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July 16, 2008

The AMA and Fake Patients

Do Secret Shoppers Have a Place in Medicine?

Docswpatient72x721 Lightening strikes and downpours seem to be the agenda for today until I read the latest news from the American Medical Association. Completely surprised me! This was no game of Jeopardy.  The Medical Association has initiated a campaign using undercover patients and/or actors to grade and evaluate a clinic, health facility, outpatient center, or an overcrowded emergency room. The goal is to grade the system for future healthcare seekers.

The Ethics Council of the American Medical Association is pressing their members to endorse such practices. How are you going to know the “fake, undercover” patients from those having real pain and real illness? What are your thoughts on this?

July 16, 2008 in Beka | Permalink


One of the problems with hospital and nursing home inspections is they depend on the paperwork to verify that patients and residents are getting good care. The facilities pay nurses to make sure the paperwork is perfect, thereby ensuring a good inspection.

To really inspect a health facility, they should have decoy patients or residents to actually experience and observe what goes on in that facility on a day to day basis. Or else have an inspector be hired as a staff nurse and work there for a few weeks to see what is really happening.

We are facing a huge increase in the need for quality in nursing home care. It strikes me that for the past almost eight years, our federal government has been run by an administration that has little regard for running good government. With private equity groups like the Carlyle Group taking-over facilities like Manor Care, nursing home care has gotten worse.

The desire for profit margins translates into less staffing at nursing homes, less training for the staff that they do have, less food (or a lower quality of food) for the residents, and less management and oversight. A conflict arises between saving dollars and providing good care.
There would be a much higher level of care given to patients if adequate staffing were provided. However, Administrators benefit from the amount of profit generated by the nursing home they manage, usually paid annual bonuses based on bed-count. They must choose between increasing the profit margins of their individual facilities or supplying more support staff for the care of residents.

Another way residents don't receive the care they need because of profit concerns, ranges from which ambulance service the nursing home calls, to whether or not a patient even goes to the hospital after a fall or other calamity.

Even nursing home abuse may occur because of the desire for profit. Caregivers who work in nursing homes are often stretched beyond their ability. They try to do the best job that they can, but the lack of additional support restricts what they can do to help patients.

You'll never catch these discrepancies with facility inspections depending on paperwork to verify patients and residents are getting good care. Self-reported and audited paperwork (data reported by the facilities themselves and no oversight agency verifies audits to ensure that it is even true).

Posted by: Gregory D. Pawelski | Oct 15, 2008 2:37:15 PM

I work in a small city hospital with a major university within the city limits, and we have a 14 bed ED, and are the only hospital in town, therefore we are usually very busy and often have longer waiting times than we would like. We were recently told that we were going to have "secret shoppers" to check on our care and follow up. I think this is very underhanded and unwarranted, but as long as it does not interfere with true patients and their care, it's may be tolerable. IF I am doing my job like it should be done in the first place, I have nothing to hide. It saddens me that in the 30 years I have been a nurse in the emergency department, that we have come to this. My managers used to talk with the patients and families and observe the unit to make sure that all was good. It appears now that management doesn't even trust their own judgement and must rely on some actor to tell them what goes on in their departments. I wonder what is next!!!

Posted by: Charlotte | Oct 1, 2008 12:00:07 PM

As a patient this upsets me and I feel endangers the care of "real" patients. Why should my care be jeopardized because of this insane manner of evaluating patient care. Why not ask me about my care, why not put together programs to help hospitals and nurses learn better care if there is a potential problem. Why not work on better staffing and support the nurses that you do have. This is ridiculous and is potentially harmful to the real patients.

Posted by: Jenelle | Sep 2, 2008 6:35:52 AM

The problem with care in today's medical arena is that too many entities have been allowed to control and dictate care, with image and profit as their drivers.

Fake patients is to unnecessarily tax an already overtaxed healthcare system. It is probable however, that since too many patient's assessment of care are blown off by the institutions if they prove negative, that the truth will never surface without "Fake patients" telling it like it is.

What has our society come too? Easy answer, a self centered, greed motivated, morally depraved herd of "do as I say, not as I do" people. Too many operate without any internal restraint, but our psychologists have informed us that choice and consequence no longer are valid. Every poor choice that reaps an uncomfortable consequence, can be disowned and a disease or disability label attached, to excuse us from making wise and profitable choices. Take a psychotropic drug and rid yourself of the guilt that comes with wrong choices.

In medicine, we are taught to believe homosexuals, drug abusers and all manner of ill, have either chosen normal alternative choices that should be accepted as "normal", or are byproducts of forces they cannot control. Even a rapist is careful to hide his actions, knowing them innately to be wrong, thus to do all covertly, if possible, and yet there is some psychologist somewhere, or lawyer, vehement to defend their innocence or helplessness. Homosexuality taken to it's logical end is to result in EXTINCTION, so how can that be normal? It is completely illogical. Yet even familiarity of untruths start to seem like truth if repeated often enough.

Fake patients will reveal the slop that goes on in today's medical facilities, but when it does, what is to be done about it? You cannot legislate honesty, integrity or morality. That is the bottom line of the out of control slop that does occur in America's medical systems. Greed has stepped in and integrity taken flight.

The problem abhorred in medicine in America is not restricted to medicine alone. It is but a symptom of a whole society gone to reprobate standards of living which has merely translated into many professions, medicine not being immune.

Nurses need to UNIFY as MD's have. To insist on being recognized with as much integrity as Doctors, whom do NOT save any patient, it is nursing in action, with professionalism and compassion that translate any ailing patient to wellness. Nursing care still existing as only part of the "room charge" speaks loudly for just how minimized our society rewards nurses.

The shortage of quality nurses has much to do with the insanity of regulation imposed by non-medically minded and trained entities as it has to do with individuals of perverse character entering the ranks of nursing to forward their agendas with little respect of the innate trust the general public traditionally rewards to the nursing profession.

How many good and knowledgable nurses have left the profession, because they are just tired of the slop that is entering it and the lack of standards enforced to weed out the uncommitted and the uncaring from it's ranks?

I love my profession, but I detest the compromise and denigration I routinely absorb, by those whom are the problem, not part of the solution, in nursing. Mediocrity, breeds the same. It's hard to fly like an eagle, when surrounded by increasing numbers of turkeys!

Posted by: John | Aug 6, 2008 7:46:12 PM

Is it really ethical to drive up the cost of healthcare by using fake patients?

Better questions:

Is it really ethical to see study after study that proves that the root cause of most poor patient outcomes is understaffing of nurses, yet pretend that this problem doesn't exist?

Is it ethical for facilities to beef up staff for the purpose of gaining accredation, then cut staff back after approval due to "budgetary constraints"?

Posted by: GCC, RN | Jul 29, 2008 11:36:53 PM

A couple things come to mind when reading this article. First, is the valuable time and resources that are being spent on this fake patient when it is aready hard to get timely clinic appointments for patients who are really sick, or those who really need to be seen in the ER are waiting longer and their condition could be worsened as a result of attending to this Fake Patient.

Second, I don't think it is very ethical on the part of the AMA to have such a practice.

What they could do that would not be abusive is to play an active roll and pose as a family member or companion to a real patient. They will be able to gather the information they need and not waste valuable time and resources.

Lastly, Medical organizations already have patient questionaires, surveys and patient advocates that are in place address issues that arrise. They also pay a lot of money for inspections such as, The Joint Commission, and CLIA.

Posted by: Laura | Jul 27, 2008 10:54:10 PM

Will the Joint Commission join the crowd ???


Posted by: beka | Jul 27, 2008 8:16:11 AM

What surprised me most is how many other groups - non-nursing based are infiltrating nursing and assessing the quality of our work. Is the same being done in medicine to physicians ??


Posted by: beka | Jul 24, 2008 8:49:10 AM

Pardon my bluntness, but this just plain sucks. Emergency rooms are overcrowded as it is without pushing "fake" patients through the system.

The best evaluators of our care and our systems are our patients - the REAL ones. They are the ones we have to answer to and their opinions are the ones I respect.

Geeze, what next?

Posted by: Kim | Jul 22, 2008 1:22:21 AM

I wonder - how many more people, agencies, commissions, etc. plan on evaluating the quality of bedside nurses ?


Posted by: beka | Jul 17, 2008 5:10:20 PM

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