Undercover actors catch physicians' contextual errors in care

Although healthcare mystery shoppers have historically been used by some practices and hospitals to identify service flaws from the patient perspective, a recent study sent actors into first-time office visits to sniff out potential gaps in medical care.

The study, from researchers at the University of Illinois at Chicago and funded by the Department of Veterans Affair, used actors trained to simulate real patients in 400 visits to a wide range of physician practices in Chicago and Milwaukee, including several VA sites. The 111 doctors involved had all agreed to participate in a study about medical decision-making, but were not told which patients were actors.

Researchers used audio recordings of the visits and medical records to calculate how often physicians picked up on red flags signifying possible complications and consequently adjusted their plan of care, explains the Chicago Tribune. The failure to do both counted as an error. In contextually complicated encounters, error-free care was provided 22 percent of the time, according to the report published in the July 20 Annals of Internal Medicine. The error-free rate jumped to 38 percent in biomedically complicated encounters.

"Physicians did quite well at following guidelines or standard approaches to care, but not so well at figuring out when those approaches were inappropriate because of a particular patient's situation or life context," said Dr. Saul Weiner, associate professor of medicine and pediatrics at UIC and staff physician at the Jesse Brown VA Medical Center, who was lead author of the study.

Weiner said physicians need to recognize underlying issues, such as the lack of health insurance or difficulty understanding or following instructions, when making clinical decisions. As a result, the University of Illinois is developing a training module to teach medical students to investigate contextual issues in patient care.

Weiner also said that doctors can take simple, practical steps to personalize patients' care, including speaking in simple language, listening carefully to concerns that patients mention and keeping a list of resources and agencies that help supply essential social services.

Dr. Timothy Hofer, an expert on medical errors at the University of Michigan Medical School, pointed out to the newspaper that Weiner's study examines first-time appointments, not care delivered over time, and that some doctors may feel more comfortable asking about patients' lives after they've developed a relationship.

To learn more:
- read the article in the Chicago Tribune
- check out this ABC News piece
- see the story in Physorg.com
- here's the abstract in the Annals of Internal Medicine