The use of 'mystery shopper'-style patients to assess doctors' performance is becoming more common - but how effective is it? Dutch and American researchers aimed to find out, through the first systematic review of the available literature. Their results show that while there is a continuing role for both SPs (standardised patients) and ISPs (incognito SPs-those that turn up unannounced which means participating doctors do not know when they will be visited), there are still plenty of questions left to be answered about their use. The researchers suggest a re-examination, for example, of whether study subjects should be asked if they are happy for ISPs to visit them. At the moment, doctors give their consent for ISPs following a furious reaction when in an early study, permission was not sought, and the doctors had no idea they were dealing with an ISP-but this could bias any study using ISPs because doctors self-select by giving or withholding their consent. The paper admits 'can one send ISPs without asking permission to do it?' is an ethical dilemma but suggests it would be interesting to explore 'provided that study protocol guarantees anonymity'.
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