In the latest in our series of articles from Dental Protection, JAMES FOSTER warns dentists of the need to be vigilant in their use of social media.

Early in my dentistry career, I joined a social group of colleagues known as the MOTHS (Monday Out, Tuesday Home). A chat about dentistry over a couple of beers was the usual format; however, it didn’t take long to discover that a more appropriate name for the group could have been MOAN.

While the initial discussions were quite relaxed, there were always one or two colleagues who, after a beer or two, would begin to talk negatively about a patient, colleague or other team members. Within the confines of the local pub this was rarely a problem. However, times have changed. The topics discussed by groups of dental colleagues today are basically the same, but the meeting place may well be the worldwide web. The sympathetic listening ear of the barman has been replaced by a much larger audience.

What are we talking about?
Social media may be defined as a form of interaction by which people create, share, exchange and comment on content among themselves within a virtual (online) community or network. It includes internet forums, blogs, social networks, podcasts, shared images, video ratings, social bookmarking, etc. Increasingly, these forms of social media are accessed on mobile devices, allowing immediate interaction while on the move or, indeed, in the surgery. Regulators now acknowledge that online communication has become part of a clinician’s personal and professional life, and that the use of social media is very common.

While these newer forms of communication can be incredibly useful, it is important that the standards of behaviour expected of clinicians in the real world are also observed online.

Saved forever
A Facebook page was actually created some years ago with the headline “I am a dental nurse and I hate patients because…”. Open criticism of patients regarding their attitudes, silly comments, and even references to personal hygiene, etc., were posted. While reading these comments, I was reminded of previous evenings with the MOTHS, except that this time the consequences were somewhat different. A spoken social remark is rarely recorded, but the same words in an internet posting can be there forever.

Dentists and members of the dental team use the internet in a variety of ways. While there may be significant benefits to this, there are also inherent dangers. The aim of this article is to encourage colleagues to consider their responsibilities and to suggest ways that can prevent you falling foul of the regulator’s expectations.

I will limit myself to the following dental uses for social media:
• discussion forums between colleagues;
• advertising or practice promotion;
• direct contact with patients;
• ratings and review websites; and,
• personal entries and blogs.

Discussion forums between colleagues
Clearly the use of the Facebook page described above was inappropriate. A difficulty arises when an individual reads a comment that raises concerns about the author’s professional standards. Referrals to bodies such as the Irish Dental Council can come from patients; however, they often come from other registrants.

Colleagues often have firmly held beliefs and, even though the immediacy of the internet is seen to be an advantage, there is also a downside in that any such exchange can suddenly take a rapid and aggressive turn. All colleagues should be aware of the standard of behaviour expected by authorities such as the Irish Dental Council, who would be critical of gratuitous or derogatory comments of a disparaging nature on the service or treatment of other members of the profession.

Patient confidentiality needs to be maintained and a detailed debate about a patient’s treatment is an obvious potential risk, particularly if the detail is specific to that patient and includes images.

Advertising and promotion
In the Council’s code of conduct pertaining to public relations and communications the Council expects that any information provided is:
• truthful;
• legal and decent;
• factual;
• relevant; and,
• accurate.

Such information should not:
• mislead the public;
• impugn the professional reputation or integrity of his/her colleagues;
• bring the profession into disrepute; or,
• exploit or take advantage of:

(i) the physical and emotional state of patients, or
(ii) the public’s lack of knowledge of dental subject matters.

Promoting a practice and services through a website has benefits; however, many colleagues will often engage an outside agency to provide this service. Such organisations may be skilled at promotion but they may be unaware of the regulatory requirements within dentistry. Without any reference to the Irish Dental Council’s guidance, a colleague who lets a marketing company lead their marketing objectives may find themselves challenged by the Council. Unfortunately, most of the complaints about websites tend to come from colleagues in the locality who object to content that perhaps suggests that the practice provides a better service than others in the area, or seems to present as a specialist practice when in fact it is not.

Testimonials
The use of video testimonials on websites is on the increase. However, while this may be an effective way of marketing your practice it brings with it a legal and ethical minefield. By its very nature, a video testimonial will display a patient’s image. There will be reference to a patient’s dental treatment and, therefore, to comply with principles of confidentiality and data protection, the patient must be informed and not misled as to the use of their personal information. The patient must give their explicit consent for the data to be used. It therefore follows that the standards of consent must be higher when processing such sensitive personal data, and in the case of video testimonials this should be reflected in the message you use for obtaining the required agreement from a patient. The same would apply to any images, models, etc., that a practice wishes to use for demonstration or promotional purposes (an example of a model release form is downloadable from the IDA website???).

Many colleagues are now using YouTube to display patient testimonial videos; however, they need to be aware that patients may assume that the video would be uploaded to the dental practice website only. Therefore, unless your intention to upload a video to YouTube is made clear, there is a risk that the patient could be unwittingly misled or deceived over the intended purpose of the video. It is perhaps much safer for dentists to invest in their own website where they can control the terms and conditions of its use and content. If not, the patient needs to be told that the video will be subject to the terms and conditions of YouTube (or any other hosting site selected), with the result that its ongoing use cannot be controlled by the dentist who uploaded it. Ownership has now passed to the video host network and it may be reused out of its original context.

The Dental Council’s code of practice confirms that registrants must ensure that testimonials are from bona fide patients at that practice who have received the treatment referred to in their testimonials. It also indicates that if patients giving such testimonials have received remuneration for doing so then this must be clearly stated. Colleagues are referred to the Dental Council’s publications, which set out the regulations against which their actions will be measured.

Direct communication with patients
All personal information that you accumulate about a patient by virtue of your professional relationship with them is bound by professional confidentiality and the need to protect the patient’s personal data. Email addresses may or may not be secure, so when inviting a patient to supply their email address they should also be asked to indicate whether they agree to receiving all kinds of communication from you by these means or simply, for example, a reminder for them to contact the practice to arrange a check-up. Once you offer an email facility, both new and existing patients can contact you for information or to make an appointment. Subject to the controls outlined above, you can then confirm appointments by email.

Just as the quality of your website reflects directly on your practice, so does the speed with which you respond to patients’ email. As a minimum standard, email should be checked daily. People seem to expect a faster response to email than to more traditional forms of communication. If a reply that takes days has the potential to frustrate your patient, then a same day response can be particularly impressive.

Complaints and emails
If a patient forwards a complaint and a flurry of email exchange follows, there is the danger of a rapid escalation in the tone of the conversation. A measured and considered response is required to a complaint, so sending a letter of response may provide a softer landing, as the patient loses the immediacy of a retort.

Ratings and reviews
There is an ever-increasing number of forums for patients to comment on their experience. While this may not yet be as prevalent in Ireland as other jurisdictions, it’s on its way, and there is potential danger for healthcare professionals. Some forums are part of a practice website where comment is invited, and others may be in association with Government-led schemes or private healthcare organisations.

Unfortunately, comments on such sites may not always be positive. If a large number of patients engage in the review process, a dilution of the negative comment can be achieved. If a negative comment appears, it is perhaps ill advised to enter into a series of exchanges with the author – this can often produce a further deterioration.

If comments are inaccurate or malicious, the first step would be to examine the terms of service for the host site. Aggressive comments may be posted anonymously and many sites will agree to remove these when requested to do so. It can be difficult to define what is defamatory; however, measured negotiation with the site’s mediator may produce a result.

Personal entries and blogs
Many colleagues have found themselves criticised for posting personal information and events. Snapshots at a party may seem harmless; however, a patient, or indeed a local colleague, may think otherwise. The code of practice relating to professional behaviour and ethical conduct clearly states that “to promote confidence and trust between you, your patients and the wider community you should aim to maintain appropriate standards in all aspects of your life, both personal and professional”. Therefore, registrants have standards to maintain, both in and out of the surgery.

Summary
There is an argument that with the common use of a variety of media the professional expectations on our everyday life are becoming increasingly important. A moan about a patient on a Monday night 20 years ago may have been harmless. The same comment made using today’s communication methods could result in a regulatory challenge.

The comments above are intended to briefly outline some potential areas for difficulty and as food for thought. If, when using various forms of communication either socially or professionally, you are aware of expectations, then you can minimise the risk of any subsequent challenge.

James FosterLLM BDS MFGDP(UK) was in general practice for 16 years in Northumberland. He also worked as a clinical supervisor in prosthodontics at Newcastle Dental Hospital. As a full-time dento-legal adviser, James serves as DPL’s deputy lead for members in Australia, as well as being part of the team supporting members in Ireland.