Could a program ethically use Mystery Patients (like Mystery Shoppers)

[BobA]

Let's say you're a PD and you want to evaluate your residents. Would it be ethical to hire a mystery patient to see how your resident does?

---

Members don't see this ad.

 

[Doc Samson]

No.

 

[BobA]

No.

why not?

 

[TSasser]

I could see that happening in a lab type of environment with approval form the head of the resident program, just not within the regular departments. Kind of like the standardized patients in med school.

 

[whopper]

The state of NJ has been known from time to time to send in someone who into a psychiatric unit, in a few of the cases I know of, as staff member, where the real intent was to see if the treatment was fair.

It led the the shutdown of a psychiatric facility where staff members were actually making recommendations on which shift was best to have sex with patients. Mind you this was decades ago, improvements were made, and the guy who made the biggest strides in these reforms later became a governor of the state and some psychiatrists were trying to get this thing fixed for some time. It was just that the state didn't give a damn at the time because they didn't want to allot money for the mentally ill, though there certainly were many psychiatrists willing to look the other way.


NAMI in NJ has been speculated to do something similar but to actually go into a place as a patient, and the people that do this are former patients now stabilized, just to make sure things are alright. I don't know for certain if they did it, but on occasion, while I was in NJ, we'd get people who were NAMI members and didn't appear to be mentally ill at all, and while in the hospital appeared to snoop around to make sure nothing was wrong. The nurse manager (who I thought was sharp though many residents hated her because she was like a Mother Superior-and heck she was an ex-nun) mentioned to the treatment team that we had nothing to fear so long as we did our jobs for real, so who cared if they were there to judge us? Just do the job right whether or not someone's spying on you.

 

[sunlioness]

NAMI in NJ has been speculated to do something similar but to actually go into a place as a patient, and the people that do this are former patients now stabilized, just to make sure things are alright. I don't know for certain if they did it, but on occasion, while I was in NJ, we'd get people who were NAMI members and didn't appear to be mentally ill at all, and while in the hospital appeared to snoop around to make sure nothing was wrong. The nurse manager (who I thought was sharp though many residents hated her because she was like a Mother Superior-and heck she was an ex-nun) mentioned to the treatment team that we had nothing to fear so long as we did our jobs for real, so who cared if they were there to judge us? Just do the job right whether or not someone's spying on you.

I just hope they're not expecting their insurance companies or the taxpayer to foot the bill for that hospitalization.

 

[Doc Samson]

why not?

Evaluation of residents has to be pretty formalized per ACGME regulations. Patients can be surveyed as part of a 360 degree eval, but I think undeclared sham patients would be seen as unethical by most in education. Medical trainees are protected by some pretty stringent ethical regs in the world of research, so I can't imagine that wouldn't extend to education.

 

[billypilgrim37]

My clinic schedule is booked until October 17th. If somebody put in a sham patient there when I have people that really need to be soon much sooner than that, I would have a cow. Moooo!!!

 

[BobA]

My clinic schedule is booked until October 17th. If somebody put in a sham patient there when I have people that really need to be soon much sooner than that, I would have a cow. Moooo!!!

I'm jealous you can see people that early!!

Seriously, though, I have had some uncanny teaching situations that I swore must have been staged. But maybe not . . .

 

[kugel]

Personally, I don't have a problem with this idea. In fact, I kinda like it.
But then again I'm a devious SOB.

I think many people act quite differently with an attending in the room, and in my training the attending was only in for 2-3 min per visit to the general psych clinic.
This practice would also be one of the only ways to get a recording of how the resident acts, without violating any patient rights. Doing it rarely and randomly would prevent it from putting a significant burden on tight schedules.

If I was a PD (and the more I talk, the less likely that becomes), I would announce that we are going to do this beginning sometime in the next 6 months, and then proceed. I think doing this once every 6 months or so per resident would keep everyone on the straight and narrow. I've known way too many residents and attendings who felt that several illegal/inappropriate activities were "no big deal" as long as you don't get caught. Knowing that "mystery patients" may show up would help curb the idea that such things are only wrong "if you get caught." I know enforcement never completely changes attitudes on it's own, but constant expectation of being caught does begin to adjust social expectations (e.g. smoking/drinking during pregnancy, drinking and driving, domestic violence, racial slurs at work, etc)

 

[whopper]

In fact, I kinda like it.
But then again I'm a devious SOB.

I like the idea too. In fact, I think medical boards should do this for attendings that have several complaints against them from multiple people. Kinda like how an undercover cop will investigate someone where there's evidence they're breaking the law.


There's just too many doctors giving out benzos/opioids like they're candy and willing to diagnose bipolar at the drop of hat.

 

[digitlnoize]

When looking at programs to apply to, I've noticed many places that videotape encounters or have attendings watch via 2-way mirror. Is this type of thing common? It seems to address the issue without the need to resort to spy tactics...

 

[whopper]

A problem is some people, when they know they're not being watched, tend to show their real selves and only then. Only a fool breaks the rules or does poor work when they know they're being watched.

 

[digitlnoize]

A problem is some people, when they know they're not being watched, tend to show their real selves and only then. Only a fool breaks the rules or does poor work when they know they're being watched.

Couldn't a program simply not tell you when the cameras were on? That way you never know...

 

[wholeheartedly]

I'd be on board with this too, both as a patient in a teaching hospital and a hopefully future doc. I've seen and heard about a few too many sketchy happenings going on when the residents feel like they can get away with it. Practicing physicians too.