Dentists as Clickbait

You know how to get people to click on your article? Here are a couple of rules:

  • Choose an irresistible headline. You know the kind. Most potential readers are probably scrolling through Facebook waiting for something to grab their eye. So give it to them! The more bombastic, the better.
  • Find a worst case scenario and then generalize. People don’t get upset if they don’t think something could really happen to them. A really good technique is to find the absolute worst case of anything and then make people think that case is the norm.
  • Pick a good villain. If you can write about someone or something that is universally hated or feared, you’ll get all kinds of clicks. Our culture is desperate to keep the outrage fires burning, so make sure your villain is really easy to hate. If at all possible, choose a group instead of an individual person because that allows for generalization. More villains = more clicks!
  • Scare your audience. People love a good scare. Make sure that people can read what you write and apply it directly to themselves. If it feels like something that could happen to them, then they’ll want to warn their friends about it!

“And I’m very pleased to see that on a busy news day this story about science and public health is finding an audience.” –Ferris Jabr

A recent Atlantic article written by Ferris Jabr follows this playbook closely. The results are awesome! He proudly boasted of his “number 1 status.” I’ll bet that’s a lot of clicks! The most frustrating thing about Mr. Jabr’s article is that there are some really good points to be discussed in the article. Unfortunately, they’re mixed in with bombastic anecdotes and worst case scenarios which makes it impossible to have a good conversation.

A quick overview of the article goes something like this:

A dentist in California had happy patients that paid a lot of money for their dental care. A new dentist bought his practice and found that the previous dentist had been fraudulently overtreating or billing for services never rendered. The new dentist brought it to the attention of the previous dentist and got nowhere so there was a lawsuit. Once patients realized that the old doc had been potentially billing fraudulently and overbilling, he was arrested and hauled into court. The author uses this anecdote to set up a much larger premise. He feels that dentistry, unlike medicine, is not scientific enough. In his estimation, dentistry isn’t based on enough good evidence and this lack of evidence makes it easy for dentists to overtreat patients. The article finishes with the tragic consequences faced by the original dentist’s patients feeling betrayed and wondering how they could have fallen into such a heinous situation. The tone is somber. No suggestions are given about how to avoid such an unethical monster. According to the author overtreatment is historic and widespread and the profession of dentistry is to be treated as charlatans until proven otherwise.

To put all of my cards on the table, I’m a dentist as well as an author and podcaster. This article makes me feel defensive. If I were a patient and I read this article it would make me suspicious of my dentist. I think the author has some points that the profession needs to look at. The evidence base for much of dental treatment isn’t that solid. In fact, many dental school educations don’t spend enough time explaining the evidence base as it is or even how to read and interpret a scientific paper. Dentistry falls short here. Dentistry also has some practitioners who “overtreat.” There are some that push the boundaries of ethics in order to benefit themselves over their patients. These would be really good conversations to have. But that’s not what the author was interested in doing. The author was interested in driving clicks. Let’s take the rules that I laid out one at a time and see how the author used them to create a very controversial article all while avoiding any meaningful discussion.

Rule #1: Choose an Irresistible Headline

“Dentists are unethical bogeymen. Film at 11!”

Remember, in 2019 you’re not writing for a discerning audience. You’re writing so that you can outrage as many as you can as quickly as possible. So you need to choose a really good headline. Ideally it will be really short, because no one’s going to read a long drawn out headline. If possible, it should be accusatory. But you don’t want to give it all away in the headline, either. You should sound incriminating but not too specific. “The Truth About Dentistry” is a nice touch, because it insinuates that dentists have been hiding things. Or flat out lying. And you’re going to give them the truth! Your reader probably has teeth. Or maybe not. But it’s likely that they’ve had some dealings with a dentist before and maybe they haven’t been that rosy. They know that if they click through on “The Truth About Dentistry” they’re going to finally verify what they’ve always wondered about those dental bastards!

Rule #2: Find a Worst Case Scenario and then Generalize:

“Now THAT is a broad brush stroke.”

The article spends a lot of time dissecting a shocking case of fraud and overtreatment. If the case is true, which is kind of impossible to know since it was settled out of court, it’s pretty horrifying. It sounds like this dentist performed a lot of work that was unnecessary and maybe even charged for work that wasn’t done. I find that disgusting. It absolutely undermines the doctor-patient relationship and it is nothing short of a betrayal. I can almost guarantee that your dentist feels the exact same way about this story. Overwhelmingly dentists are trustworthy, competent and have their patient’s best interests in mind. It’s worth remembering that the original doctor in question was brought to justice because another dentist found and disapproved of what he had done!

The author then takes this awful outlier of a case and applies it to dentistry in general. He says that dentistry’s evidence base isn’t as good as could be and that this fact makes it easy for dentists to overtreat:

The general dearth of rigorous research on dental interventions gives dentists even more leverage over their patients.

Essentially, since the science isn’t that good, dentists can use this to justify overtreatment. This broad brush stroke connects a single shocking case of fraud and overtreatment to every dentist. The most frustrating thing about this article was that Mr. Jabr explained that dentists are probably overtreating you, but he gave no helpful information about how to avoid it. In fact, he suggested that patients are too helpless or lazy to seek out the right information:

When a dentist declares that there is a problem, that something must be done before it’s too late, who has the courage or expertise to disagree? When he points at spectral smudges on an X-ray, how are we to know what’s true? In other medical contexts…we are fairly accustomed to seeking a second opinion before agreeing to surgery or an expensive regimen of pills with harsh side effects. But in the dentist’s office—perhaps because we both dread dental procedures and belittle their medical significance—the impulse is to comply without much consideration, to get the whole thing over with as quickly as possible.

What is it about dentists makes patients unable or unwilling to ask questions or seek second opinions? Mr. Jabr doesn’t specify, but it seems pretty insidious.

Rule #3: Pick a Good Villain

A good villain drives clicks!

This one is easy. Dentists are the safest punching bags in all of health care. So many news stories are made juicier by including the fact that the main antagonist of the story was a dentist. How good would the “Cecil the Lion” story be if the guy who pulled the trigger was a gynecological oncologist? Not very good. Because there was one. And no one has ever heard of it.

It’s delicious to hate dentists because almost everyone has had some kind of interaction with a dentist. Unfortunately, many people end up in a dental office due to pain or infection. So the experience of dental care is tainted with memories of pain and possibly fear. It’s an unfortunate side effect of biology, but teeth that are broken or decayed can hurt and become infected. A lot of our time as dentists is spent trying to help people with this unpleasantness.

Most of the negativity directed toward dentists have to do two main problems:

  • Dentists do surgery on awake patients. Be honest, you would hate your orthopedic surgeon as much as you do your dentist if you had to be awake when they do what they do. Dental procedures can be kind of uncomfortable, but frankly dentistry is pretty great at anesthesia and pain management. Just remember, your veterinarian won’t even touch your dog’s teeth until they’re under general anesthesia.
  • Dentists explain what treatment costs. In fact dentists explain what treatment will cost, what dental benefits may or may not cover and explain that the patient is responsible for the balance. The lack of transparency of the cost of medical procedures makes the relative bluntness in the dental office seem greedy or mercenary. I blame this on the typical bureaucracy in medicine.

As a profession, we’re used to being the butt of jokes. As relative high income earners, we’re also pretty easy targets. In general, we handle the disdain pretty well since it comes with the territory. But that doesn’t mean we’re uncaring or dishonest.

Rule #4: Scare Your Audience

To really drive the clicks, it’s important to freak your audience out. Mr. Jabr’s article does this relentlessly. I’m pretty certain that he’s had some poor experiences at the hand of some dentists. I’m led to believe that from the language he uses throughout his piece. If you walk away with anything from his article it’s that dentistry and dentists are scary.

When you’re in the dentist’s chair, the power imbalance between practitioner and patient becomes palpable. A masked figure looms over your recumbent body, wielding power tools and sharp metal instruments, doing things to your mouth you cannot see, asking you questions you cannot properly answer, and judging you all the while.

This is an effective ploy to drive clicks because a lot of people have anxiety or fear during dental visits. It’s understandable because being a dental patient can make you feel vulnerable. One of the primary responsibilities of the dental team is to explain your condition, suggest treatment (or no treatment) and then walk you through what needs to be done step by step, leaving no questions unanswered. When that is done well, dentistry can become a lot less scary. Add to that modern techniques of anxiolysis which could incorporate medication but more often includes distraction techniques like television or even VR glasses and we’re creating a whole generation of dental patients that are unencumbered with the fears of their parents. You don’t see a lot of articles about that, though.

You’re probably thinking to yourself, “this is just another defensive dentist making excuses.” To some extent you’re correct. Mr. Jabr’s article makes me as a dentist feel defensive. It’s just one of a long series of takedowns of my profession and I get tired of it. Do we have problems with our profession? Sure. There are definitely a few bad apples that overtreat patients and take advantage of the knowledge gap between dentists and patients. But that’s a tiny minority of the profession and I would suggest that dentists don’t have a larger percentage of bad guys than any other medical profession.

“Science is HARD!”

Throughout Mr. Jabr’s article he talks about how unscientific dentistry is. And while we have our weaknesses in the evidence base it’s not like dental treatment options are just a stab in the dark. Most conventional dental treatments have long clinical histories of success. Technology in dentistry continues to make huge leaps which makes for better outcomes and less invasive options. It’s worth mentioning that science is hard! Experimental design is a huge challenge. We continue to get better at designing studies to make sure we’re measuring what we think we’re measuring. Our profession is leaning into our role in prevention as well as minimally invasive procedures. It’s slow work, but it’s work that’s being done by some of the greatest minds in our profession.

Unlike the article I’ve been referencing, I have a few suggestions that might help dental patients. Mr. Jabr suggests that dental patients are putty in the hands of a skillful dental salesman with no ability to question suggested treatment and no will to know more. As a dental patient you do have some responsibility. Most dentists try their hardest to make themselves understood, but we’re not perfect. As a patient you have the perfect right to understand what you’re getting into. If you don’t understand a treatment, ask questions. Be annoying about it. Don’t allow anyone to treat you until you truly understand your condition and any treatment you’ve been proposed. The ability of a dental office to show you what we’re talking about has never been better. Ask to see photos of your teeth if the office doesn’t present them. And if they can’t, find someone who can.

Finally, ask for second opinions. And third opinions. It’s not prohibitively expensive to get another set of eyes to examine your situation. In many cases, dentists will give free second opinions. If what’s being proposed to you doesn’t seem right, you don’t have to agree to it. Most dentists are ethical practitioners that want nothing more than to help you with your oral health. I personally love serving as a second opinion and most of the time find patients returning to their dentist knowing that their treatment plan isn’t out of line.

Digital media has changed the landscape of journalism. Having good conversations about things that matter is tough. Many outlets prefer to write tawdry takedowns that aren’t anything more than clickbait designed to enrage instead of enlighten. The dental profession is full of good and ethical practitioners doing a job that often goes unappreciated. It’s cheap and easy to make dentistry the butt of jokes and accuse us of ethical lapses. I hope you can see this clickbait for what it is.

Alan Mead is a dentist in Saginaw, MI who is just as disgusted by overtreatment and fraud as you are. He’s pretty disgusted by journalism, too. He can be reached at alan@meadfamilydental.com.