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A friend sent this ... thought I would pass it on...

what if we assessed.......

Absolutely the Best Dentist

("This would be like grading teachers on a test of the children's
progress without regard to influences outside the school, the home, the
community" )

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, and 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 license 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. I don't get to do much preventive
work. Many of the parents I work with can't afford to bring their
children to see me until there is some kind of problem."

"Also," he said, "many of the parents I serve let their kids eat way too
much candy from an early age, unlike other 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. "Some of my 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 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 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 thing 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 He walked off with that look of hope mixed with fear and
suppressed anger that I see........ in the mirror so often lately.

John S. Taylor
Superintendent of Schools for the Lancaster County School District.

---

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