y 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 in South Carolina."
"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," he said, "many
of the parents I serve let their kids eat way too much
candy from a young 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.
"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'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're over-reacting,"
I said. "'Complaining, excuse making and stonewalling
won't improve dental health '... I am quoting that from
a leading member of the DOC," I noted.
"What's the DOC?" he
said.
"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
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 patients 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 will 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'll see my point."
He walked off with
that look of hope mixed with fear and suppressed anger
that I see in the mirror so often lately.
John
Taylor is a retired superintendent of schools for the
Lancaster County School District. A graduate of Davidson
College with MEd and EdS degrees from USC, he has served
as a teacher or administrator in several of South Carolina's
most economically challenged school districts, including
Allendale, Clarendon, Colleton and Dillon. He also
has worked in Richland 2 and Rock Hill and served as
an education consultant at the Department of Education.
"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.
