Who watches those watching physicians?

Who watches the watchers?  It’s an old Roman saying from the poet Juvenal, and it had to do with infidelity. But over the years it has been applied to politics as well.  It means, “How do I know that the people guarding me are worthy?”  It has also been translated, “Who guards the guards?”

But it seems to me that it applies to medicine quite appropriately.  Who watches those watching physicians?  We don’t ask this question often enough.  We are subject to every form of inquiry and endless credentialling. We face maintenance of certification and poorly validated patient satisfaction scores.

All across medicine, but particularly in the emergency department, nurse surveyors and department managers, nurse quality officers and CMOs, MBA managers and others are constantly reviewing the times within which we live our professional lives.

“Did you see the patient within ten minutes of their arrival?  Did you enter the order as quickly as possible?  Did you document, on paper and electronically, the EKG or CT interpretation immediately, even as you immediately went to the bedside? Were you sensitive to the patient’s cultural needs and personal issues?”

And yet, who watches them?  Who guarantees to me, to us, that the nurse, or business office member who is going through my records has even the slightest qualification to do so?  Who certifies that they are trained, rather than simply someone’s cousin or sister or brother, or someone who just needed to be moved to a new department?  What yearly tests do they take to prove that their assessments of my care are valid?  What test, every ten years, what volume of continuing education, proves to clinicians (or potentially to patients) that those people who stand in judgment over the clinicians of the world has even the slightest ongoing validation to do the work for which they are paid, and by which they make our lives ever more difficult?

I want to check their references and see what education they have; every year or two, just as I am re-credentialed, they should be. I want there to be certifying bodies that require them to take tests unique to their skill sets; whether nurse surveyor or CEO near retirement.  I want medical staff bodies to have access to their paperwork on a routine basis, so we can see what notes they take about us, since that is parallel to their assessment of our notes about patients.

I want the same thing for those in the insurance industry, and for politicians holding forth on their expertise about how to “fix” medicine. I want them to demonstrate their knowledge; especially once they have re-engineered the entire system with distastrous results.  Ditto for attorneys.

Quis custodiet ipsos custodes? Who watches the watchers, indeed . Apparently, nobody. That’s why it’s so much fun to be a watcher.

But it’s time that someone does.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test

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  • SteveCaley

    Ah! You have found the modern law of infinite recursion, Ed. The Authority is the Hive Mind – we all just report to it. We have come to worship a primitive superstition, and put it on an app – the iBorg, perhaps.
    Nobody is interested in the fidelity of data, Ed; and, as you know, the outrageously erroneous outcompetes the multiplicity of correctness.
    The NPI database – you recall, the One Provider Number that came to substitute for the One Provider Number, the – oh, what was it? I forget. The NPI database is reputed to be less than 50% correct on a physician-by-physician basis. With the challenge of Mass Data, really, who has time to check that all the data is RIGHT?
    Entropy dictates that with sufficient hiding places, errors can never be rooted out, and the Internet cannot be corrected, of course. Fifty years ago, a disgruntled person could spray-paint “ED SUX” on the wall. Now, they can report some factitious dereliction of duty on your part – and you will be under scrutiny by the Borg Mind.
    The only qualifications that the Borg Mind expects of them is the Joy of Assimilation. That is enough of a qualification to belong to the Watchers.
    And the EMR/EHR, of course. One Watcher can put down in a patient’s file of their Terrible Heroin Problem – and from then on, the electronic mind will require the, the…. I can’t think of what to call healthcare workers in the future…. the ___ will be required to ask – have you used heroin in the last few months? Of course, the patient will respond in spluttering denial and ask how this lie got into the chart. Addicts have a problem with denial. So do the Assimilated. Like Kubler-Ross, there is Denial and Anger at the start of Assimilation.

  • https://www.facebook.com/arobert6 Alice Robertson

    It’s not just a problem of administrator watchdog types. Even patient advocacy has become so laden with those who are coin-operated the patient feels trodden on and yelping.

    • SteveCaley

      There’s nothing more helpful to the patient to have an intelligent and interested patient advocate AND a team providing care.
      There’s nothing worse than an uninformed, reflexive, bigoted patient advocate. I’ve seen both.

  • Dee Coyle Tocci

    Actually, there are multiple certifying bodies for watchers… but that doesn’t make it right. Love the response reguarding the Borg – resistence IS futile – or is it?

  • rbthe4th2

    Google Christopher Duntsch and Charles Cullen and you’ll understand why we are apprehensive. I was just followed by 5 people yesterday almost to my car, if I had not called the cops, in regards to the former surgeon I had. I was on public property and never attempted to go any where near them or anything else. I can’t be in the area I guess and then you tell me that these people are being watched?

  • Bob

    More often or not it’s he EHR computer that is a self reporting method that puts everyone on the clock and since most of the patients are government paid the FBI working with the FBI and the local Medicaid Fraud Control Units can come in do a audit and send you a bill or even arrest you. Think not, ask around, as since they can’t catch the biggest frauds they have to do something and are doubling down on providers. And all of these pay the least, so why take them?