(From an email I received several years ago, author unknown....)
The Best Dentist---"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
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 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."
"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," the 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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