Measuring quality: What doctors and teachers have in common


I was watching Jon Stewart recently, and he had Michelle Rhee on.  For anyone who doesn’t know her, she’s the superintendent of schools in Washington D.C. who made a bunch of reforms that caused some controversy and resulted in her being one of the main spokespersons for education reform in this country.  Her conversation with Jon made me realize the similarities between what’s happening in education and what’s happening in health care.

One major emphasis of education reform is the regular testing of students and the evaluation of teachers based on the test results.  There has been a lot of push-back from teachers on this method of evaluation.  One major emphasis of healthcare reform is the regular measurement of “quality indicators” and the evaluation of doctors based on the results.  There has been a lot of push-back from doctors on this method of evaluation.

When things need to be changed the easiest thing to do is to target the people on the front lines.  If our kids aren’t getting educated, it must be the teachers’ fault.  If patients aren’t getting quality health care, it must be the doctors’ fault.  Here’s the problem with that logic in both cases:  most of the real culprits in the lack of good education and good health care have nothing to do with the teachers or the doctors.  Society, parenting, systems, legal considerations, and politics play at least as big a role.

Let’s consider teachers.  I truly believe that teaching is the most important job on earth.  If aliens landed on this planet right now and evaluated our economics they would probably conclude that football players were the most important, based on remuneration per hour.  Or movie stars.  But our future is determined in large part in how well educated our population is going forward.  The problem with the current standard of evaluating teachers is that the social environment surrounding each student is as important as the teacher.  Parents have to step up and emphasize education, do homework with their kids, be pro-active in supplementing children’s education.  You can’t just drop your kid off at school and assume he’ll end up at Harvard.  No kid can study effectively if they don’t have enough to eat, if their parents are on drugs, if the home environment is chaotic, if the parents are not involved.

Consider the doctors. I can’t say I truly believe doctoring is the most important job on earth.  I will say that our future is determined in part on how healthy our population is going forward.  Doctors can do some things.  We can grant access to screening tests, laboratories and imaging facilities, and our own training and advice.  But the responsibility for being healthy, barring unexpected and unpreventable events, belongs with each of us.  It is not the doctor’s responsibility to make you eat right, or exercise,  or not smoke.  The health of our population is heavily influenced by societal pressures including poverty, obesity, lack of education, lack of social supports, and addiction.  Doctors can help with these things, but they cannot be held responsible for them.

This is why teachers are frustrated.  This is why doctors are frustrated.  Both professions are being asked to take accountability for the breakdown of society.  We will continue to do what we can.  We should not be judged for our efforts.

Shirie Leng is an anesthesiologist who blogs at medicine for real.


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