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A study was undertaken whereby a set of standardized (simulated) patients visited general practitioners without being detected, in a health care system where doctors had fixed patient lists. Thirty nine general practitioners were each visited during normal surgery hours by four standardized patients who were designed to be indistinguishable from real patients. The objective of the study was to see whether the actual performance of general practitioners, as assessed by standardized patients, met predetermined consensus standards of care for actual practice. The patients presented standardized accounts of headache, diarrhoea, shoulder pain and diabetes. The mean group scores of the doctors on the predefined standards of care for the different complaints ranged from 33 to 68%. The results show that standardized patients may be the method of choice in the assessment of the quality of actual care of doctors. It is hypothesized that the substandard scores of the doctors do not reflect inadequate competence, but are a result of the difference between competence and performance.