My daughter’s pediatrician visits in her first couple of years would always start the same way. We would fill out a checklist, or answer questions from a nurse, to determine if our daughter was reaching her milestones. One time the nurse asked my wife if our daughter was playing patty-cake, which my wife said no. We had never thought to teach her the game and she didn’t magically start playing. The funny part happened when the doctor came in saying, ” I see she has yet to reach the patty cakes milestone…”. The milestone is more about playing games than a single game but by her list, it was patty-cake or nothing. These are the kinds of moments where it’s easy to lose a little faith in screening tools, survey instruments, and performance measures.