I am a fourth year marketing student at the Sauder School of Business and the son of a dentist. After watching the Marketplace episode “Money Where Your Mouth Is,” I was disgusted by the inaccurate framing of dental issues and the many biases expressed throughout the CBC’s “research” process. In this blog post, I hope to clarify some outstanding issues surrounding the ethics of dentists and provide some “crisis management” suggestions that can be utilized by dentists and organizations such as the British Columbia Dental Association, Ontario Dental Association and Canadian Dental Association.
Image and Perception
After reading online comments on the online article, “Dentists vary widely on diagnosis and cost, CBC Marketplace finds,” it was clear that the vast majority of reader comments were negative towards the dental profession. A handful of readers claiming to be dentists responded to some of the negative comments in an attempt to defend the reputation of their profession. However, it quite simply is not the responsibility of individual dentists to handle these significant public relations issues. Dentists are trained to do dentistry, not address misinformed comments. These issues are best handled by professional organizations such as the British Columbia Dental Association and the Ontario Dental Association. So how exactly did these organizations respond???
They issued generic statements
“...The ODA wants to assure CBC and patients that the dentists in Ontario are committed to serving the patients of this province to the highest ethical and professional standards. Dentists will continue to work with their patients to ensure they receive the care they need when they need it.”
Courtney Sorger
Manager, Public Affairs & Communications
Ontario Dental Association
“…We wish to reassure dental patients that BC dentists place great importance on ethical procedures in the interest of promoting the highest level of dental care.”
Susan Boyd
Manager, Communications
British Columbia Dental Association
By solely issuing these statements, dentists and their respective dental associations have missed a golden opportunity to connect with patients through social media. This CBC story could have provided an opportunity for community engagement and been leveraged into positive public relations campaigns. I understand that the aforementioned organizations may not have the required staff or training to internally implement large scale online campaigns. However, they have essentially accepted defeat through failing to establish a response that is convincing and regains the trust of skeptical patients.
These associations should have cooperated and hired external consultants to try and respond to as many comments as possible.
A reader, Cbcreadercanada commented
“…Come on, Canadian Dental Association. You are doing a good job of recommending the best tooth pastes to Canadians. Why not recommend ethics to your dental association members?”
Someone should have responded informing the reader that codes of ethics are issued at a provincial level and provided a link to the College of Dental Surgeons of British Columbia so the reader could review the code.
Moreover, many comments suggest dental tourism to destinations such as Mexico in order to receive discounted dental work. Patients need to be informed of the risks associated with dentists who are not trained and regulated like their Canadian counterparts. Check out this story about patients who visited a Mexican dentist and ended up worse off than they were before!
The vast majority of dentists in Canada are ethical and perform the highest quality of work. With any profession or job, there are a few people who do not exhibit ethical values and perform sub-standard work. Canadians need to be informed that they can contact these professional organizations to seek further information if they have any questions or concerns about their dentist or particular treatment plans. If you have a complaint, the College of Dental Surgeons of British Columbia will investigate it and ensure the situation is resolved. Dental associations and regulatory bodies need to encourage a dialogue with patients and patients need to know these associations are approachable and will listen to them! Furthermore, these organizations needed to issue a statement that examined the issues and biases expressed in the CBC’s research.
CBC’s Research Errors
Patient Inconsistency
The CBC has based their claims on what appears to be a “test” for the dentist. The dentist is given a set of x-rays and allowed the opportunity to look inside a patient’s mouth. However, we the viewers are not told how the patient approaches each dentist. Does the patient ask for each dentist to estimate only essential work? Does the patient inform the dentist that they want the perfect smile? Does the patient ask each dentist the same questions? In the field environment of varying offices, the researcher (patient) must make every effort to give each dentist the same information and ensure each dentist is aware of the same objectives. Every effort must be made to ensure each dentist has the same understanding of the patient’s dental goals.
Selection Bias
Dentists were not randomly chosen for this experiment. An acceptable marketing research sampling method was not employed. The show admits Marketplace visited a dentist who had the highest estimate many years ago when they ran a similar experiment. In order for the results to be valid, a significant number of dentists must be randomly selected. They can not be hand picked or sampled on the basis of convenience.
Only a minority of dentists appeared on television
Although 20 dentists were surveyed, only a handful of these dentists were featured in the television program. Furthermore, only a snapshot of their conversations were featured. We do not know how the patient approached the dentist and what values she expressed.
Story does not explain different types of dentistry
Almost all of the treatment plans presented were 100% acceptable. However different people value different types of dentistry. Personally, I am conservative and do not want to undergo dental procedures unless they are absolutely necessary. Although I could choose to spend mega $$ on whitening and orthodontics, I chose not to. However, I have friends who are spending thousands of dollars on optional orthodontics to get a perfect smile. I also have female friends who are planning on breast implants to improve their appearance. The choice of elective dental treatments depends on the values of the patient. It is up to the patient and the dentist to differentiate between cosmetic and essential procedures.
The CBC “expert” Dr. Dorothy McComb stated:
“Unfortunately in dentistry more than in medicine, things are not absolutely black and white so [there are] a lot of shades of grey and it depends very much on the dentist’s personal experience.”
Of the handful of dentists I have discussed this article with, I have yet to find a single person who agrees with Dr. McComb’s “expert” opinion on treatment being based on a dentist’s personal experience. Different dentists tend to specialize in different areas, however personal experience should not play a significant role in determining treatment options. All Canadian dentists are certified by the Canadian Dental Association and should recommend comparable solutions to fix similar problems. In this report, it seems the wide variety of estimates was due to dentists differing approaches to elective cosmetic issues.
Understanding a Patient’s Insurance Coverage
Marketplace implied that a dentist wanting to know a patient’s insurance coverage is a warning sign for a shady dentist. It is almost always in the patient’s best interest to have their dentist take the effort to understand their insurance coverage. Often dental issues can be dealt with through implementing a wide variety of treatment plans.
Let’s say a patient has a badly broken molar tooth. Below are several acceptable treatment plans ranging from low to high in cost and preference. The below numbers are ballpark estimates and for illustrative purposes only.
- An amalgam filling (most people avoid this option as it will tarnish and contains mercury) $160
- A composite filling (tooth coloured) $280
- A gold crown and/or porcelain (tooth coloured) restoration $1,000
In this example, if cost is no object, the optimal treatment plan would be the gold crown/ porcelain restoration. If a patient is paying out of pocket, they have to make a decision. Dental plans vary widely in the procedures they cover, annual dollar limits and percentage of the cost of the procedures that they will cover. Some dental plans will cover 100% of fillings, while others may cover 50% and some may only cover silver fillings. Patients want to know THEIR cost for each treatment option. After understanding a patient’s insurance situation, a dentist can present the patient with estimates for the various treatment options. Insurance plans are often confusing and extensive dental work can be preauthorized through insurance companies. This way, the patient knows the exact price their insurance will cover and the remaining amount they will need to pay. Explaining your budget and allowing your dental office to investigate your insurance coverage helps you make the best decision for the treatment that you can afford.
Marketplace implied that a dental office inquiring about insurance coverage could be a sign of fraud. It is actually a courtesy provided by some dental offices to assist the patient in choosing the best treatment plan for their budget. Fraud is a serious criminal offense. Dentists who are caught fraudulently billing insurance plans are prosecuted. Again, it is very rare for a dentist to fraudulently bill an insurance company. The majority of dentists are ethical and trustworthy.
Poor Choice of Control Group (“Dental Expert”)
The chosen dental expert’s charisma was virtually non existent. As an audience member, I wasn’t engaged by her interview. Although I’m sure Dr. McComb is a technically competent dentist, she is an academic who practices part-time. She has areas in which she is an expert. However, her excellent research is focused on a few specific areas of dentistry. The best way to ensure an accurate expert opinion would be through the utilization of a diverse panel of dentists. Such a panel should include a combination of dentists who practice full time with various specializations and dentists who focus on academic research. These dentists could then evaluate the various proposed treatment plans and arrive at a consensus. There are many practicing dentists who work full time, yet travel the world lecturing who would likely volunteer to be part of such a panel.
Ethical issues
Although my parent was not featured in this story, I find it unethical to film a dentist without their permission. If I were to be filmed at work without my consent, I would feel violated even though I likely would have nothing to hide. I think many dentists would voluntarily agree to be filmed and interviewed. This would allow them to explain the rationale behind varying treatment plans. Furthermore, dentists could utilize cameras to educate the public on the work involved to successfully implement these treatment plans.
In summation, the vast majority of Canadian dentists are scrupulously honest. I hope my blog post has provided a broader picture into how dental organizations could have better handled this situation and provided patients with an understanding of why the presented treatment plans varied in price and treatments. Please feel free to comment on my posting if you have any questions about my opinions, would like to share your own or would like to seek clarification about the business and patient relations aspects of dentistry. I’m not a dentist so I can’t speak to any technical dental issues. For any technical issues, it is always a good idea to ask your dentist for an explanation of a dental problem and the range of acceptable treatments.
