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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 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 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 age10, 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."
"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.
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