An article in the USA Today recently discussed the epidemic of test tampering by teachers. In fact, they are calling 2011 the year of the Test Scandal. What does this have to do with medicine, you ask? Actually, a lot. The No Child Left Behind Law parallels the Pay-for-Performance concept in healthcare; they are just a few years ahead of us. I have blogged about this before. In the school example, evidence of teachers changing test grades were found in Washington DC, Atlanta and NJ. This is nothing to sneeze at as Georgia law says anyone tampering with test papers faces up to 10 years in prison for falsifying public documents. The article states that lawmakers are still comfortable tying teacher pay to test scores and that new generation of computer-based tests will be harder to game. Is that really the point? The pressure of NCLB is doing this. In fact, who is to say that it is better to teach the kids to the test or actually teach them to learn and then cheat? What we are seeing here is what we will see with healthcare. Doctors will change what scores or readings that they can (blood pressures) and crank up medications in order to get better scores for patients (diabetes, cholesterol) at the risk of even hurting patients. If this doesn’t work physicians can just fire the patients for “noncompliance”. This would be an “erasure” of a different kind.
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