AMA considers fake patients

Lori Erickson-Trump has faked headaches and back pain. She has had physicals and MRIs she didn't need, and she gets paid for it – all to evaluate the performance of doctors and their staffs.

Hospitals and health clinics are increasingly turning to undercover patients to grade the health care experience offered.

Now the ethics council of the American Medical Association is pressing the doctors group to endorse such practices. AMA delegates are expected to vote on the proposal, along with dozens of others, during their five-day meeting beginning Saturday.

Some doctors are outraged at the idea.

Dr. Richard Frederick, of the University of Illinois College of Medicine in Peoria, called it “official deceit” that could have disastrous consequences.

“In some instances sham patients have presented to overcrowded emergency rooms with chest pain,” he wrote in May's edition of Virtual Mentor, the AMA's online ethics journal. “How could the hospital administration defend this exercise to someone who suffers an adverse outcome while waiting his turn behind the person who is only pretending to be sick?”

The proposal to the AMA does include restrictions that address that and other concerns. The recommendation is to have a system that makes sure fake patients don't interfere with treating real ones; gives doctors a heads-up that undercover patients might be visiting; and ensures that bad reviews aren't used to punish doctors.

And Dr. James Loden, writing an opposing view in the journal, says undercover patients are neither “devious” nor “spying.”

“Employees, including doctors, are paid to do specific tasks; if they choose to perform at a level that is less than acceptable, they need to improve or find other jobs,” he wrote.

Loden, an ophthalmologist in Nashville, Tenn., started using undercover patients to evaluate his business two years ago.

The sham patients showed “that I consistently left the examining room without asking clients whether they had any questions,” Loden wrote. He also learned that some employees didn't always introduce themselves or explain why tests were being performed.