Minimizing Triage in The Classroom

I went to the doctor a few weeks ago for one of those summer physicals that falls in the line of things I do in June that I have no time or energy for during the school year. I never quite know what to expect for these things, but I’m basically just trying to have decent blood pressure and get a few refills for my anxiety medication. 

Sometimes, they ask me how I’m doing and send me on my way. 

This year, however, I was not so lucky. 

The nurse took my blood pressure, which was higher than normal, and then asked me to strip down for my physical and put on this folded piece of paper that she handed me. Immediately, I thought about how being half naked with a ‘folded paper robe’ on will likely make my blood pressure rise even more. I spent the next 20 minutes waiting for the doctor to come in trying to figure out how to wear that thing, then trying to figure out how to sit in a way that seems anywhere close to normal, then imagining all the possibilities for the conversation I was about to have with my doctor while trying to keep my paper garment from blowing in the central air breeze that suddenly seemed too much for my immodest covering to handle. 

I crossed and uncrossed my arms. I held the frock in the back. I crossed and uncrossed my legs. I experimented with standing, sitting, stretching out and curling up. Insecurities started to creep up that I didn’t even know were there and I actually considered just putting my clothes back on and leaving before I had to deal with this coming interaction where only one of us was wearing clothes. 

Eventually, the doctor came in and I had to force myself to settle on a conversational pose and act like an adult. 

She seemed fine with the whole arrangement. Of course she did, I thought. She was the one wearing clothes. 

She jumped into a 20 minute medical history inquiry and most of the time I spent wondering why I had to be mostly naked for this part. She asked me about any past medications, any past issues, allergies, and even asked about what I do and my family. 

I thought about the inefficiency of the moment. I also thought a lot about the gentle breeze that kept opening the back of my wannabe robe. 

There was a computer directly beside the doctor with my medical records open on the screen. I questioned in my mind why she had to be asking me about everything from my weight, to my blood pressure, to any previous medical interventions when I assumed all that she needed to know could have been checked on that chart, preferably before she entered the room.

This has always sort of annoyed me about medicine. Shouldn’t all this information be on your chart? It seems like a waste of time to ask me about my sulfa allergy that hasn’t been relevant since I was 3 years old every time I come here. 

Then I started thinking about a different reality: what is inefficient for me as a generally healthy 36 year old middle class man who has gone to the same neighborhood health clinic for 15 years would likely be completely ineffective for a person whose life is more unpredictable. The system is annoying for me, but could be dangerous for people with chronic pain, mental illnesses, addictions, or chronic disease. I thought about people without insurance who rely on a variety of different practitioners who don’t share information, I thought about the last time I went to the ER and they treated my like a medical alien who had dropped from some unknown planet, and I thought about what inevitably happens when people feel shame and answer questions incompletely or incorrectly. 

It all seemed like a bad system. 

We do the same thing in education. We act like we are treating new patients from an alien universe every year, instead of relying on the wealth of information that we can usually access. Consequently, many teachers spend a third of their year in a triage loop that is a waste of time, losing valuable instructional time trying to figure out more about their students. 

We do all this like the doctor who saw me, with a computer beside us that has much of the baseline information we need. 

Then, a few weeks later, I found myself stuck in a 15 passenger van with my family on a trip from Pittsburgh to Oklahoma to visit my sister. It just so happens that my brother-in-law is a doctor at a health clinic in North Philadelphia. I asked him about efficiency in healthcare. 

He told me that I was right, and that, predictably, these issues of inefficiency were much larger issues in low-income, uninsured, and under-resourced settings. He told me that in some settings, where patients had more stability and saw the doctor regularly, record-keeping was much easier. Also, those patients tended to be insured more fully and the healthcare providers had more money to buy better electronic records. 

I heard the same story that I often notice in education: we have built a system that continually rewards the rich, while it places roadblocks in front of everyone else. 

He went on to tell me about his clinic and how they were beginning to try to work in teams and collaborate to help mitigate the negative effects of this problem. He said that every morning, he met with a few nurses, another doctor, a secretary, and a social worker or a mental health professional. As a team, they reviewed every patient they were going to see that day. They talked about missed appointments, warning signs that needed addressed, medications, interventions, and rehearsed all the questions that needed to be asked and the actions that needed to be taken. 

He talked about how some patients may need referred to mental health care, another may need help getting a ride to get medication, another may have a significant language barrier keeping them from their health, and another may have financial issues keeping them from needed care. All of these problems were fixable, or at least addressable, but they needed efficiency in the systems that provide care. They also need hard work and caring, intelligent professionals. 

I thought back to my conversation with the doctor when I was mostly disrobed. I thought about how much more we could have accomplished for my health if we were more prepared for the conversation. I thought about how impressed I would have been if she had done her homework. I thought about a possible patient after me who could have been an addict who missed their last 5 appointments. I thought about how important that homework would have been for that person. 

But I’m a teacher, and this is an education blog, so I naturally think about the 100 or so students that are being loaded on to my roster right now. I know most of their names because they have been in our school for years, and I can find out almost everything about their educational history. 

I came home from Oklahoma and began the necessary education equivalent of my brother-in-law’s morning meeting. I loaded all the student names into my trusty spreadsheet, and started to upload all the information that I could find about each one. I looked into grades, attendance, test scores, and any notes on interventions that have been tried for each student. I noted students who looked like they are struggling, and noted students who are excelling. 

I’m not finished yet. There is a lot of work to do before students come back to school next month. I have new test scores to incorporate, and work to do on planning for interventions and the questions that need to be asked. 

I have to collaborate with the English department at my school, and in some cases, we have to call in all the help we can possibly get. We may need social services, or administration, or family and community, or any number of other interventions that extend well beyond the classroom. 

All of this work in the service of students. Sure, there is a lot more to learn about each student that I cannot learn until I meet them. But I don’t want to waste time with the questions that I could have learned on my own and they may not be able to answer for themselves. I want students to feel like we have done our homework and we are prepared.
To not do this, I think, would be educational malpractice. 

It’s almost August, folks. Let’s get to work.