Another summer has passed, and with its passing the rites of autumn have begun. Verklempt parents, myself included, have put their children on school buses for the first time. Pumpkin spice flavoring is regaining its inexplicable seasonal dominance in places it doesn’t belong (i.e. anywhere other than a pie). It’s getting harder and harder to defy the weather and leave the house without a jacket in the mornings.
As a pediatrician, I see my own special signs that the school year is truly underway—the stupid appointments have started.
Please don’t get me wrong. While parents often bring their kids in for visits that aren’t technically necessary, I understand perfectly well why they do so. Even if the illnesses are mild and likely to resolve without any intervention on my part, I consider reassuring mothers and fathers that their kids are going to be OK an important part of my job. I don’t think those appointments stupid in the least.
No, the stupid appointments are the ones where nobody in the room thinks they should have to be there—not me, not the patient, not the parent. In fact, during visits like these, the parents are often downright apologetic about it. They’d have skipped it if they could have.
So why are they there when they’d really rather not be? Because their kids have had one of those mild, self-limiting illnesses and missed a day or two of school, and the parents need a note to get the absence excused. Their say-so isn’t enough for the school to consider the absence appropriate, and only a certain number of these “unexcused” absences are tolerated before truancy penalties set in.
Thus, everyone has to waste their time for a totally pointless doctor’s visit. In fact, the person whose time is wasted least is me. As I hasten to reassure these exasperated moms and dads, I had to be in the office anyway. They’re the ones who had to take time off work to schlep their kids in when they’re clearly back to feeling dandy, just so I can hand them a piece of paper validating their entirely prudent decision to keep their children home when they were sick.
Not only are these appointments a waste of time, they’re also a waste of money. There’s the lost productivity of parents who have to leave work. Plus, there’s the cost of the office visit. No matter how sympathetic I am to the plight of parents complying with a benighted attendance policy, I can’t just give my time away, nor can I simply write blanket excuse notes sight unseen. Some parents have transportation problems that entail further costs.
Stringent attendance policies such as these are no doubt a result of No Child Left Behind (NCLB), the 2001 law meant to improve the quality of the nation’s schools. Among the different problems the act attempts to address is the problem of chronic absenteeism [PDF]. One of the performance measures under NCLB is school attendance, and performance measures are tied to funding [PDF]. Under a system of “shared accountability,” school districts and states are responsible for coming up with solutions to combat chronic absenteeism.
And so we get policies where parents are given no discretion over whether or not to keep their kids home. Their authority is abrogated, to be replaced by mine.
To make matters worse, it is my observation that these policies do not hit all parents equally. My office is located such that I have many patients from both affluent and impoverished communities. The parents who sheepishly book appointments to get needless doctor’s notes are much more commonly poor, and more likely to be of color. When well-to-do parents bring their kids in for minor illnesses, they’re far more apt to wave away my queries about needing a note to excuse the absence. Apparently their authority is still sufficient.
There are data that show schools with a higher percentage of students on free or reduced cost lunches have higher rates of chronic truancy. It follows that parents who send their kids to such schools will face stricter measures to combat the problem. But policies demanding doctor’s notes for brief, uncomplicated illnesses merely put further burdens on parents who already have fewer resources, and for whom compliance is an even bigger challenge.
I do not dispute that chronic absenteeism is a problem worth addressing, and if prior policies in troubled districts were too lax then perhaps changes were indicated. And in cases where there are prolonged or repeated absences attributed to illness, or in special circumstances like concern about contagiousness during an outbreak, of course I understand why a note from me would be necessary. But for a day or two missed because of a minor sickness, the word of the parents should be enough.
As much as I enjoy the change in seasons, the stupid appointments are a sign of the passage of time I’d like to do without. The pumpkin spice lattes are bad enough.