All of the buzzwords and phrases bandied about regarding health care and education puzzle me. We are hearing them all the time. "Quality of care" and "outcomes" are two of the most prominent.

The discussion goes something like this: Educators should be evaluated and paid based upon the student's performance on standardized testing. Health care providers should be paid based upon whether the patient's disease state is either eradicated or markedly better by the end of treatment. Nowhere are the terms "individual responsibility" or "behavior" factored into these equations.

I have spent 38 years treating children's dental disease. We spend many hours every day educating parents about dental hygiene and dietary issues, which are the basics of prevention.

"Don't put infants to bed with a bottle of milk or juice!" we say to the parent of a 1-year-old. They often return months later with early childhood decay, and the child requires general anesthesia at age 2 for severe dental decay.

Then the next child is born, several years go by, and we are faced with the same dilemma. Bad outcome? My fault? No, because I have spent time trying to educate. The change has to come from behavior modification of the parent and/or the patient.

If a desired outcome were so easy to accomplish, there wouldn't be any tooth decay or overweight people. These things are preventable, but only with behavioral changes by the patient -- just as in education, where lack of parental controls regarding time spent reading and studying, or help with homework and reading to children, are not within the purview of a teacher to change.

Check out all the advertisements for dietary plans you see daily. If education were enough, the plans would theoretically be putting themselves out of business. Not happening! It shows what all professionals have known for years: Changing behaviors is one of the most difficult things we attempt, and one of the least predicable and successful.

So while we're reforming the health care and educational systems, let's put the emphasis on the partnership required for the desired outcomes and recognize that these cannot be "done to someone or for someone" but instead must be "done with someone" to have the desired results.


Dr. David Lipschultz is a pediatric dentist in Edina.