Fielding standardized patients in primary care settings: lessons from a study using unannounced standardized patients to assess preventive care practices

Objectives. To document detection and suspicion rates of unannounced standardized patients visiting community-based practices. Design. Primary care physicians were recruited to participate in a study using standardized patients. Four standardized patient scenarios were used. Setting. Community-based primary care physicians' practices in southern Ontario between September 1994 and August 1995. Study participants. Sixty-two primary care physicians. Main outcome measures. A 'believability' questionnaire completed after all four standardized patients had visited the practices. Results. Of the primary care physicians approached 50% (62) agreed to participate. Twenty-one per cent of all visits were suspected as standardized patient encounters. Forty-six per cent suspected one or more standardized patients. Only five physicians (8%) suspected all four standardized patients. Reasons for suspecting standardized patients were associated with the characteristics of the physician's practices, the physician's practice profile and the standardized patient cover story. Conclusion. The portrayal of asymptomatic patients seeking a new primary care physician presents unique challenges. Carefully constructed cover stories, and detailed knowledge of the local area and of the practices of the participating physicians is required to allow standardized patients cases to be tailored to fit into primary care settings without arousing suspicion.