American Medical Association To Vote on Endorsing Undercover Patients

The American Medical Association ethics council is pressing the organization to endorse the use of undercover patients to evaluate the quality of care at medical facilities and physician offices, the AP/San Francisco Chronicle reports. AMA delegates and others are expected to vote on the endorsement proposal during their five-day meeting, which begins on Saturday. The undercover patients evaluate the overall experience including how well physicians appear to listen, how well staff explain procedures and the length of waiting time.

The proposal to AMA includes restrictions that would ensure undercover patients do not interfere with the treatment of actual patients. Physicians also would be given advanced notice that undercover patients may be visiting and that bad reviews would not be used to punish physicians, according to the proposal.

Some physicians oppose the practice. Richard Frederick of the University of Illinois College of Medicine at Peoria said using undercover patients amounts to "official deceit" that could have adverse consequences. In a commentary in the May edition of AMA's online ethics journal, Virtual Mentor, Frederick wrote, "In some instances, sham patients have presented to overcrowded emergency rooms with chest pain," adding, "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?"

James Loden -- an ophthalmologist at Loden Vision Centers where undercover patients have been used for two years -- wrote an opposing view in the online journal that states undercover patients are neither "devious" nor "spying." Loden wrote, "Employees, including doctors, are paid to do specific tasks; if they choose to perform at a level that is less than acceptable, they need to improve or find other jobs."

Brooke Billingsley -- vice president of Perception Strategies, a company that provides undercover patients in 25 states -- said that when asked to evaluate physicians' skills, the company tries to use undercover patients who need specific tests performed. To evaluate emergency departments, Billingsley said the company uses undercover patients who have a real medical problem, such as pneumonia symptoms (Tanner, AP/San Francisco Chronicle, 6/12).

The Virtual Mentor commentaries are available online.