Monday, June 14, 2004

"Absolutely" the Best Dentist
By John Taylor
Superintendent
Lancaster County School District, South Carolina

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, 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 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 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'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
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.

*****************

Especially these days. These days, especially.