ArticleThe Milbank quarterly2012
Simulated patient studies: an ethical analysis.
Article in The Milbank quarterly, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
40 citing papers in PubMed, 1 synthesis or guideline pooled it, 91 citations in OpenAlex.
- How to do (or not to do) … using the standardized patient method to measure clinical quality of care in LMIC health facilities.Health policy and planning · 2019Pooled it
- Effect of Documenting Prognosis on the Information Provided to ICU Proxies: A Randomized Trial.Critical care medicine · 2019Trial
- Accessibility of ADHD Assessments in Australia: A Secret Shopper Study.Journal of attention disorders · 2026Article
- Access to cervical screening in Australian general practices: a cross-sectional study using a 'secret shopper' approach.Cancer causes & control : CCC · 2026Article
- Private Equity-Acquired Residential Treatment Facilities vs Other For-Profit Facilities.JAMA health forum · 2026Article
- Simulated patient methodology applied in health services research: a scoping review.BMC health services research · 2026Article
- Incognito standardized patients for studying healthcare stigma: partial deception and other ethical challenges.BMC medical ethics · 2026Article
- "Miss, I want itchy medicine": Understanding what, why, and how antibiotics are used in Central Java province, Indonesia through the drug bag method.PLOS global public health · 2026Article
- Medication Recommendation, Counseling, and Pricing for Nasal Sprays in German Community Pharmacies: A Simulated Patient Investigation.Advances in respiratory medicine · 2025Article
- Quality of Information on Medication Abortion in Private Pharmacies: Results from a Mystery Client Study in Kinshasa, Democratic Republic of Congo.Healthcare (Basel, Switzerland) · 2025Article
- Using simulation to uncover care aides physiological and emotional responses to their work: A research protocol.PloS one · 2025Article
- Exploring the usability of simulated patient methodology in dental clinics in Western Australia: A pilot survey.Clinical and experimental dental research · 2024Article
- Tuberculosis care provided by private practitioners in an urban setting in Indonesia: Findings from a standardized patient study.PLOS global public health · 2024Article
- Improving eye care quality through brief verbal intervention on optometry service provider by using unannounced standardized patient with refractive error: study protocol for a randomized controlled trial.BMC ophthalmology · 2023Article
- Do private providers initiate anti-tuberculosis therapy on the basis of chest radiographs? A standardised patient study in urban India.The Lancet regional health. Southeast Asia · 2023Article
- Oral emergency contraception practices of community pharmacies: a mystery caller study in the capital of Germany, Berlin.Journal of pharmaceutical policy and practice · 2023Article
- Article
- Use of standardised patients to assess tuberculosis case management by private pharmacies in Patna, India: A repeat cross-sectional study.PLOS global public health · 2023Article
- Secret shopper studies: an unorthodox design that measures inequities in healthcare access.Archives of public health = Archives belges de sante publique · 2022Article
- Improving Data Surveillance Resilience Beyond COVID-19: Experiences of Primary heAlth Care quAlity Cohort In ChinA (ACACIA) Using Unannounced Standardized Patients.American journal of public health · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextIn connection with health care reform, the U.S. Department of Health and Human Services commissioned a "mystery shopper," or simulated patient study, to measure access to primary care. But the study was shelved because of public controversy over "government spying" on doctors. Opponents of the study also raised ethical concerns about the use of deception with human subjects without soliciting their informed consent.
methodsWe undertook an ethical analysis of the use of simulated patient techniques in health services research, with a particular focus on research measuring access to care. Using a case study, we explored relevant methodological considerations and ethical principles relating to deceptive research without informed consent, as well as U.S. federal regulations permitting exceptions to consent.
findingsSeveral relevant considerations both favor and oppose soliciting consent for simulated patient studies. Making research participation conditional on informed consent protects the autonomy of research subjects and shields them from unreasonable exposure to research risks. However, scientific validity is also an important ethical principle of human subjects research, as the net risks to subjects must be justified by the value to society of the knowledge to be gained. The use of simulated patients to monitor access is a naturalistic and scientifically sound experimental design that can answer important policy-relevant questions, with minimal risks to human subjects. As interaction between researchers and subjects increases, however, so does the need for consent.
conclusionsAs long as adequate protections of confidentiality of research data are in place, minimally intrusive simulated patient research that gathers policy-relevant data on the health system without the consent of individuals working in that system can be ethically justified when the risks and burdens to research subjects are minimal and the research has the potential to generate socially valuable knowledge.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.