I got this email today at school, thought I'd share.
No Dentist Left Behind
My dentist is great! He sends me reminders so I don't forget
Check-ups. 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
"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, 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 re 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
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.