Imagine you’re a doctor. As a doctor, your responsibility is to improve the health of your patients, and so you sometimes administer some routine, standard tests to find benchmarks of your patients’ health. One such test tells you the systolic and diastolic blood pressure of your patients. It takes about 30 seconds to administer and can tell you early if there are warning signs that a patient isn’t thriving, or whether a treatment you prescribed is helping.
One year, you walk into an interesting new reality. All doctors must administer the same blood pressure test at the same time of year, as part of the accountability system for clinics, doctors, and healthcare administrators. You tell all of your patients to come to the clinic at the same time of day for the test. The test takes a total of 15 hours. Some clinics administer the whole suite of blood pressure assessments over the course of one week, where other clinics spread the process out over two or more weeks. All patients must be tested, and so make-up blood pressure tests tie up the clinic for another week after the tests are done. You’re very curious about this new blood pressure test, but you had no part in creating it, and even though you are actively administering the test, you’re forbidden from looking at the testing instruments or the patients’ results as they are in process. You take this rule very seriously as you know someone who lost her job practicing medicine for explaining part of the test to a patient. In fact, you need to remove anything from your office that would give any help to patients in understanding their blood pressure test, and if any patient discusses the test inside or outside the office, their result is invalidated. Their invalid result is then sorted with the rest of your patients’ scores.
It would be great to know the results of the blood pressure test right away, so you could make some changes to your treatment plans for some patients. Alas, you get the results after four months of waiting anxiously for this important benchmark of your medical practice. With quivering hands you open the results file and get two numbers for each patient you tested. You sort and analyze the data.
It’s pretty interesting stuff. As a rule, your patients had improvements in their blood pressure over last year. You wonder if other doctors saw similar improvements. One clinic across town is still on an improvement plan for having consistently unhealthy blood pressure readings for years. Ninety percent of the staff turned over and they got a new administrator. Blood pressure readings are improving slightly, but you hear the workload and stress have been unbelievable. The stakes are so high that you’ve heard rumors of clinics cheating and falsifying patient blood pressure data, major scandals that paint an ugly picture of your profession.
Although you are encouraged by your patients’ overall results, the clinic administrator wants you to meet with a coach to craft treatment plans for patients whose readings were unhealthy. Does our clinic need a nutrition plan or should we prescribe beta blockers for all? You wonder about individual patients. This patient probably just didn’t try very hard on the blood pressure test. Motivation has been an issue all year and you suspect there are emotional issues related to a recent divorce. That makes it hard to focus on a blood pressure test for 15 hours. Another patient would probably thrive with diet and exercise, but you wonder if there are genetic issues at play or a hormonal issue. You just don’t have enough information to create a treatment plan, so the session with your coach is difficult. She wants answers you can’t give her because you only have blood pressure numbers. It seems a little silly to have tested patients for 15 hours and get no actionable or diagnostic information, but this apparently is the new set of rules for doctors.
You don’t want to seem as if you’re against doctor accountability, but the process is frustrating. Blood pressure readings used to give you a quick snapshot of information. You would like to be able to use the blood pressure reading to guide further questions for coming to a diagnosis. It blows your mind that the blood pressure reading is now seen as an outcome instead of a data point in the picture of a patient’s overall health. That you and your administrators are actually making diagnoses, treatment plans, clinic personnel assignments, and long-lasting community health decisions based on a blood pressure reading. That a simple snapshot of overall health takes 15 hours over the course of days of secrecy and stress. If I’m testing a patient for 15 hours, couldn’t I have diagnosed and treated their actual problem instead of just getting one indicator? How can anyone be expected to practice medicine in this kind of environment?
Wait. I didn’t actually mean “doctors”, “clinics”, “patients”, and “blood pressure readings”. What I meant was “teachers”, “schools”, “children”, and “math and reading achievement scores.”
This is a picture of my classroom almost ready for standardized testing time. I’m not done covering every poster. I think it’s OK to share this because there are no testing items in the room.
It’s time for a teacher-led manifesto for what we really want and need in order to improve the educational experience for our kids. Some people may look back on this era and wonder why our educational system didn’t rocket to the top of the international charts after putting these reforms into place. But if you have boots on the ground, you will not be one bit surprised. We work in a baffling world, friends.