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Defining oversight

care health soundness attention well-being oversight healthcare

care * 6. watchful oversight, charge or supervision

In contrast to attention, which narrows the cognitive focus of care (see Defining attention), oversight and supervision broaden the perspective. Attention picks out small details; oversight looks at the big picture. If attention is the sprint, oversight is a marathon. Attention requires a one-to-one relationship ( between provider and patient or even between provider and problem), while oversight implies one-to-many or many-to-one relationships. On the other hand, supervision and attention are not mutually exclusive. To supervise (that is, to superintend *) implies directing one's attention to the object(s) of supervision.

Vision and supervision

Vision is a powerful, pervasive metaphor for cognition. There are three Indo-European roots ([weid] *, [sekw-] *, [spek-] *) having to do with vision and sight, and all three give rise to words that have to do with aspects of consciousness and thought. The root [weid], for example, gives rise to wise, wisdom, wit and idea and a host of words dealing with more specific notions of cognition (Table 11).

Table 11. Derivatives of the root [weid] *
form etymon word sense
weid- Ge. witan guide to look after
weid-to Ge. wissaz wisdom wise
wise wise
wise manner
guise manner
weid-es Gr. eidos idyll form, shape
wid- Ge. wit wit intelligence
wide
weid-to
L. videre view * to look at
vision * something seen
visit * go to see
advice * what seems good
evident * apparent
interview * to see between
provide * to look ahead
prudent * to look ahead
revise * to look at again
review * to see again
supervise * to oversee
wid-es-ya Gr. idea idea appearance
wid-tor Gr. histor history learned
dru-wid L. druides druid seer

A number of words in this table have found their way into everyday parlance in the healthcare arena: outpatient visit, medical advice, evidence-based medicine, patient interview, healthcare provider, shunt revision, review of systems, history and physical.

Hyper- versus hypo-. These two English prefixes are frequently found in medicine, as in hyperactivity and hypotonia. Because of their similarity, they are often confused (misheard) with dire consequence because their meanings are quite the opposite. The prefix hyper- comes from the ancient root [uper] * meaning over. The English word over itself stems from this root, as well as super and the German über. Thus hyper-, over and super have the same root and much the same meaning. On the other hand, [upo] * means under, but up comes from this root, perhaps looking up from under, as in the supine position. Some sources give the derivation of over as this root, [upo]. Perhaps the confusion of sounds may be of ancient origin.

Sight and oversight

In any case, super-vision and over-sight are similar both in origin and meaning. The word sight comes from a different root, [sekw-] *, of course. This root is also the source of the English words see and seer, but the offspring are comparitvely few. To oversee * is to watch over and direct. To direct *, in turn, literally means to lead straight. Oversight thus implies two subjects, one to lead and another to be led, one doing the overseeing while the other is acting or behaving in a way that is overseen. Typically, one overseer gives supervision to more than one, often many, subjects of supervision. One healthcare provider typically provides oversight for the health of many patients. On the other hand, a given patient may receive care from a number of different providers, and in this case a particular provider (the primary [first] care provider) should oversee the care given by all the others.

Paradoxically, oversight * can also mean an unintentional omission or mistake, and to overlook can mean to ignore deliberately. This is precisely the opposite of what is meant by care. This is, in fact, what care tries hard to avoid. The second definition of is watchful care or management; supervision, a rather tight circle of definitions:

The common denominator here is the vision metaphor of watching and watching over. Before investigating watchfulness, however, we should take a quick look at another bodily metaphor contained in the definition of oversight, the hand. This definition also mentions management, a word derived from the root [man-] *, hand, (also manual, maintain). The English word handle means to manipulate, manipulate coming from the same root. Thus the metaphor of using one's hands to direct or guide is a part of the definion of care and oversight. From this metaphor we get the terms managed care and health maintenance organization.

Watchfulness

The third root for sight and vision mentioned at the outset is [spek-] *, to observe. From this root we get a number of English words having to do with various aspects of cognition (speculate, introspection, expect, repect, and skeptic to mention but a few). Three words are especially related to oversight: scope, bishop and episcopal. Scope* comes to us through the Latin skopos, target, aim, and it means the range of one's perceptions, thoughts and actions. Attention narrows one's scope, oversight widens it. Episcopal comes from the Greek word episkopos (also bishop), which literally means one who watches. And this brings us to the notion of watchfulness, part of nearly every definition related to oversight.

Watching, of course, is part of the vision metaphor as well. To watch * is to observe, but more importantly it means to keep one's eyes open, to stay awake. The prehistoric root is [weg-] *, to be lively, to be awake (also awake, vigilant). Care as watchful oversight, then, is staying vigilant, making sure that nothing falls through the cracks, keeping track of what has been done and what needs to be done. This aspect of care has to do with awareness. It uses alerts and reminders to avoid errors of negligence. Watchful oversight means paying attention, but in a way that is more like staying awake at the wheel while driving a car than focusing on a particular problem. Watchful oversight allows the healthcare provider to care for a given patient over an extended period of time, or over a number of patients at the same time. It allows the provider to set priorities and focus attention on the details of health problems without missing the forest for the trees.

A charge to keep

The final aspect of oversight and especially supervision is the notion of duty. Watchful oversight is a charge to keep, an obligation to be discharged. The word charge * found in this definition of care has a fascinating history. It stems originally from the root [kers-] * meaning to run, from which we get course. This root is also the source of the Latin noun carrus, a two-wheeled wagon or cart (also car, cart, and carry). From this was derived the Latin verb caricare, to load, which produced the French verb charger, antececdent of the English word (noun and verb) charge. The same Latin verb became our noun cargo via the Spanish cargar. Thus the notion underlying charge is of a load or burden, still detectible in the modern idea of charge card.

To provide watchful oversight and supervision, then, is to incur (also from [kers-]) certain obligations. Oblige * literally means to bind together, from the Latin ligare (also ligate, ligament, liable, and rely). Through legal or moral means, the care provider is bound to provide attention and oversight for the health of the patient.

Along with these obligations come certain privileges, including that of access to private * information.

 

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