NPR and Dan Ariely on Dentistry,
First off, let me say that I have been an NPR supporter (yes, including financial support) for many years, so please do not misunderstand my post and think I am bashing NPR itself. HOWEVER………I have an axe to grind with Mr. Robert Siegel of All Things Considered, the evening news program that used to be one of my favorite programs for the drive home from work. And it all has to do with the particular interview with Professor Dan Ariely, of Duke’s Fuqua School of Business in Durham, NC, about dentistry, which was aired on Tuesday, October 5th. Please take a moment to read the transcript:
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ROBERT SIEGEL, host:
Dan Ariely conducts experiments, too. He’s a professor of psychology and behavioral economics at Duke, where he does research into our predictably irrational behavior. And he comes on the program from time to time to share his research.
Today, Dan Ariely on irrationality at the dentist’s office.
Professor DAN ARIELY (Behavioral Economist, Duke University): So, you know, you go to a dentist and the dentist x-ray your teeth and they try to find cavities. And one of the questions you can ask is, how good are dentists, right?
SIEGEL: Mm-hmm.
Prof. ARIELY: So imagine, you came to a dentist, you got your x-ray and then we took your x-ray and we also gave it to another dentist.
SIEGEL: Right.
Prof. ARIELY: And we asked both dentists to find cavities. And the question is, what would be the match? How many cavities will they find, both people would find in the same teeth?
SIEGEL: And I’d really hope it would be somewhere up around 95-plus percent.
Prof. ARIELY: That’s right. It turns out what Delta Dental tells us is that the probability of this happening is about 50 percent.
SIEGEL: Fifty percent?
Prof. ARIELY: Fifty percent, right. It’s really, really low. It’s amazingly low. Now, these are not cavities that the dentist finds by poking in and kind of actually measuring one. It’s from x-ray. Now, why is it so low? It’s not that one dentist find cavities and one doesn’t, they both find cavities, just find them in different teeth.
(Soundbite of laughter)
Prof. ARIELY: And here is what happens. Imagine you’re a dentist and you see a patient, and you really want to find a cavity because you get paid more if you find cavities and you can fix them. And the patient is already on the chair. He’s already prepped. You might give them the treatment right now, really good marginal income for you. How is this motivation to find cavities will influence your ability?
Now, you look at an x-ray, which is a little fuzzy and unclear and there are shadows and all kinds of things are happening. What happens is this unclarity, thus the x-ray helps in some sense the dentist to interpret noise as signals and find cavities where there aren’t really.
SIEGEL: And fill them?
Prof. ARIELY: And fill them, and drill them, expand them. I don’t think they ever tell their patients, hey, I thought it was a cavity but turns out it was just a mistake.
(Soundbite of laughter)
Prof. ARIELY: But they do fill them.
SIEGEL: You’re describing a very private relationship between patient and dentist.
Prof. ARIELY: Yes.
SIEGEL: You’re telling us we should, on average, expect our dentist to be getting it wrong on the x-rays, but that’s not how people feel about their dentists, right?
Prof. ARIELY: That’s right. And the dentists actually have a tremendous loyalty. People are really loyal to their dentist, much more than other medical profession. And I think one of the reasons we go back to cognitive dissonance. Cognitive dissonance is the idea that when people do something painful, they become more committed to the goal. If we have a fraternity and we haze people in a more difficult way, they become more loyal to the fraternity.
SIEGEL: You have dentistry as a hazing experience right now.
Prof. ARIELY: That’s right. And I think the same thing happen with dentists. Dentistry is basically the unpleasant experience. They poke in your mouth. It’s uncomfortable. It’s painful. It’s unpleasant. You have to keep your mouth open. And I think all of this pain actually causes cognitive dissonance and cause higher loyalty to your dentist. Because who wants to go through this pain and say, I’m not sure if I did it for the right reason. I’m not sure this is the right guy.
(Soundbite of laughter)
Prof. ARIELY: You basically want to convince yourself that you’re doing it for the right reason.
SIEGEL: Every visit to the dentist is an episode in the Stockholm Syndrome here, is what you’re describing. You studied these dental insurance records and you looked at what happens over time as our relationship with the dentist grows over many years, and you find it affects the kinds of decisions the dentist and the patient make, the choices.
Prof. ARIELY: That’s right. So you can imagine that at some point in your dental treatment, you have a choice between things that have the same possible outcome, but one of them is more expensive to you and better financially for the dentist. Which one would you choose and how the duration of relationship be affecting that?
And it turns out that the more time people have seen the same dentist, the more likely the decision is going to go in favor of the dentist. People are going to go for the treatment that is more expensive but has the same outcome. More out of pocket for them, more money for the doctor. So in this case, loyalty actually creates more benefit for the dentists.
SIEGEL: More expensive filling material, for example.
Prof. ARIELY: That’s right. That’s right.
SIEGEL: Well, Dan Ariely, thanks for talking with us again.
Prof. ARIELY: My pleasure.
SIEGEL: Dan Ariely, professor of psychology in behavioral economics at Duke University. His book is “The Upside of Irrationality,” and he talks with us about our rational and irrational decisions from time to time on ALL THINGS CONSIDERED.
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Now…….as you can imagine, this has created quite an uproar among dentists, and especially among those of my colleagues and I who have long considered NPR to be a source of (mostly) unbiased and reliable news, as Professor Ariely, whose field is Behavioral Psychology, in 1 fell swoop, condemns all dentists as money-hungry, greedy, unethical, and incompetent!
Of course, there are several problems with this interview that I would like to address:
- As far as we can tell, Professor Ariely has absolutely NO background in dentistry, nor has anyone been able to learn where he learned to read and evaluate x-rays.
- No one has yet been able to find any published research by Professor Ariely on this topic, so we really don’t know where he’s pulling this stuff out of, except probably his a**.
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- Please read the quote below, from Delta Dental’s Director of Public Relations (posted on another blog), especially the underlined text (my emphasis). So……if Delta Dental did not provide the alleged research, where did Professor Ariely get it?
Charlotte Dentist | Cosmetic, Laser, & Implant Dentistry - Charles D. Payet, DDS, PA
Thanks,
Chris Pyle
Director of Public Relations
Delta Dental Plans Association
So, according to Professor Ariely, all of our Patient Reviews are just because they were somehow pressured into it? And all of their problems were made up by me so I could make money? Wow, who knew! I thought it was because my team and I do our best to make our patients comfortable, take care of their problems at a time and pace that is comfortable for them? And the lady I referred to another dentist today, because I know he can do better dentures than I can……what in the world was I thinking, doing the right thing for her like that?
Ah well………can you tell I’m fired up? Let me just say in closing: I love dentistry and I love taking care of people. That’s why I invest so much time and money in improving myself and my skills every year, as well as in making sure we have leading technologies and techniques to make appointments faster, more comfortable, and just better. No matter what some Duke Professor says.