kitchen table math, the sequel: Allison on trusting schools and doctors

Tuesday, June 23, 2009

Allison on trusting schools and doctors

I would say we've reached a point in society that parents should not be willing to simply trust the teacher or school as they would have a generation or more ago.

Fundamentally, there are too many people in the system claiming to be experts who aren't; too many people claiming their credentials give them knowledge they don't have; too many people in the system working at cross purposes with parents; all told, the authorized people can't be assumed to know more about your child's needs than you do.
This is my experience. I would add, too, that while there are some very good public schools (Karen H's high school, for instance) even there I would 'trust but verify' for my own children. I say that because even very good public schools are set up to teach and succeed with cohorts of children, not each individual child across the board. The measurement of success is the group mean.

I believe that "professional learning community" schools -- real ones -- have rejected this model, and I'm planning to get some posts written about "PLCs" soon.

doctors & patients
This isn't just a phenomenon related to schooling. We've reached the same point in medicine--we no longer trust doctors as we once did, or that they are our advocates. We have to be our own advocates. Our model has really shifted--we're expected to partner with our doctors in our healthcare outcomes; we're expected to "partner" with our kids educational outcomes. We've reached it in most of parenting too--we're expected to be far more responsible for our childrens' outcomes than any prior generation of parents; we're supposed to be deeply engaged in their molding (regardless of how possible that is), and we're supposed to be highly active in all levels of their universe. We're not really supposed to leave this stuff up to others anymore.
Now this is interesting because I am old enough to have lived through this history, and I often use the shift in the doctor/patient relationship as a model for what I'd like to see happen between teachers and parents (or administrators and parents).

When I was a child, the relationship between doctors and patients was fantastically hierarchical, and doctors were arrogant - or were certainly seen as arrogant by the grownups around me. "Doctors think they're God," people said. Or: "Doctors aren't God." And: "Doctors shouldn't play God. They're not God."

In short: they do what they do. (I have the sense nurses might still say this, but that's an impression so correct me if I'm off base.)

The most egregious case was that of the terminal cancer patient. Doctors would make the diagnosis, would know that the patient was dying, and would elect not to tell the patient because, in the judgment of the physician, he or she couldn't handle it. As I recall, family members weren't necessarily told, either.

I have no idea how often this kind of thing actually happened, but it was talked about constantly, and it was seen as the ur-case of doctors thinking they were God. Doctor Gods were in the movies, too. I remember a couple of years ago, flipping through channels, coming across an old war movie, maybe from the 1940s. The scene was a military hospital. The doctor comes into the ward, takes a quick look at a soldier's leg, and orders it removed. The soldier screams and begs. "No! No! Don't take my leg! Pleeeease!" Tough luck. Doctor's orders. The leg comes off.

Watching that scene, I marveled. How long has it been since anyone has heard the expression, "Doctor's orders?"

Doctors don't give orders any more. Doctors make diagnoses and prescribe treatment. Patients make the decision whether to comply.

I wish I understood the history of how this changed. I had always assumed that some kind of 'patients' rights' movement came into being and succeeded in changing the relationship between doctors and their patients. However, I'm pretty sure that's wrong; it seems more likely that, as I once read, there was a war between doctors and lawyers and the lawyers won. Which isn't what I would have wished; in a conflict between doctors and lawyers, I'm on the doctors' side. (I don't say that to attack lawyers! Or to imply that malpractice should not exist. It should. I think.)

In any event, the upshot is the partnership Allison describes. Having raised two children with autism, Ed and I have been deeply involved with doctors for many years now; we've been on the cutting edge of psychiatry and, at times, neurology.

Our doctors invariably, with perhaps one exception in lo these many years, treat us as partners in our children's treatment. Moreover, our respective roles are flexible. Any number of times I've come to one of our doctors with studies that have just been published or informal opinions from researchers and our doctor has immediately agreed to a medication trial. Other times, I've raised the possibility of trying a treatment based on something I've read, and our doctor has explained why it doesn't make sense.* And there have been perhaps two occasions on which Ed and I have decided not to give our kids a test our physician recommended. The tests would have been expensive, difficult to administer, and would not have made any difference to the treatment plan so we decided against. That was not a problem for the physician. In one case, we didn't pursue an experimental med that cost thousands, wasn't covered by insurance, and I think had to be specially ordered from Europe (?) Something like that. That was also not a problem because the relationship is a partnership: our physicians make the recommendations and we decide whether to follow their recommendations -- which we almost invariably do, or we would not be working with that particular physician.

This relationship works. The doctor is the professional; we are the clients and the ultimate deciders. It would be unthinkable for a doctor treating our kids -- or any kids -- to give 'orders.' The doctor's authority is based in his or her knowledge and expertise, not in power to force compliance.

For years, now, I've longed to have the same relationship with my kids' schools that I do with my kids' doctors -- and in fact, in special education, I do have that relationship here in Irvington. My kids' teachers see us as experts on our particular kids; we see them as experts in teaching autistic kids. And, because teaching autistic children, like treating autistic children medically, is not remotely a science, our kids' teachers here have always been interested in what we're doing at home that works. (ha!)

My take on Allison's observation is that she's right: the model has changed. We're supposed to partner with the professionals and experts in our children's lives.

The problem in the education realm is that parents aren't partners. We are subordinates who are expected to work up the chain of command.

That doesn't work.

* I'm sure patients bringing in stuff they found on the internet is a problem for plenty of doctors. And, of course, from the patient's perspective arrogance hasn't disappeared, either. Recently a young physician contemptuously dismissed my mother when she tried to tell him that whopping big doses of Acai juice had dramatically reduced her blood pressure and thus her need to take blood pressure medicine, a statement easy to confirm with a quick check of her medical history or a phone call to her internist. Or a phone call to her children, for that matter. Hearing her story, her new cardiologist rolled his eyes, turned on his heel, and walked out of the examining room. He didn't come back.

She changed doctors and wrote to Medicare about another problem that occurred on her visit to his office. I got a kick out of that. My mother has diabetes and heart failure; she's come back from the brink of death at least 3 times now. And on her good days she's watchdogging the medical profession. I applaud that.


Independent George said...

More than lawyers, a big part of the equation is the fact that we (currently) can change doctors if we so choose.

This has its own inherent drawbacks (such as when parents choose not to vaccinate their children), but it seems to me that the key is that in medicine, as all truly professional relationships, patients are clients.

I've repeated this statement ad nauseum, but for every teacher that wants to be treated like a professional, there are twenty parents who would gladly oblige if they were treated as a client.

Catherine Johnson said...

I've got to get this comment up front.

That's a great way of putting it.

Catherine Johnson said...

We could change doctors back when they were God, too. Doctors in my town were all in private practice and my parents didn't have insurance by choice.

Barry Garelick said...

I would guess that the "doctor as God" phenomenon diminished because of the proliferation of malpractice suits that started probably in the late 60's.

Unfortunately, parents do not have similar protections under general education. They do have the right to sue, however, under IDEA, which sets out parents and student rights for special education services.

Ben Calvin said...

Add in a few more factors.

There are more doctors per capita in the U.S. than in the past, so more people have the chance to switch if desired.

There is a far more information available to the lay person than in the past. Previously no WebMD, little info beyond an occasional general interest story in the press.

There is more medicine now. More drugs, more treatments, more options. If you got cancer 40 years ago, you died. If you didn't it was a miracle.

This is one of the biggest cost issues in medicine. We have more stuff that works. It costs a lot of money, but it works. Which is why we will not save any money via preventative care. If you save someone from a heart attack or lung cancer in their 50's (cheap outcomes), you are creating a patient for more expensive end of life care when they are in their 80's-90's.

Allison said...

--- would guess that the "doctor as God" phenomenon diminished because of the proliferation of malpractice suits that started probably in the late 60's.

A few others reasons, too. One more not yet mentioned relates to teachers, too, I think.

in the past, before the GI bill changed who went to college, and before the modernization and globalization of employment, the smartest men in town became the lawyer and the doctor. Those were simply the careers available to the best and brightest. Bright women had nursing and teaching and librarian. They didn't have anything else.

So it was easy to trust the doctor and the lawyer and the nurse and the teacher--they were the top of the heap in the first place, and no one else even competed with them. They were the elite folks.

Nowadays, the best and brightest can go into anything and everything. The not-so-bright can make it through med school or law school or ed school. We no longer have that institutional trust in part because of averageness of the skills and intellect of the people in this fields. We don't see them as better than everyone else anymore because they aren't, so we don't trust them more than we trust anyone else, either.

Catherine Johnson said...

You know, having lived through it (which isn't enough to base history on, obviously) I don't think these explanations explain it.

I grew up in a small town, where in fact doctors didn't particularly 'play God' - though I heard my mom complain about this NOT re: local doctors, but re: doctors in the abstract.

Also, I personally continue to see doctors as highly intelligent.

That's another interesting thing in our experience. Because of Jimmy & Andrew, and because I was on the board of NAAR & Ed was at UCLA, we've seen some of the most important doctors and researchers in the world. Literally: the world.

I have a hypothesis that people who are at the very top of a field may be less 'arrogant' or condescending or whatever....but that's just a hypothesis.

The point is: we have seen physician-researchers who, if anyone is entitled to play God, they are.

And that is not the relationship. The relationship is friendly & cooperative; it's accurate to call it a partnership.

Catherine Johnson said...

I finally had a blinding revelation the other day: we've been talking about everything except the central thing, which is culture.

This is Richard DuFour's point about public schools: they need a culture change.

Somehow and for some reason(s) the culture of doctors and patients changed.

DuFour's point - I MUST get this posted - is that unless the culture of a school changes "professional learning communities" and "formative assessment" and "data" and "incentives" and all the rest of it is, as I think Paul has said before, noise.

vlorbik said...

insurance companies run america.
what else is new.

Allison said...

i have more comments on an analogy between the healthcare model and education model, but to Catherine's main point:

We may be subordinates, but we are expected to be our childrens' advocates in a way we never were before. And the teachers and administrators expect an outrageous amount of time and commitment on the part of parents. They expect us to be coteachers. Are the teachers subordinate too? But of course, as coteachers, we haven't been indoctrinated, so we don't work with the system. The system seems especially annoyed that we don't live up to their expectations of us as coteachers!

They have moved the goalposts on the parents without moving them in the same way for the teachers. Children are EXPECTED to be "ready to read!" before kindergarten now. Children should know their ABCs and numbers and colors and etc. etc. etc. That means parents are expected to teach them. In elementary school, they are expected to read to their children at night, correct their homework mistakes, do worksheets with them. Obviously the expectation for the dioramas etc. is parental participation, too.

I am not saying that doing these are bad things per se; the issue is this is really an unwritten cultural shift.

This is a massively different idea than 50 years ago, where the teachers would teach anyone, regardless of how doltish or not their parent was.

Another piece of this puzzle though is that just as parents now don't trust the school, the school doesn't trust the parents.

How often do we read about parents undermining teacher's authority by arguing about grading with the child's full knowledge? or arguing about some disciplinary action? How often is there that subset of parents that seems bent on excusing their child's boorishness? So they don't trust us to back them up, and they don't really trust us as parents, and certainly, they don't trust us as educators.

Which all points back to: what do parents want, and do we have to convince schools that we are trustworthy? are we?

Barry Garelick said...

Which all points back to: what do parents want, and do we have to convince schools that we are trustworthy? are we?

Well, true, it's hard to be objective with one's own child, but still...there are things the schools should be expected to do but aren't. The social compact, as you point, has changed. Catherine and others have pointed out that when they were kids, their parents rarely helped them. Same here. I've used as an example recently my daughter's 7th and 8th grade math experience. She had great teachers and for the first time, I wasn't spending time helping her with homework because she could do it herself, except maybe for a problem here or there. But I certainly wasn't doing after-schooling or re-teaching as I had been doing in elementary.

This felt so strange that I started feeling guilty, that I should be doing more for my daughter's math education when it hit me that what was happening was the way it should be. If the idea is for students to learn independence, then give them a structured curriculum with good teachers so they learn it by themselves without mom and/or dad's help. Kids want to be able to do things without their parents help.

But stating that we want things to be as I just described is tantamount to saying we want things to be like it was when WE were in school. Those are trigger words. School administrators interpret that as "Parents want things done as it was when they went to school, and they're uncomfortable with change" blah blah, sound of vomiting.

This is simplistic garbage and avoids the whole argument by taking away the parents' platform and dismissing it as "old school" and dismissing the parents as fuddie duddies.

vlorbik said...

when the enemy says, in effect,
"we've tried it your way and it doesn't work"
(you old-school fuddie duddie),
they're *not actually lying*.
not by their own lights, anyway.

kids getting ahead by their own efforts
is *not* what they want; they're admitting this.
groupwork and whatnot *is* what they want;
they admit this. teaching the actual "content"
*doesn't* work... if you want to teach dependency.

hell, they're even admitting they refuse
to take us seriously by openly using such
trivial verbal ju-jitsu.

it seems pretty pointless to just keep
trotting out the hotbutton magic words
over and over; the enemies of clarity
are *even* admitting, in effect, that
they win for as long as our energies
can be diverted into helping them pretend
that they're trying to understand us.

it's politics. reasons don't matter. so i say:
quit trying to *reason* with these people.
they're not actually trying to reason with us.

SteveH said...

I don't want schools to be what they were when I was growing up, but they're going in the opposite direction. That was my first reaction when my son was in pre-school and I heard that our school used Mathland.

The goalposts are moving. More is expected from parents and less from teachers. Teachers want to do the fun, creative stuff that makes everyone feel warm and fuzzy, and they want to have parents make sure that real learning gets done.

Schools have always had a level of sink or swim, but it's gotten worse. It may not seem like that with all of their multi-year spiraling and talk of developmentally appropriate, but they are just pushing off the big filter to years later when the blame can more easily be placed on the child, parent, or society. There is nothing that can be traced back to any one teacher.

On top of it all, soon after first or second grade, teachers get very defensive about what is expected of them. Who can blame them considering what walks into their classrooms; fifth graders who add 7 + 8 on their fingers.

At least when I was growing up, the sink or swim didn't get delayed much past the end of each year. Kids were held back or required to go to summer school. Teachers had to try at least a little bit because they couldn't flunk everyone or send their kids along to the next grade where everyone could see what was happening. Few children would get to fifth grade not knowing 7 + 8, and for those who did, everyone knew why. Social promotion was social promotion, not some sort of developmentally appropriate excuse for not trying.

Schools say that all they can do is lead the horse to the water, but in reality, there is no water in sight. If a horse does not find water, they tell the horse that maybe it will discover the water next time they pass through the area. The horse will find the water when it's ready. They just point to other horses who have found water.

Schools and teachers must know that this is a big problem. They see kids coming into their classes who are perfectly ready and capable of learning the material, but they don't. They must see the correlation between their best students and the most involved parents. They see some kids doing poorly even though they KNOW that the kids can do the work and that there is nothing funny going on at home.

On top of it all, we are told that this is not less, but more. However, one older teacher told me once that the best students (and those best supported at home) will do fine. Many of the lowest level students will be better supported (most likely), but the kids in the middle will get killed, and they will end up blaming themselves. I've met some of these people as adults. I've seen enormous math potential that was wasted, but they just say that they are not good in math.

SteveH said...

"... so i say:
quit trying to *reason* with these people."

KTM is really a support group for parents who want to help their kids. We might also harbor the silly idea that we can effect real change. For that, we look to Catherine for inspiration (and guts).

There are also some KTM members from CT who are involved in a real fight over standards there. However, it is true that arguments have to evolve from being strictly content-based to those that are politics-based.