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.
