Those who can, do; those who can’t, teach.

There is an important role for good health communication, both to tackle health myths and educate patients, but also to improve the quality of health care delivery by clinicians.

It was George Bernard Shaw who said ‘Those who can, do; those who can’t, teach.’ Earlier this week I came across a comment on social media from a dental practitioner who paraphrased this famous quote by claiming that people who chose to work in dental schools did so because they are not cut out for the ‘real world’ of dental practice - whatever that means. The implication was that only private practice dentistry was ‘real’ dentistry. This week also marked the sad passing of Dr Michael Mosley, a prominent health communicator who used his science-based journalism to tackle medical myths to make people healthier.

These events highlight the very important role for people who tread a non-traditional path in healthcare. Although Dr Mosley he had trained as a doctor, he was not involved in the hands-on treatment of patients. Instead, he used his knowledge and skills as a medical practitioner combined with his experience in journalism to help educate and guide people to better health. As a result, he has probably helped more people than had he practiced as a doctor. In the same vein, academic clinicians play a critical role in generating new evidence and educating both the current and next generation of health professionals with new knowledge.

No professors, no profession.

What both health journalists and academics have in common is a passion for quality health communication, whether it is for patients or health practitioners. From a patient perspective, many non-communicable diseases are rooted in behaviours such as diet, oral hygiene and smoking. Therefore, in order to prevent disease, we need to change behaviour. This requires people to rethink their knowledge and beliefs. Which is why behaviour change is not easy.

Myths in healthcare are persistent, and it is difficult to change peoples’ minds, particularly when they have already decided on something. Where and how people source their information has changed dramatically in the past 20 years, making it even more challenging for people to separate fact from fiction. And we are battling human nature, because we seem to be inherently resistant to new ideas.

James Clear in Atomic Habits wrote “Humans are herd animals. We want to fit in, to bond with others, and to earn the respect and approval of our peers. Such inclinations are essential to our survival. For most of our evolutionary history, our ancestors lived in tribes. Becoming separated from the tribe—or worse, being cast out—was a death sentence.”

It is an ingrained human trait that once impressions are formed, they become remarkably sticky. In some areas this is referred to as group-think, and it is a particular problem in the political sphere as groups become more polarised and isolated from each other, and less susceptible to changing their views based on new evidence. But it is equally apparent in health, with people coalescing on social media in groups that support and reinforce their particular views on health and disease, sometimes to their detriment.

But it is also a problem within healthcare too, with practitioners often just as resistant as patients to accepting new evidence to change the way they practice. There is a frequently cited study that estimates that it takes 17 years on average for new research to make its way into clinical practice, and even then, only 1 in 5 evidence-based interventions will be adopted. This is a real problem in improving health outcomes for patients. Two quotes underscore this stubbornness to accept new information and change:

“Faced with a choice between changing one’s mind and proving there is no need to do so, almost everyone gets busy with the proof.” J.K. Galbraith

 “The most difficult subjects can be explained to the most slow-witted man if he has not formed any idea of them already; but the simplest thing cannot be made clear to the most intelligent man if he is firmly persuaded that he knows already, without a shadow of doubt, what is laid before him.” Leo Tolstoy

Why do false or outdated ideas persist in healthcare? Part of the reason is that they are passed down by osmosis – younger clinicians turn to their more experienced peers for mentoring and guidance, and so some of the ideas pass down through generations, backed by the certainty that ‘it works in my hands.’ This is reinforced by the view that the dental school environment is ‘not the real world’ and it is necessary to ‘unlearn’ certain practices after graduation. For many, it is easier to accept the so-called wisdom of the crowd than it is to buck the trend to adopt the new evidence.

Confirmation bias plays an important role. As Galbraith noted, people tend to seek out information, data or evidence that confirms their own point of view or way of doing things and avoid or ignore any information that contradicts that. There is also a strong bias towards maintaining the status quo. Breaking away from the status quo requires action and effort. It also means taking responsibility for a potentially negative outcome that might result from change. The status quo is passive and requires no additional action and therefore has the perception that it minimises the risk of failure.

We must challenge the accepted orthodoxy and embrace new and emerging evidence. Health communication is critical, both at the individual dentist-patient level and at the broader population level if we want to change behaviours and improve health outcomes. And that applies equally to clinicians as it does to patients.