"My dentist is great! He sends me reminders so I don't forget
checkups. He uses the latest techniques based on research. He
never hurts me, and I've got all my teeth.
When I ran into him the other day, I was eager to see if he'd
heard about the new state program. I knew he'd think it was great.
"Did you hear about the new state program to measure effectiveness
of dentists with their young patients?" I said.
"No," he said. He didn't seem too thrilled. "How will they do that?"
"It's quite simple," I said. "They will just count the number of
cavities each patient has at age 10, 14, and 18 and average that
to determine a dentist's rating. Dentists will be rated as
excellent, good, average, below average, and unsatisfactory. That
way parents will know
which are the best dentists. The plan will also encourage the less
effective dentists to get better," I said. "Poor dentists who
don't improve could lose their licenses to practice."
"That's terrible," he said.
"What? That's not a good attitude," I said. "Don't you think we
should try to improve children's dental health in this state?"
"Sure I do," he said, "but that's not a fair way to determine who
is practicing good dentistry."
"Why not?" I said. "It makes
perfect sense to me."
"Well, it's so obvious," he said. "Don't you see that dentists
don't all work with the same clientele, and that much depends on
things we can't control? For example, I work in a rural area with
a high percentage of patients from deprived homes, while some of
my colleagues work in upper middle-class neighborhoods. Many of
the parents I work with don't bring their children to see me until
there is some kind of problem, and I don't get to do much
preventive work. Also, many of the parents I serve let their
kids eat way too much candy from an early age,unlike more educated
parents who understand the relationship between sugar
and decay. To top it all off, so many of my
clients have well
water which is untreated and has no fluoride in it. Do you have
any idea how much difference early use of fluoride can make?"
"It sounds like you're making excuses," I said. "I can't believe
that you, my dentist, would be so defensive. After all, you do a
great job, and you needn't fear a little accountability."
"I am not being defensive!" he said. "My best patients are as good
as anyone's, my work is as good as anyone's, but my average cavity
count is going to be higher than a lot of other dentists because I
chose to work where I am
needed most."
"Don't' get touchy," I said.
"Touchy?" he said. His face had turned red, and from the way he
was clenching and unclenching his jaws, I was afraid he was going
to damage his teeth. "Try furious! In a system like this, I will
end up being rated average, below average, or worse. The few
educated patients I have who see these ratings may believe this
so-called rating is an actual measure of my ability and
proficiency as a dentist.
They may leave me, and I'll be left with only the most needy
patients. And my cavity average score will get even worse. On top
of that,how will I attract good dental hygienists and other
excellent dentists to my practice if it is labeled below average?"
"I think you are overreacting," I said. "'Complaining,
excuse-making and stonewalling won't improve dental health'... I
am quoting from a leading member of the DOC ," I noted.
"What's the DOC ?" he
asked.
"It's the Dental Oversight Committee," I said,"a group made up of
mostly lay persons to make sure dentistry in this state gets
improved"
"Spare me," he said, "I can't believe this. Reasonable people
won't buy it," he said hopefully.
The program sounded reasonable to me, so I asked, "How else would
you measure good dentistry?"
"Come watch me work," he said. "Observe my processes."
"That's too complicated, expensive and time- consuming," I said.
"Cavities are the bottom line, and you can't argue with the bottom
line. It's an absolute measure."
"That's what I'm afraid my parents and prospective patients will
think . This can't be happening," he said despairingly.
"Now, now," I said, "don't despair. The state will help you some."
"How?" he asked.
"If you receive a poor rating, they'll send a dentist who is rated
excellent to help straighten you out," I said brightly.
"You mean," he said, "they'll send a dentist with a
wealthy
clientele to show me how to work on severe juvenile dental
problems with which I have probably had much more experience? BIG
HELP!"
"There you go again," I said. "You aren't acting professionally at
all."
"You don't get it," he said. "Doing this would be like grading
schools and teachers on an average score made on a test of
children's progress with no regard to influences outside the
school, the home, the community served and stuff like that. Why
would they do something so unfair to dentists? No one would ever
think of doing that to schools."
I just shook my head sadly, but he had brightened. "I'm going to
write my representatives and senators," he said. "I'll use the
school analogy. Surely they will see the point."
He walked off with that look of hope mixed with fear and
suppressed anger that I, a teacher, see in the mirror so often
lately.
If you don't understand why educators resent the recent federal NO
CHILD LEFT BEHIND ACT, this may help. If
you do understand, you'll
enjoy this analogy, which was forwarded by John S. Taylor,
Superintendent of Schools for the Lancaster County , PA, School
District.
Be a friend to a teacher and pass this on."
