New Emphasis on Customer Service in Medicine

En español | A middle-age woman flips through dog-eared magazines in the teeming waiting room of a doctor’s office. A man in his 60s arrives at a hospital emergency room describing the symptoms of a possible heart attack. And a patient recently diagnosed with breast cancer telephones a busy urban teaching hospital, confused about which specialist she should consult.

Although these sound like real medical encounters, they’re not: The patients are fake. Each is a “mystery shopper” hired to report back to management about whether their experiences meet the standards of the hospital or medical practice that hired them. Their work is aimed at improving your experience in the hospital, clinic or doctor’s office.

For more than half a century, mystery shoppers, also known as secret shoppers, have been fixtures in retail, hotel and banking businesses, surreptitiously scoping out how customers are being treated, where service falls short and why patrons may be fleeing.

Now, as competition for patients has intensified, customer service has assumed new importance in health care, too, and the ranks of mystery patients have swelled—although statistics documenting their number and use are sketchy at best.

How it works

Medical mystery shoppers generally focus on customer service rather than clinical skills, and they operate in much the same way. Most fill out detailed checklists and submit descriptions of encounters with everyone from telephone schedulers who are sometimes rude, to receptionists who ignore them to pursue long personal conversations, to doctors who are abrupt or who fail to wash their hands.

Some hospitals, among them Massachusetts General Hospital in Boston, deploy their own employees instead of hiring outsiders. Either way, the use of medical mystery shoppers is usually designed to “improve customers’ experiences so that’ll improve the bottom line,” says John Swinburn, executive director of the Dallas-based Mystery Shopping Providers Association, which has 150 member companies in the United States. “It’s very much about quality control.”

Swinburn estimates that revenue from the total mystery shopping industry will approach $1.5 billion this year. No one knows what percentage of that money is from medical shoppers. But, he says, “anecdotally, there does appear to be quite a lot of recent interest in medical shopping.”

Controversy

The American Medical Association, the nation’s largest doctors’ group, has considered the practice of medical mystery shopping, but has not taken an official position.

Swinburn and officials of mystery shopping companies say shoppers must be careful to avoid diverting care from those who really need help.

That possibility is of paramount concern to Richard C. Frederick, M.D., a veteran emergency room physician who opposes the practice, which he regards as inherently dishonest and bad for morale because it breeds mistrust.

“Truthfulness is a core medical issue,” says Frederick, vice chairman of the emergency department at the University of Illinois College of Medicine at Peoria. Mystery patients may tie up scarce resources that real patients need, he says.

“I think that’s particularly unconscionable,” says Frederick, who teaches a course in medical ethics. He says in his emergency room “we have 42 beds and it’s not unusual for us to have 60 to 70 patients” waiting to be seen.

Nancy Berlinger, deputy director of the Hastings Center, a bioethics research institute in Garrison, N.Y., says she finds the use of mystery patients less problematic in settings outside of hospitals, such as doctors’ offices. But Berlinger has reservations about the practice because it is based on deception.

“Are we trying to play a ‘gotcha’ game or improve health care?” she asks. “And is there no other way we can understand what is going on?"