|
Blog: FCAR
Speakout
|
Support open, broad-based assessment of learning --
contribute to FCAR.
|
| |
Forget the Children
- My Dentist Now Gets A Top Rating
by John Taylor, Superintendent of Schools,
Lancaster School District, South Carolina
http://teachers.net/gazette/DEC02/marshall.html
My dentist bent over me in his usual no-nonsense manner.
"Open wide," he said.
"Hold on a second," I said.
It had been quite a while since I'd seen my dentist (despite his timely
reminders).
"I couldn't help but notice the rating posted in your waiting room. I thought
you had a bunch of objections to rating dentists on the cavity counts of their
young patients, but for someone who was so upset about the new state program for
improving children's dental health, you seem to have come out quite well," I
said smugly. "I told you that you had nothing to worry about."
"One does what one has to do," he responded somberly. "The cavity average of my
young patients is now as good or better than that of dentists of my training and
expertise across the state."
"Aren't you embarrassed about how you responded to the State Dental Improvement
Program when I first brought it to your attention?" I said. "I knew you were a
great dentist! I've noticed you have even improved the look of your office since
my last visit. The waiting room is much neater."
"That's probably because fewer children are running around in there," he said.
"Fewer children?" I said. "Why?"
"I've lost some of my patients because they and their parents wouldn't do their
part. I now require all my patients to see me every six months as long as they
are progressing well. For patients with above the state average of cavities for
their age, I require visits every three months. It's working better than I
feared," he said. "I've only had to drop about 30-35% of my children for failure
to meet my requirements. And the dental health of my remaining young patients is
now really quite good," he said.
"But what about the children you dropped?" I asked, horrified. "Where do they go
for dental care? There aren't other dentists in this area who serve that
clientele."
"I don't know," he said gravely.
"How can you do that?" I gasped. "Think of the children - you can't just drop
them. Besides, that's like cheating. Your rating doesn't mean anything."
"Don't go getting 'holier-than-thou' with me," he said. "I'm the one who told
you the ratings don't mean anything. There are too many factors dentists can't
control. I have simply chosen to control the things I can control to preserve my
reputation, and possibly my practice."
"But...the chil-children," I stammered.
"Look," he said sternly. "If I lose my reputation, or, heaven forbid, even my
license to practice, I won't be helping any children--or you either."
"But, the children," I murmured again. "What happens to the ones who failed to
meet your standards?"
"Look," he said, "I don't feel so great about that either. So, I do what I can.
I do some probono work at the emergency room on really severe dental crises;
they don't count such work against my average. I'm doing the best I can under
the circumstances."
"But," I said, "if this is happening all over the state, think of all the
children who aren't getting any dental care. Surely this is not what the law
intended."
"Listen, I've become quite an expert on what happens when you beat people up
with numbers and ratings," my dentist said.
"Do you remember when I said no one would ever think of trying a program like
this with schools?
"Well, I found out they have," he continued. "In Texas and South Carolina and
many other states around the country, schools are being rated with raw averages
of student test scores, just like the Dental Improvement Program with cavity
averages. And, in many schools, students who don't meet standards within
arbitrary time frames are failed. And many are dropping out."
He glared at me and went on. "I just read an article about the large number of
children who drop out of school in Texas. It should be a disgrace, but instead
it drives up the averages, and Texas is being touted as a nation model for
school reform. Need I say more?"
"Wow," was all I could think of to say. I should have said, "Ugh."
He was wound up now, and he did say more.
"W. Edwards Deming, the famous management expert often credited with Japan's
great economic turn-around after the war, said that when systems beat people up
with numbers, averages, and quotas, the numbers invariably rise but are most
often meaningless. Deming often said that the most important factors are not
quantifiable--but, obviously, no one is paying attention to him."
"This is a bad system," I said. "I see it now. We need to change it. Averaging
cavities is the wrong measure. We need to observe dentists in practice and
account for differences in clientele. We need to assess and help people
individually."
"Too complicated and time consuming--to use your own words to me," my dentist
smirked. "Besides, cavities are an absolute measure, and you can't argue with an
absolute measure."
"Now, open-wide," he said, jerking my jaw down.
"Ughmmph," I said.
|
