Friday, February 22, 2002

Absolutely the Best Dentist

This originally appeared on the Web site, American Association of School Administrators. The original link is no longer active but it was a guest column that appeared in June 2000.

Absolutely the Best Dentist


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, at 52, I've still got all my teeth.

When I ran into him the other day, I was eager to see if he'd heard about the state’s new initiative to help him succeed in his work. 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 responded. "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.

"That's not a good attitude," I told him. "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 went on, "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, many of the parents I serve have allowed their kids to consume way too much candy and soda from an early age, unlike more-educated parents who understand the relationship between sugar and decay.

"To top it all off," he continued, "so many of my clients have well water that is untreated and has no fluoride in it. Do you have any idea how much difference early use of fluoride can make?"

On the Defensive

"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 protested. "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 the color of a beet. From the way he was clenching and unclenching his jaws, I was afraid he was going to damage his teeth.

"Try furious," he raged. "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 state 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, turning to some printed material about the new statewide accountability program. "'Complaining, excuse making and stonewalling won't improve dental health.' That was straight from a leading member of the DOC."

"What's the DOC?" my dentist asked.

"It's the Dental Oversight Committee, a group made up mostly of laypersons to ensure dentistry in this state gets improved," I explained.

"Spare me," he said. "I can't believe this. Reasonable people won’t buy it," he said with hope.

Help at Hand

The program still 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.

"Now, now," I said, "don't despair. The state will help you."

"How?" he asked.

"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."

Legislative Rescue

I just shook my head sadly, but he had started to brighten. "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--the same sort of look I’ve seen in the mirror a lot lately.

John Taylor is superintendent of the Lancaster County School District, P.O. Box 130, Lancaster, S.C. 29721. E-mail:

1 comment:

Bob Purcell said...

Hi Bonnie:

I picked this up on Quora and followed to your blog. Thanks for this amusing, but somewhat sad, story. I too am retired from teaching/administration and saw similar changes that rose and fell like the tides. Several years ago in Nova Scotia teacher "accountability" was being promoted as the way to improve student "outcomes." As the poor dentist described despite HIS best efforts, the efforts, habits, and previous history of the patients left something to be desired. I wrote a response to our minister of education along similar lines, but using an analogy of a steel mill making railway rails (which followed a closure of such industry in NS):

You want to judge my ability to create a high quality rail, but you tell me I must use the coal only from this mine (for economic development) and I have to employ any one who shows up at the mill door regardless of training, background, skills, and even desire to be there. I must produce the best rail from (sometimes) inferior steel, with a workforce that has a 15% absentee rate, and many of the rest who constantly complain about being there, and challenge why they can't just do their own thing. And I have to deal in a disciplinary way with those in worker-to-worker conflict, or those who bully, or those who do little but expect full pay and even want praise for a less than stellar effort. And then I face criticism from their families who attack me or my company because I treated their loved ones unfairly or with disrespect or because I did not support them and deal with their differences and haven't met their needs. And ALL you want to measure is the dimensions, hardness and durability of the rails to see if I am a successful creator of rails. And you will rank my mill against all of the others, some with much newer and more efficient equipment, some who have a much more determined workforce, and yes, some with a more highly skilled and motivated supervisor/foremen and forewomen group.

No mill owner or manager would like this or even tolerate it. The manager would want only the best of raw products, technology, and resources if his or her success were judged like this. And though every educator wants the best for his or her students, he or she knows to judge their schools entirely by the achievement of student outcomes on standardized tests is a false and incomplete measure of success.