Connoisseurs of Care?

Unannounced Standardized Patients' Rating of Physicians

Though patients are often asked to evaluate the performance of their physicians, positive bias and poor response rates may limit the usefulness of these evaluations. Unannounced standardized patients are actors who are trained to portray patients in order to assess physician job performance and may be less biased and more discerning about physician behavior than actual patients are in their assessments. This study examines whether unannounced standardized patients can reliably rate physicians' interpersonal and technical skills as well as their own overall satisfaction.

The authors used data from the Patient Centered Communication (PCC) study and the Social Influences in Practice (SIP) study. In the PCC study, five standardized patients made 192 visits to 96 physicians. In the SIP study, 18 standardized patients made 292 visits to 146 physicians. Standardized patients' visits to physicians were randomized and each standardized patient rated 16 to 38 physicians on interpersonal skills, technical skills and overall satisfaction.

The study provides evidence that unannounced standardized patients can reliably distinguish among individual physician performance in interpersonal skills, information gathering and satisfaction. The authors note several limitations, including many physicians suspected they might be seeing a standardized patient, and the authors cannot determine whether reliability scores would change if they had a more diverse standardized patient population. The authors conclude that unannounced standardized patients can be used to reliably evaluate the job performance of physicians and that their evaluations have advantages over patient evaluations, as they reduce the positive bias seen in real patient evaluations.