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.