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Just What The ER Needs – Fake Patients

This is one of the worst ideas I’ve heard of in a long time - “secret shoppers” in the ER (h/t KevinMD and Dr. Wes). In an attempt to assess hospital quality, patients with fake complaints are sent to the ER unannounced to see how they will be triaged and treated. In one case, a woman complained of stroke-like symptoms (headache, slurred speech, and difficulty moving the left side of her body). She underwent a head CT (which was normal) and then signed out of the hospital against medical advice.

Let me tell you why this “secret shopper” idea is so bad:

1. The woman was exposed to unnecessary brain radiation via the CT scan – this risk is acceptable if a patient’s life is in danger, but why would a normal person wish to be exposed to additional radiation? I smell a law suit in her future…

2. The woman’s triage experience could not possibly represent the average stroke patient experience because she could not replicate the signs of a stroke and (if she tried) any good ER doc or neurologist would know that she was faking. A patient faking the symptoms of a stroke would likely be treated differently than a patient with objective signs.

3. Wait times are dangerously high in ERs across the country. Bumping legitimate patients with “secret shoppers” is unethical and downright dangerous.

4. If hospital staff know that some of their patients will be fake, this could result in mistrust of symptoms or stories and a backlash against real patients who might be confused with secret shoppers.

The ER secret shopper movement was clearly conceived by people who don’t understand the complexity of healthcare, and are applying reductionist principles that will cause unanticipated consequences. Physical harm to the shoppers, longer wait times for real patients, further mistrust by the medical community, and inaccurate quality assessments are only the beginning. I hope the AMA voices their disapproval of this practice.

Quality is better assessed by an average of real patient experience, along with data comparing treatment protocols with medical records. Fake patients have no place in the ER.

What do you think?This post originally appeared on Dr. Val’s blog at

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5 Responses to “Just What The ER Needs – Fake Patients”

  1. rlbates says:

    So do you think “worker’s comp” covers any injuries this “fake” patient might receive getting the un-necessary workups? 

    Good post, Dr Val.

  2. rlbates says:

    So do you think “worker’s comp” covers any injuries this “fake” patient might receive getting the un-necessary workups? 

    Good post, Dr Val.

  3. SGray says:

    No wonder the price of health insurance is going up.. Unnecessary treatments and time wasted;  not to mention the overload on the ER staff.  What are these morons thinking.  Just send a note to the patients to find out about their experiences.  No wonder the average wait in the ER is 7 hours.

  4. CeeBee says:

    If I or my family waited in any ER for any condition and I found out that thier care was delayed I would sue so fast.  I know that this could never pass liability State Regulation gurues… If it did I’d move.  I could very well cause an injured or sick person to avoid the ER after losing trust.

  5. shea3 says:

    I am a Nurse Practitioner and am saddened and shocked by the stories I hear from my patients regarding their care in the ER. I hope that if the staff knows they have secret shoppers that they will order colonoscopies with double preps for them !!

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