in the way of providing needed care to actual patients, according to more than 12 doctors who testified before an American Medical Association panel, the Chicago Tribune reports. AMA on Sunday held its annual House of Delegates meeting in Chicago.

According to the Tribune, the use of secret shoppers "is becoming part of the consumer health information wave," spurred by insurers, employers, consumers and others seeking to "ensure they are making informed choices about the kind of care and service they will receive."

The group's Council on Ethical and Judicial Affairs has asked that the 565-member House endorse the practice, noting that secret shopper evaluations would focus on professional relationships with patients, not on clinical practices (Japsen, Chicago Tribune, 6/16). AMA information released on Friday stated that secret shoppers would be "individuals hired to act as patients to monitor service quality." It added, "Secret shoppers have been used to evaluate most of the steps of the patient experience, from the ease of making an appointment over the phone, to the environment and flow of patients in the waiting room, to the encounter with the physician" (Snowbeck, "Medical Hotdish," St. Paul Pioneer Press, 6/13).

Rex Greene, a member of the ethics panel, said secret shopper evaluations can "highlight things that we are not aware of that can benefit our practices." He said, "We would like certain parameters where ethically appropriate," adding, "This is a practice-management tool." However, physicians testifying before the panel disagreed.

Howard Chodash, an associate professor of gastroenterology at Southern Illinois University School of Medicine and an AMA delegate, called the practice "grossly unethical." George Anstadt, an AMA delegate representing the American College of Occupational and Environmental Medicine, said, "This goes against the grain of the doctor-patient relationship," adding, "We should use real patients as sources of real information we need about quality of care." The physicians also expressed concerns that information gathered by secret shoppers could be used to cut physician payments or used by trial lawyers in medical malpractice lawsuits.

The proposal could be endorsed, rejected or referred for more study when the AMA House of Delegates votes this week (Chicago Tribune, 6/16).

AMA President

In a speech before the AMA House of Delegates on Saturday, AMA President Ronald Davis told physicians to "never take away someone's hope" when treating patients with deadly or terminal diseases. Davis, a doctor of preventive medicine, has been diagnosed with stage-4 pancreatic cancer. He said, "I know the survival statistics for someone with stage-4 pancreatic cancer," but "if the five-year survival is 5%, that is not zero. And as someone with relative youth, good functional status, outstanding health care, love and support from family and friends, and a thirst for life that feeds into a strong mind-body connection, then who knows what the future holds for someone in my situation."

Davis also said physicians should take a leading role in advocating healthy lifestyles, better patient information, expansion of health coverage to all U.S. residents and a reduction of medical errors (Japsen, Chicago Tribune, 6/15). Davis added that AMA should support additional federal taxes on tobacco and work to stop Medicare physician payment cuts (Babwin/Johnson, AP/Arizona Republic, 6/15).