Sunday, October 2, 2011

Secret Shoppers in Doctors' Offices: Placebo Medicine for Physicians

Physicians are still debating whether prescribing placebos is ethical. Dissenters argue that this is dishonest and would erode trust between patients and their physicians. If the practice were to gain acceptance, then physicians’ credibility would be diminished. Patients would wonder whether the medicines their doctors are recommending are evidenced-based or fraudulent.

Patients can now push their own snake oil right back onto their physicians. I learned that the ‘secret shopper’ mechanism for quality assessment has been introduced into the medical profession. I first read about this in the March/April 2010 issue of the Journal of Medical Practice Management, a periodical that I suspect is not widely read by physicians.

Folks are hired as pretend patients and are dispatched to doctors’ offices and hospitals to document their findings. Their mission is to assess office staff, appointment issues and the waiting room experience. I wonder if soon they will add encore performances and will subject themselves to Pap smears and rectal examinations to assess doctors’ clinic skills and techniques directly.

Surprisingly, the American Medical Association’s Council on Ethical and Judicial Affairs endorsed the practice, although many physicians objected.

I agree that these pseudopatients could improve office quality by highlighting flaws that have not been recognized or remedied. Yet, I cannot support the stealth tactics of this quality control method. On its face, it is dishonest. It also costs medical practices and institutions time and money attending to people who are masquerading as actual patients. If the secret shopper strategy did gain traction in medical quality assessment, could it be used as an investigative tool by malpractice attorneys? Finally, the concept is wholly unprofessional using a technique that is generally used in large big box retail establishments and restaurants. It is demeaning that physicians are already being evaluated on Angie’s List and the Zagat survey, as if we are automobiles or toaster ovens.

The federal government has now indicated that it will initiate its own secret shopper program to gauge how difficult it is for patients to gain access into primary care physicians' offices.  Big Goverment becomes Big Brother.  Hours after this stealth plan was boldy announced, it was rescinded in a Big Retreat.

Let's make a deal.  Don’t make an appointment to see me unless you truly are seeking medical care. In return, I’ll never prescribe you a sugar pill. This will strengthen the trust between us, the foundation of a successful doctor-patient relationship.

7 comments:

A. Bailey said...

The writing is on the wall, isn't it? Medicare reimbursement will be slashed as both sides of the political aisle try to contain costs. Physicians won't exactly stop seeing Medicare patients, but they will severely limit access. Enough Medicare patients will complain, and in order to facilitate access, the Feds will mandate Medicare patients being seen in a fixed period of time or under some sort of quota system, with the physician under threat of criminal injunction if he/she doesn't comply.

It won't be pretty. Unfortunately, I don't see any way to avoid this scenario under the pressures and forces involved.

tired resident said...

actually, the alternative to the scenario is many patients will be seen by a new type of "doctor".

http://www.nytimes.com/2011/10/02/health/policy/02docs.html

a quote from the article: "Physical therapists once needed only bachelor’s degrees, too, but the profession will require doctorates of all students by 2015 — the same year that nursing leaders intend to require doctorates of all those becoming nurse practitioners."

in upcoming turf wars, many allied health care fields will be elevating their degree requirements to doctorates and therefore be called "doctor" in the clinical setting. the goal of this is to eventually gain independent prescribing and treatment rights. after all, to the patient, everyone who wears a white coat and introduces themselves as Dr. ______ must be equally qualified. the problem is that when you google doctorate of nursing, many of the results are for online degree programs.

another example of this turf war is optometry vs ophthalmology. in kentucky, optometrists have successfully lobbied to increase their scope of practice to include laser eye surgery after taking a 32 hour weekend course.

Michael Kirsch, M.D. said...

@AB, see you point. When Medicare rates tank, be prepared for gov to have measures in place to prevent physicians from opting out. Our leverage? Sorry, lost is a generation ago.

A. Bailey said...

@tired resident - GIs are used to it. We trained for two to three years to learn colonoscopy, but it's not unusual to compete (back in the old pre-Katie Couric era) for patients with MDs who got creditialed to perform colonoscopies after a weekend course in the dog lab.

In any case, the wise MD will learn to accept the democratization of health care at all levels, except for malpractice. When it comes to that, we'll still the "captain of the ship".

Michael Kirsch, M.D. said...

@AB,"the captain of the ship"? Remind me, what's the captain of the ship supposed to do when the ship goes down?

Ian Random said...

IANAD

I'm baffled at the need for a real placebo. Why not just prescribe homeopathic meds and claim that it is outside the realm of allopathic medicine?

kaney said...

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