“Who Watches the Watchers? Quis custodiet ipsos custodes?
This is a Latin phrase found in the work of the Roman poet Juvenal from his Satires (Satire VI, lines 347–8)”
I suspect that most people have been themselves, or know someone who has been, in a situation where they had a critical medical illness but simply failed to fully understand the medical terminology and their real chances of cure or even survival. When an individual has access via business, occupation, family or personal friends to physicians that they can trust, the situation is often different. When you can pick up a phone and ask a physician-friend to review with you your latest lab results and even to discuss choices like chemotherapy versus surgery, this yields a completely different healthcare experience. But even in these cases, the physician friend doesn’t necessarily have access to all of your x-rays and other studies, in order to give you a complete picture of your status. If this doctor-friend calls the hospital and begins poking around, he or she will often be shut down by the healthcare staff.
Not incidentally, most doctors feel an allegiance first to their own kind. Therefore, if a doctor identifies an error in management, this doctor might not mention it to the sick friend or even family member. Of course this is wrong. I would go so far as to say that this is fundamentally, morally wrong. But it goes on all the time. Every doctor lives in abject fear that one day he or she will be in need of a colleague to stand up for them, and thus is loathe to become known as the one who “snitched”.
In the past, I have spoken of having a hospital ombudsman that would truly and primarily be the representative of the patient, even if it meant challenging the hospital. But an ombudsman is still not a physician, and more so, such a role is limited to a particular hospital. Therefore, if the patient is receiving care across multiple healthcare institutions as well as primary physicians, there is no ONE representative that crosses all the lines and fully represents the patient for all their needs.
When there is a plane crash, a special task force sets out to analyze the crash scene and wreckage. This task force has no primary allegiance to a given travel agency or airline. And it is this task force which will put together the report that may conclude that this was a freak accident or that may say that a fundamental change across the airline industry is necessary. The public counts on such a task force to keep planes and air travel as safe as possible. Within the police, there are formally trained police whose primary task is to weed out “bad apples”. These police officers, often referred to as “Internal Affairs”, is often disliked if not even reviled by the other police officers. But the need for such a service is clear, and there are those who are very devoted to this task.
Doctors cannot self police. This is not specific to doctors and does not speak to some inherently moral failing of physicians. There is probably no group that can effectively self police. As such, especially when dealing with a topic as critical to everyone as healthcare, the time has come to set up an independent and parallel service that is paid for by a client and/or public, and answers first and foremost to the patient.
Imagine establishing a residency, or perhaps a subspecialty after having completed other formal training in internal medicine or surgery or pediatrics, where this new residency deals primarily with knowing patients’ rights, knowing how to properly represent patients, knowing how to review complicated charts which include extensive CYA materials. Such new specialty training would include financial studies so that the specialist could help patients calculate both health factors and actual costs of care (and help patients find the best cost-benefit ratio). This new residency would even include a certain amount of legal training to know what a healthcare service can legitimately claim. Such subspecialists would also be well trained in handling computerized medical records and extracting information that even most doctors did not realize was still online.
This new subspecialty would most likely be reviled by “regular” doctors, which would probably be an indication of their doing their work properly. These new subspecialists, which we will call from now on “Watchers”, would be an independent unit, with an independent overseeing board that would very clearly operate outside the standard parameters and world of all other physicians. Patients would come to know that they could lodge a complaint and have it fully assessed by a fully qualified watcher-physician who knows how to get to the truth. The same Watcher could be brought in when patients are faced with difficult decisions that their doctors are simply not addressing (or perhaps not well trained enough to address). The Watchers could either force the patient’s physician to take the time and answer all of the patient’s questions, or the Watchers could answer the questions themselves (backed up by AI systems like IBM Watson). If the Watchers end up presenting a very different picture than the patient’s personal doctor, this would immediately spark an investigation and perhaps even the transfer of the patient to another doctor.
The Watchers would take full advantage of any and all cyber tools available. And it could very well be that the Watchers would have access to records that regular physicians don’t [just as the FBI can access certain information that other police cannot]. I even suspect that the Watchers would have their own computer services that would create tools that make it possible for them to get to the true story, with or without the treating physician’s help. I have no doubt that a whole fleet of startups will emerge in order to answer the specific needs of the Watchers. I would like to think that at some point, doctors who really do want the best for their patients will welcome such a service.
Who will cover the cost of these Wacthers? It is a very good question. It could be that every healthcare institution and insurance company will have to pay a certain amount to support these services. Actually, it may be that insurance companies will welcome such a service as it will most likely make doctors much more self-aware, as well as bring to light medical conditions that are not due to poor luck but rather due to malpractice. With the Wacthers around, it’ll be much harder to maintain the shroud of secrecy around the medical world. In this new reality, insurance companies will become aware of cases that were a doctor’s fault. This will mean that the insurance companies will not have to pay out but rather will be able to sue the treating doctor for the funds necessary to compensate the patient.
The Watchers may do something as basic as enforce existing protocols that are clearly beneficial to patients. Watchers will make sure that handwashing truly becomes standard. And when a Watcher identifies a physician that regularly fails to wash his or her hands before treating patients, the Watcher will have the power to even revoke that physicians’ privileges in the specific hospital. Because all Watchers will be connected by a universal network, the same physician who commits malpractice in one institution in one part of the United States, will be immediately identified as problematic in a different institution in another part of the United States. Those doctors who fail to wash their hands in multiple institutions will be identified and may very well have their license revoked. Yes, this is very much “Big Brother”. And I for one welcome it.
No system is perfect. In the police force, you will occasionally find Internal Affairs’ agents who are corrupt. In banking, you will find FTC agents who have been bought off. And in time, there will be some of these Watchers who also go the wrong way. Nevertheless, without oversight, there is only chaos. In the case of healthcare, the ones who suffer in the chaos are you – Joe public, who has no choice but to put his trust in the hands of the healthcare system. I personally think that Joe-public deserves more.
Who watches the doctors? The Watchers will.
Thanks for listening