Sunday, July 15, 2012

Secret Shoppers in the Doctor's Waiting Room- A Twist on Pay for Perfomance

Image Depicts Doctor'sWaiting Room Flow Plan

On a prior posting, I opposed using secret shoppers to evaluation medical offices. I admit, however, that physicians’ office practices do need some healing. Patients who phone their doctor pray they will reach living breathing human beings, but often find themselves trapped in the expanding phone menu universe. Waiting room patient ‘flow’ can be stagnant. Getting medical records transferred, a reasonable and routine request, can test the mettle of even the most steeled and seasoned patients. Office staff, who are often multitasking machines, may be impatient with patients.

I don’t need a secret shopper to make these diagnoses in my practice. We already know them and struggle to improve them. We have made progress where we could and tried to mitigate the damage when we couldn’t remedy a particular situation.

Our most important resource of identifying our flaws is our patients. When they point out when we have missed the mark, they give us valuable quality improvement advice. They are exposed to aspects of our practice that we physicians, who are busy in our exam rooms, may not be aware of. Their suggestions improve our practices, and I am grateful when we receive them. I hope that they will continue to speak out.

Sometimes, these ‘recommendations’ are simply the gripings of a disgruntled patient. Often, however, they are constructive comments from patients who truly want to help us. We may know these patients for years and trust them. They are not hired hands on someone’s payroll who will never see us again. In general, our patients speak up because they care.

They don’t just address our waiting room and secretaries; sometimes they point the finger at me. When I fall short, and a patient calls me on it, I take it to heart and try to get back in gear. For me, these lessons from patients are my most potent and effective quality improvement program. For me, this is the right prescription for effective and honest quality review, not paid reports from sneaky and anonymous thespians.

This secret shopper strategy is a variant of the absurd pay for performance 'quality' scheme.  The impostors are paid to perform.  Let's bring the curtain down on this performance.


  1. I like your post Michael. My friend recently had a tragic accident at work where is middle finger was cut off and he had to wait 15-20 min for an ambulance on top of more time to get to an operating table. I think that is too much time for someone seriously injured to get medical attention. He's still alive but he was kind of upset with the amount of time it took to get picked up and worked on.

  2. This is such a great post Michael. It throws things into perspective for so many about what some "pay for performance" for medical care.

  3. Another great blog, Michael! I forgot to mention in my last comment that adding a quote from Meatloaf, a 20th century prophet, was exquisite!

  4. Appreciate comments. Yes, Meat Loaf was not sufficiently appreciated! The ideas and programs that are in place to measure medical quality are mind boggling. They are so transparent with regard to their true design to control the medical profession and to cut costs. Find me a doctor who truly believes that these initiatives improve his doctoring. If you do, then seek a second opinion.