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Shared wisdom

Sometimes all we need is a quick suggestion from our peers to zero in on a good story. Here we turn to front-line journalists for advice, some simple insight to add to our repository of “shared wisdom.”

What advice do you have for reporters who might find themselves putting together a dental death story on deadline? – Sammy Caiola

My best advice would be to make sure you have a trusted expert for the wider context.

If someone dies, their family won't likely be in a place to tell you the deeper medical meaning behind that death, and framing the death as preventable could make the family feel you are pointing blame at their loved one. A knowledgeable provider will be able to explain the death from an academic perspective and share any cautionary messages.

Sammy Caiola (@SammyCaiola) is a public health reporter for The Sacramento Bee. She wrote about the death of a young California father from complications of a dental infection.

What wisdom can you share on how you stay on top of a wide-ranging beat? – Paul Sisson

Paul SissonAttend AHCJ meetings as often as you can. Realize that, with the Internet, the world of research is at your fingertips in ways that journalists just 15 years ago could only dream of.

Try to find outside sources to test what people are telling you. Follow the best journalists in your field, the ones presenting at annual AHCJ meetings, on Twitter.

Paul Sisson (@PaulSisson) covers health care for U-T San Diego. He has written about an innovative nonprofit dental clinic that opened in a senior center.

How do you choose the stories you decide to tackle? – Andy Marso

Reporting on health care, like a lot of things, should ultimately be about people and their stories. I need to get better at putting human faces on policy stories.

But if I know the policy side, then I know when I hear from somebody like Dr. Fasbinder that I’ve probably got a story.

Andy Marso, M.A., is a writer for the KHI News Service who has covered Medicaid dental services. 
He previously covered state government news for the Topeka Capital-Journal, where he won the Burton W. Marvin Kansas News Enterprise Award and received the Great Plains Journalism Award for investigative/project reporting. His memoir, “Worth the Pain: How Meningitis Nearly Killed Me – Then Changed My Life for the Better,” was named a 2014 Kansas Notable Book.

In your exploration of the Medicaid system in Florida, what discovery has surprised you most? – Maggie Clark

Maggie ClarkI am consistently surprised at the scale of the Medicaid program. It’s responsible for the health care for nearly half of all children age 0-17, or about 2.2 million kids as of August 2016.

Depending on how you look at it, that’s either a huge problem or a huge opportunity.

Maggie Clark's Two Million Kids series for the Sarasota Herald-Tribune has delved into many aspects of Florida’s troubled Medicaid system. See her Q&A on the series and her tip sheet for other reporters.

What should reporters be looking for in cases of death and injury related to dental anesthesia? – Brooks Egerton

First, don’t assume that anesthesia is the only issue or even the main issue. As I reported in Chapter 2 of Deadly Dentistry: “The risks go far beyond oversedation. Others include inhaling objects, bleeding, accidental stabbing, deliberate violence, unsterilized equipment, intoxicated dentists and facial fire.”

Second, don’t assume that children are the main victims.

Third, don’t assume that your state’s public regulatory records tell anything close to a full story. As I reported in Chapter 3 of the project, there’s a national pattern “in which state dental enforcers ignore many malpractice cases and leave the public in the dark. The starkest example is in New York. Insurers reported death payments for 31 dentists there from 2004 to 2013, federal data show — more than in any other state. Yet New York did not discipline a single dentist for a death during that time.”

What we all need — “we” meaning not just journalists, but all dental patients — is more data. I believe dentists should be required to tell regulators about all patient deaths, unplanned hospitalizations and medical emergencies that might have any relationship to treatment or lack of treatment. I believe that these reports should be public records (with patients or their survivors choosing whether to be identified). Then some more powerful analysis could begin.

Brooks Egerton was a staff writer at The Dallas Morning News when he reported "Deadly Dentistry," a seven-part series that raised questions about how many dental injuries and deaths may be going unreported across the country – and how many dentists may go undisciplined for malpractice.

With so much to do on any given day, how do you decide where to place your attention? What is your strategy to covering your beat? – David Olinger

David OlingerI get calls and emails every day from people touting whizzbang gadgets and amazing disease cures, which makes it hard to spot the gem in a cheap jewelry case.

What I'm trying to do is develop a trusted list of sources, so I can seek their opinions about the latest "advances" in medical care.

David Olinger has worked at The Denver Post since 1997, winning national awards for stories of physically and mentally wounded soldiers sent back to combat, Colorado's foreclosure crisis and homeowners victimized by predatory real estate investors. He also played a key part in the Post's Pulitzer-winning coverage of the Columbine High School massacre.

Do you have a few words of wisdom to share with reporters who may find themselves tackling this issue themselves in the coming year in their own states? – Will Drabold

Will DraboldAccess to consistent, reliable, effective dental health care is a critical problem for the country. And it has been for years. Everyone agrees on that, so this is a subject worth any reporter’s time.

My main advice is to stay persistent and curious on this topic and realize a large community is interested in this subject. If you write about this, you will be surprised, perhaps overwhelmed, by the level of response your story receives.

Will Drabold (@WillDrabold), a senior at Ohio University, reported about dental therapists as an intern on The Seattle Times investigations team. He can be reached at willdrabold@gmail.com.

Do you have a pearl of wisdom you can share with the reporter who might tomorrow get a phone call that will set him or her off on a journey like this one? – Brooks Egerton

Brooks EgertonTrust your gut!

If you see something or hear something that shocks you, make time to check it out. Maybe no one has been down this road before — and maybe there is a way to quantify it.

Brooks Egerton (@brooksegerton) covered problems with enforcement system that is supposed to hold the nation's dentists accountable when he was an investigative reporter for The Dallas Morning News.

Covering events year after year is one of the great unsung challenges many reporters face. Please share a little wisdom on how you keep finding something new and important to say. – Susan Abram

That's a great question. I began covering health before the ACA was signed, so I think that gives me some context and makes me want to know what's changed since those days when people were denied health coverage because of pre-existing conditions.

I've visited the megaclinic in Los Angeles three times since that first one was organized in 2009 and each year, I want to know what's different than the year before and if it will continue as we get deeper into a different health care landscape.

Susan Abram (@sabramLA) covers public health news for the Los Angeles Daily News and Los Angeles News Group.

Was it difficult to get people to open up to you about their pain and need? – Hanah Cho

I write a lot about financial issues and it's always hard to get people to open up about personal issues like that. With this story, the challenge wasn't having patients like Thelma open up to me, it was first finding them. I really didn't know where to turn at first to find patients, but once I started reporting, sources led me to public clinics like the one I featured. I found that once I explained to Thelma and others that I was trying to shed light on this important issue and the challenges faced by older Americans, they were willing to tell me their stories.

Hanah Cho wrote about seniors struggling to get dental care for The Dallas Morning News. She is a a writer/editor at NerdWallet.

Can you share a little wisdom on exploring a personal health care story for its wider lessons? – Elizabeth Piatt

Elizabeth Piatt

One thing I learned through the process of writing about this is that I needed to really be honest about what I was thinking and feeling and not be afraid to make that part of the story. It was in that space that I “found” the wider lesson.

It wasn’t until I started to write about my own feelings about my sister that I had my final “aha” moment: navigating a complex system is only part of the issue.  We really need to be talking about and examining our own attitudes toward the poor to address disparities in care.

Elizabeth Piatt is an assistant professor and chair of the Sociology Department at Hiram College in Hiram, Ohio. She wrote about trying to help her sister, who is disabled, navigate the Medicaid system for a piece that appeared in Health Affairs.

How did you weave so many facts into an engaging narrative when writing about dental care for people with specials needs? - Elizabeth Simpson

Elizabeth Simpson

It helped to talk with several different dentists, both retired and still working. The retired ones seemed more willing to talk about gaps in the system.​ I tried to keep the human story flowing throughout the policy part.

Elizabeth Simpson covers health issues at The Virginian-Pilot. She has been with the paper since 1989 and has covered education, family and social issues in the past.

What lessons did you learn from reporting on such a complicated issue?  Elise Oberliesen

Elise Oberliesen

When you’re reporting on a complex topic, realize that sometimes you can’t rush the process. This story tested my patience time and again. Ask questions and keep asking questions — especially when the answers don’t line up or people cannot answer the infamous “why” question. Don’t be afraid to question the science. Always try to communicate with your editor — especially if you uncover elements of surprise or suspicion. A good editor will steer you out of the weeds. Best advice — always trust your gut instincts.

Elise Oberliesen recently wrote about the almost-routine removal of wisdom teeth and those who are questioning the convention.

Can you share the best piece of advice you offered to the students as they headed out to the clinic? – Julie Drizin

Julie Drizin

Be a human being. You are going there as a journalist trying to get a story on deadline, but connect with people on a human level. That’s how you can make the most of this experience. Just keep your mind, your eyes, your ears and your heart open. Stories are everywhere.

Drizin, director of the Journalism Center on Children & Families, teaches an undergraduate journalism class at the University of Maryland in which she sent students to report on a 100-chair free dental clinic.

How did you get dentists to talk with you about the uncomfortable subject of Washington’s rising spending on Medicaid braces? — Sheila Hagar

Sheila HagarThe first thing I would caution is to go slowly. I found dentists here so afraid of losing Medicaid authorization, they would not even return calls to say they couldn't participate. Fear of retribution was palpable. Washington can't be the only state with that problem. Talk to dentists and orthodontists — and those professional associations — on background to learn whatever you can and ask them to tell colleagues what you are working on. Ask them for copies of any correspondence they've had with state officials on the matter. Ask about issues the reader might not know. For example, I didn't even realize kids on Medicaid could get braces, period. I had old data in my head.

Sheila Hagar is a medical and social servces reporter at the Walla Walla Union-Bulletin in Washington. She has freelanced for newspapers and magazines, joining the Union-Bulletin staff full-time in 2004. She recently wrote about Medicaid’s orthodontics benefits.

Any tips for reporters who might look into possible Medicaid fraud or overtreatment in their own states? - Becca Aaronson

Becca AaronsonMedicaid claims data is really complicated. I think that talking to people about what they are noticing on the ground is really good because then you can request data and verify what they are seeing on the ground. When you are actually working with the data itself you have to know the procedure codes. Sometimes that can be complicated. There are trends in what providers overbill for. They don’t necessarily bill for the most expensive procedure. They bill for the one below that often. So the best advice is actually finding people, talking to the investigators who are into it. The people who are noticing trends.

Becca Aaronson (@becca_aa) develops news applications and works on special investigative projects for The Texas Tribune. She joined the Tribune in 2010 and began covering health care in 2012. She has been covering the state’s Medicaid orthodontic scandal.

How accessible and useful have Medicaid records been? – Becca Aaronson

Becca AaronsonOne of the best things you can do is build relationships with sources who are really familiar with the documents. One of the things I was looking at were lawsuits, so I got to know lawyers on both sides and had them explain the case to me. They were often quick to provide me with copies of the lawsuits if something happened because they knew I was following it. It’s always good to get both sides in those things. The other thing is to build relationships inside the agencies, so I knew a lot of what was going on…

Becca Aaronson (@becca_aa) develops news applications and works on special investigative projects for The Texas Tribune. She joined the Tribune in 2010 and began covering health care in 2012. She has been covering the state’s Medicaid orthodontic scandal.

In your reporting, you talked with experts about the benefits and risks of conscious sedation, which, according to legal documents, appears to be the type Finley received. What did you learn about what might go wrong? – Alia Wong

One dentist told me that conscious sedation is typically used on "tense cooperative children" who need a lot of work done on their teeth. But it can cause the children to lose their inhibitions and become more difficult to control. That can make it challenging for a dentist to intervene when a child's oxygen levels start going down. That's why it's so important to regularly and frequently monitor a child's heartbeat and oxygen levels.

Alia Wong recently wrote about a child who died after being sedated for a dental procedure. See her Q&A about questions that have been raised about that case. Wong writes for Civil Beat.

Any wisdom to share with other reporters who might tackle a story like this that unfolds over time? – Marc Ramirez

It helps to have some sort of filing system, whether through saved emails or online documents or physical folders, for sources or stories that are worth following up on from time to time. We’re all facing the regular ongoing demands of breaking news and enterprise stories, but when those moments pop up where we’ve got time to breathe and look ahead, those files are worth reviewing to see what might be worth a new look. And obviously if you know there might be a milestone or new angle down the road and the approximate date, you put a reminder in your calendar. When you know a story like this will develop over time, it’s also useful to let your sources know that they shouldn’t be shy about contacting you again with new developments. In this case, Mary Ann Siller, who had originally told me about Robina, followed up to let me know the reconstructive work was nearly done – not only because of how Robina’s teeth had improved but because of the changes she’d seen in Robina’s personality. And that became the new angle I built my follow-up story around.

Marc Ramirez of The Dallas Morning News recently offered readers an update on a story he began to write more than two years ago.

Did you learn anything new about oral health in working on the story? — Melissa Daigle

Melissa Daigle"Yes! I learned your diet is even more important than how much you brush your teeth.

"Dr. Boren told me if he could pick between not brushing your teeth and not eating candy, his advice would be to not eat candy."

Melissa Daigle is a reporter at KYTX-Tyler, Texas. Just before Halloween, she did a story about one dentist's candy "buyback" program.

When you started asking questions about how your state exchange was handling kids dental benefits, what did you learn? — Chad Terhune

Chad Terhune

“One of the first things we all hear about essential health benefits is that there are ten things that every plan must cover. But I soon learned you can be an essential health benefit but not be required…It’s not really 10. It’s 9.5.”

Chad Terhune is a health care reporter at the Los Angeles Times. He recently wrote about the difficulty in getting pediatric dental coverage integrated with California's health insurance marketplace.

What is one of the biggest challenges in covering the debate over fluoridated water? – Kyle Hill

Kyle Hill

Kyle Hill is a freelance science writer and research fellow who wrote about attempts in Portland, Ore., to fluoridate the public water supply.

“As science communicators, we have to stress accuracy instead of encourage defensive, emotional thinking. Of course, we could always use people on government science committees who actually believe in science, and more scientists and engineers in government positions.

"It's a long, hard fight, supporting good science. But we have to do it, if for nothing else than to save a few teeth.”

How do you cultivate sources for covering a big story? – Shannon Muchmore

Shannon Muchmore

Shannon Muchmore, health reporter for the Tulsa World, has been deeply involved in coverage of a major state investigation into lax sanitation practices at the office of a local oral surgeon.

“It's good to already have a relationship with the local health department before something like this happens, so you know whom to talk to and they are more comfortable giving you information. Be sure to step back from the initial scare and look at and report the science behind how these diseases are transmitted and how often that happens in whatever setting you're dealing with. And as always, try to anticipate the questions your readers, listeners or viewers will have and be thinking about the next story.”

What advice do you have for journalists reporting on dental health? – Eric Eyre

Eric Eyre

Eric Eyre, of The Charleston (W.V.) Gazette, reported "State of Decay: West Virginia's Oral Health Crisis" and has contributed a story, tip sheet and spoke on a panel about the topic.

“Do 'on-site' reporting. Spend the day at a dental clinic or a same-day denture practice that serves low-income patients. Find dentists willing to show you the 'good, bad and ugly,' as one West Virginia dentist promised me. It’s a largely untold health story that deserves attention.”

What sources did you use in reporting on dental care debt? – Kelley Weiss

Kelly Weiss

For Capital Public Radio, Kelley Weiss reported "Charge It: Patients Rack Up Dental Care Debt." Read more about her reporting.

“I reviewed financial tax filings to trace the money the credit company, CareCredit, was giving the American Dental Association and California Dental Association for their endorsements of the dental credit cards.”