Hospitals Turn To Spying On Doctors

Undercover Patients Fake Ailments, Evaluate Docs

(AP)  Lori Erickson-Trump has faked headaches and back pain. She's had physicals and MRIs she didn't need and she gets paid for it - all to evaluate the performance of doctors and their staffs.

Hospitals and health clinics are increasingly turning to these undercover patients to grade the health care experience being offered.

Now the ethics council of the American Medical Association is pressing the doctors group to endorse such practices. AMA delegates are expected to vote on the proposal, along with dozens of others, during their five-day meeting beginning Saturday.

Some doctors are outraged at the idea.

Dr. Richard Frederick, of the University of Illinois College of Medicine in Peoria, called it "official deceit" that could have disastrous consequences. He wrote a commentary in May's edition of Virtual Mentor, the AMA's online ethics journal.

"In some instances sham patients have presented to overcrowded emergency rooms with chest pain," he wrote. "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?"

The proposal to the AMA does include restrictions that address that and other concerns. The recommendation is to have a system that: makes sure fake patients don't interfere with treating real ones; gives doctors a heads-up that undercover patients might be visiting; and ensures that bad reviews aren't used to punish doctors.

And Dr. James Loden, writing an opposing view in the online journal, says undercover patients are neither "devious" nor "spying."

"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," he wrote.

Loden, an ophthalmologist at Nashville, Tennessee-based Loden Vision Centers, started using undercover patients to evaluate his business two years ago.

The sham patients showed "that I consistently left the examining room without asking clients whether they had any questions," Loden wrote. He also learned that some employees didn't always introduce themselves or explain why tests were being performed.

The idea was to help the centers compete with others offering similar services including Lasik surgery. The centers have worked to eliminate the revealed shortcomings and Andy Patrick, Loden's chief operating officer, said client-to-client referrals have since increased.

"We don't always like what we hear, but it makes us get better and better," Patrick said.

Erickson-Trump, 37, works for Perception Strategies, an Indianapolis-based company that provides undercover patients to health systems in about 25 states. Her preferred job title is "mystery shopper," a service more familiar in the retail and food industries.

Brooke Billingsley, vice president of the company, said that when asked to evaluate a doctor's skills, the firm often tries to use undercover patients who really need a specific test, such as a mammogram.

When a hospital wants its emergency room evaluated, Billingsley said sometimes she'll schedule a fake patient with a real medical problem, such as pneumonia symptoms.

Occasionally, undercover patients have been asked to undergo invasive tests that reveal a surprise ailment, she said.

"Health care mystery shopping is so unique," Billingsley said. "It's just not like going and getting a Happy Meal."

Erickson-Trump said one memorable "shop," as she calls each job, was to a dentist's office, where she had her teeth cleaned and X-rayed.

The receptionist offered her gourmet coffee and the dental chair had a neck massage pillow, she recalled. "I was so surprised at the good treatment ... that I ended up making them my permanent dentist."

The MRI was also memorable "because it wasn't my favorite," she said.

Erickson-Trump said she exaggerated some minor back pain for that test, which requires patients to lie still inside a noisy cylindrical scanner while internal images are made.

She had no complaints about the MRI technician, but the office staffers didn't explain enough about what to expect.

"That's a very scary procedure" that can be claustrophobic, Erickson-Trump said.

On other jobs, she's been asked to evaluate how well the doctor listened, whether logical referrals were made, and how long she was kept waiting. "You can show up and sit for hours on end sometimes, and you're not sure why," she said.

Henry Ford Health System spends $35,000 to $60,000 a year on undercover patients to identify just that kind of problem at its Detroit area clinics.

"Industry research shows that the patient perception of quality of care is based upon their whole experience," and not just on their doctor's medical skills, said Henry Ford spokeswoman Rose Glenn.

Awards are given to staffers who get high scores, while education and customer-service training is given to those who fare poorly, she said.

[abigail70]

I think this is fantastic. I don''t look at it solely as pointing out bad things - but also that great caregivers can be pointed out as well. I''m well aware that physicians are not demigods, but on the other hand, they perform a very needed service, and most put in an enormous amount of hours, at the expense of everything else in their life. Quality assurance is key these days, with healthcare prices skyrocketing, and ridiculous, frivolous lawsuits ensuring outrageous malpractice insurance rates. Patients deserve quality care, and healthcare professionals generally want to provide just that.

[babooph]

A very ill patient not getting care,while a DR. wastes time . What idiot should be sued by the DR. & patient for this junior g-man stunt?

[barbaraf4]

If the doctors aren''t doing anything wrong, why would they care if undercover patients are coming in? I''m sure they still get paid for it and afterall, that''s the only reason they chose medicine over the legal field. The medical field usually has insurance (or they turn you away).

[rushlimpdrug]

this could start a trend:

Fake convicts in jail

Fake shoplifters

Fake drug addicts

Fake pharmacists

Fake Fakers (not really)

Fake posters.

[cyberus-2009]

Its about time .. they do it to almost every industry why should doctors be exempt?

[republic1776]

Great, here%u2019s capitalism at it''s finest.
We the people.
I am tired of a big fat Uncle Sam.
They take %u201CHundreds%u201D out of my pay and I am sick of it.
If more occupations take the lead in this example we can petition our bloated and controlling Government

[stn_sage]

My comments are as follows:

1. Having ''fake'' patients, go into doctors'', dentists'' and hospitals'' facilities to research what kind of service/treatment is available, is a GREAT idea! Those doing their jobs'', have nothing to worry about!

2. That the AMA---and various other groups---are worried about this, is an indicator/acknowledge that there are medical personnel who are NOT doing their jobs'' correctly! If those persons are identified and reckoned with, it''ll be better for everyone; the consumer, the insurance companies, and the medical community as a whole!

3. Under this idea/plan, maybe that 100,000 patients figure, of those killed in hospitals each year, can be reduced!

[wl7bzh]

This is nothing new-Federal Inmates routinely complain of fake ailments in an attempt to get controlled substances.

This is nothing new. Big Pharma has been bilking millions out of Medicare system for ever.

[zcotter]

Not against undercover quality assurance but....I suspect the same corporate big wigs that arrange it also tell clinic physicians that they must see a certain number of patients in a shift. They do this without regard for the added time needed to treat and educate very ill or slow to comprehend patients. These are the same medical managers that fight tooth and nail when nurses try to have safer nurse/patient staffng ratios implemented. The health care industry is no different than any other bean counting business. Too bad.

[darnedsocks]

THE MEDICAL INDUSTRY IS THE WORST WHEN IT COMES TO THE CONCEPT OF "CUSTOMER SERVICE"

I HAD HIGH BLOOD PRESSSURE...WAS TOLD BY THE FIRST DOCTOR THAT I HAD TO TAKE MEDICATION. I TOLD HIM I DIDN''T WANT MEDICATION, I WANTED TO FIND THE ROOT CAUSE OF THE PROBLEM. HE DIDN''T LISTEN.

SO I WENT TO TWO MORE DOCTORS....ALL THREE OF THESE A$$HOLES JUST SAID, "YOU WILL BE STUCK ON THIS MEDICATION FOR THE REST OF YOUR LIFE" HA!

I HAVE SUBSEQUENTLY ENROLLED IN A "WELLNESS PROGRAM" AND FOUND OUT THAT IT IS THE HUGE AMOUNTS OF "SODIUM" IN OUR FOOD THAT CAUSES HIGH BLOOD PRESSURE. SINCE I HAVE STOPPED EATING AT RESTAURANTS, MY BLOOD PRESSURE HAS COME DOWN TO NORMAL!

THESE DOCTORS ARE BRAINWASHED INTO THROWING PRESCRIPTION DRUGS AT EVERYTHING AND TRYING TO LEGALLY "COVER THEIR A$$" INSTEAD OF ATTENDING TO YOUR HEALTH!

THEY DON''T CARE! ALL THEY WANT IS YOUR MONEY!

[darnedsocks]

AS I SAID THE MEDICAL INDUSTRY HAS NO CONCEPT OF "CUSTOMER SERVICE"!

THEY DRUG YOU UP WITH XANAX AND HAVE YOU SIGN A BUNCH OF LEGALLY-BINDING PAPERWORK, SAYING YOU''LL PAY FOR ANYTHING THEY DO TO YOU!

WOULD YOU GO TO A CAR DEALER AND LET THEM DRUG YOU AND SIGN LEGALL-BINDING PAPERWORK, GIVING THEM CARTE BLANCHE?!

THIS IS WHAT THE MEDICAL INDUSTRY DOES! THEY ARE ALL A BUNCH OF CROOKS, INCLUDING THE ADMINISTRATORS!

ALL THEY WANT IS YOUR MONEY AND DON''T CARE ABOUT CURING PEOPLE.

[alphaa10-2009]

"darnedsocks" said everything in caps, which is the equivalent of shouting in a confined space. Posters who believe caps attract attention may be surprised to learn most readers bypass them.

[alphaa10-2009]

The use of fake patients by the HMOs and hospitals is a "process efficiency" measure, and can be useful to patients only if the right questions are asked.

Unfortunately, patient advisory boards and followup surveys are structured by the very people who do not always appreciate surprises, and have a built-in need to justify certain policies and avoid questioning other policies.

That the AMA should bridle at the prospect of being held accountable means it objects to two sacred cows occupying the same space, at the same time-- the physician and the HMO.

Ultimately, both parties have an interest in making patient treatment run more smoothly and with less cost. Again, however, where is the advocate of the patient?

[oneworldusa]

This is a great idea! Who HASN''T been in an ER for hours and hours with no help? It needs to be addressed.

Now, these people should certainly stay out of the ER when a hospital is very busy, or simply observe. This will improve the quality of care and help to reduce or limit costs.

[creeper00]

Big Brother finds another area to poke his nose into.

This is disgusting.

[omnibus66]

Most doctors today run an assembly-line type of system, and really don''t give a d**n what you think. You are nothing more than a collection of data inside a manila folder, to be disposed of as quickly as possible, so that he or she can get to the next manila folder waiting in the next room.

To those who rail at the thoughts of a future "socialized medicine system", keep this in mind. One, if you are in an HMO, you already have socialized medicine. Two, if you have private or group insurance, you are not the doctors customer, the insurance company is.

If you are really, truly pleased with the treatment you get from your doctor and hospital, consider yourself lucky, because you are in the minority.

[johngaltwho]

As a physician, if you''re gonna abuse my time by faking an illness for the purpose of an evaluation, then you need to reimburse me for that time. These types of patients often require the greatest amount of time and thought, (ie when the symptoms don''t fit with the exam) and depending on the complaint, I would hate to think that I would waste additional time or perform unnecessary tests to try to rule out some uncommon presentation of an illness in a patient who has nefarious motives. This sounds like fraud.

[faith_in_w]

Typical liberals, business finds a way to improve their customer service and you are against this.

[extremophil]

I think doctors have been too busy for a long time with patients who fake illnesses just to get attention, and now they have to deal with ones who get paid for it.

[imconcerned]

Monitor them all! I am all for monitoring doctors in hospitals,not only in emergency rooms, but during a patient''s medical treatment, and acess to (alleged) rights, including HIPAA. I have experienced absolute betrailal by the medical community, and deception by doctors and by hospital medical professional, and by the hospital. I am left with severe emothional tramma, at the least. Even the (alleged) my medical records did not reflect the care I actually received. There should be separate oversight over the medical community that assures compliance and quality care, Monitor discrimination, in provision of care/treatment, including those who have no health insurance.

[orthodoc9]

To the poster who said I chose medicine as a career field over law because of financial gain, you need to have your head checked. Rather than push air around in a court room, I''m sorry if I''d rather spend my time saving lives. To all those suggesting that doctors are the money-hungry antagonists of the medical industry, why not reserve your judgement until you take a closer look at the insurance companies? In regards to the article, I sympathize with indivduals who have had to put up with uncaring physicians (we''re not all that way); however, to comprimise treating real medical problems at the expense of fake ones is outright stupid. There are simply better ways to ensure that patients are being treated with respect.

[slim1h2o]

"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," he wrote.

Thats what I''ve been saying for the last two years.
Do your job,,or get out of the business.

And maybe it''s time to start rating doctors too. Maybe that way we will be ensured that the doctor that we go to, will do his/her job. We would also be able to tell if they''re competent, or not.

[pristinabrea]

I love this idea and have been working in the mental health/addictions field for years. I have been wanting a job like this. How does one get such a job?