From: Robert Zafran (marklin@redshift.com)
Date: Thu Aug 31 2000 - 06:44:20 PDT
Date: Thu, 31 Aug 2000 06:44:20 -0700 Subject: A true anology... From: Robert Zafran <marklin@redshift.com> Message-ID: <B5D3AF44.6AA%marklin@redshift.com>
Following sent to me my Retired Teacher John Colombero, now working in
Education Office at NASA Ames...
John S. Taylor, Superintendent of Schools for the Lancaster County School
>District, South Carolina writes (in a long-winded but pointed story):
>
>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, so 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 the
>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. It 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; so much depends on things we can't control?
>For example," he said, "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," he added, "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 couldn't believe my
>dentist would be so defensive. He does a great job.
>
>"I am not!" 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. My more educated patients who see these
>ratings may believe this so-called rating actually is a measure of my
>ability and proficiency as a dentist. They may leave me, and I'd 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
>laypersons 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 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 said.
>
>"If you're rated poorly, 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 on a test of children's progress without
>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 senator," 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 see in the mirror so often lately.
>
****************************
Robert Zafran *
659 Cayuga Drive *
San Jose CA 95123-5506 *
*
****************************
Email: "Robert Zafran" <marklin@redshift.com>
Web: (www.redshift.com/`marklin)
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