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A question of boundaries

28 July 2022

How did a friend request on social media complicate this patient-practitioner relationship?

Dr M had been treating Mrs K and her family for many years; they were both of a similar age and their children attended the same schools and shared similar sporting interests. They often enjoyed conversations about parenting during the family’s dental appointments, and they often crossed paths as their daughters played in the same soccer team. Recently Mrs K had extended a friend request to Dr M over social media.

Though Dr M felt a little uncomfortable about becoming friends with Mrs K in a personal capacity and over social media, he accepted her request and reasoned that he had always found Mrs K to be very pleasant. Similarly, he was worried it could prove awkward if he didn’t accept her request, given that he ran into Mrs K most weekends at their daughters’ soccer matches, and they were often tagged in the team photos.

While at the soccer club one evening, Mrs K sought Dr M out while he was waiting to order dinner with friends. She mentioned that she had noticed one of her teeth had become sensitive, and thought it was likely one of the last fillings Dr M had placed. She wondered if the tooth had cracked or indeed broken, and subsequently opened her mouth and pointed to the tooth. She then advised she had taken a photo of the tooth and would send it through to his social media account for him to take a look at.

Dr M, feeling quite uncomfortable and confronted by Mrs K’s out of the blue request for advice in a social setting, tried to make light of the subject. He encouraged Mrs K to make an appointment with him on Monday. Mrs K seemed offended by his response; however, Dr M was unsure of how to explain that ‘now’ was neither the time nor place to complete a consult or offer any meaningful advice. Moreover, he was unable to see or identify with any certainty which tooth she was pointing to. Dr M was also aware that people were looking on and listening to their conversation, and he wanted to avoid any difficult or embarrassing conversations for them both.

The next day, Dr M received additional pictures of the tooth worrying Mrs K. The images accompanied a comment about Dr M fobbing Mrs K off at the club, which she found to be rude and disrespectful when considering she had been a long-standing patient. He was also surprised by this demeanour change as they had always been on good terms, and she referred numerous friends and family to him over the years.

This was not the type of conversation Dr M wanted to pursue over social media, and he was unsure about how he should respond. After considering his options Dr M decided not to respond at all. He felt it would be more appropriate to have his administrative staff reach out to Mrs K on Monday and offer her an appointment at the practice to review her troublesome tooth.

Mrs K noted Dr M’s silence and also noticed that Dr M had been active on his social media and found it offensive and rude that he had not replied to her messages; after all, she had a genuine tooth problem and he was ignoring her.

That Monday, a call was made to Mrs K, offering her a review appointment with Dr M. However, Mrs K advised that she had gone elsewhere and signed the paperwork for hers and her family records to be transferred to her new dentist as soon as possible. She advised that she would no longer attend the practice and considered Dr M to be a dismissive, rude and uncaring dentist.

Dr M was completely taken by surprise by Mrs K’s response and her decision to transfer her and her family’s care to another dental practitioner. He had spent a lot of time over the weekend considering the best way to handle this matter. He had not answered her messages over his personal social media account because his intention was to preserve their therapeutic relationship by maintaining his professional boundaries. His intention had always been to assist Mrs K, and he had believed that this was best achieved in a professional capacity, and via correspondence through his dental practice.


Where did it go wrong?

Regrettably, when Dr M accepted Mrs K’s friend request her view of Dr M changed, as the lines between health practitioner and friend became blurred. Mrs K believed that as a friend, she was now afforded access to Dr M outside their professional relationship and consequently viewed their relationship as a friendship, opposed to the professional and therapeutic relationship they had successfully maintained over the years.

When Dr M did not respond to her messages sent over social media, outside surgery hours and over the weekend, Mrs K – somewhat offended and annoyed – then changed her view of Dr M. She then held Dr M to the high standards expected of a health practitioner and believed he should have at the very least responded to her concerns directly.

In the absence of any response from Dr M, Mrs K then interpreted Dr M’s silence as a professional decision to withhold dental treatment, assistance and care. She then proceeded to seek alternative treatment with another practitioner, thereafter requesting her records be transferred and effectively ending their therapeutic relationship.


Learning points

It is imperative that we attempt to construct and maintain professional boundaries with various forms of social media as well as our interactions with our patients across these platforms.

Accepting friend requests from patients can engender the belief that it is permissible and reasonable for contact over personal platforms, opposed to professional platforms. Instigating a shift from a therapeutic relationship to a friendship can prove to be a slippery slope.

Preserving the therapeutic relationship allows the practitioner to maintain their professional boundaries, while also acknowledging that the patient’s wellbeing and care is at the centre of practice.

Maintenance of the therapeutic relationship enables protection of the space that exists between the egalitarian norms that pervades social media and the patient-practitioner relationship. This allows practitioners to sustain a definitive separation between their professional and private lives.

When advice or behaviour and actions conflict with a patient’s values and beliefs, they are likely to shift their perspective and view you as a professional in power, not as a ‘friend’, and hold you to a higher accountability.

If in any doubt, err on the side of caution – choose to maintain the ‘therapeutic relationship’ and not the ‘friendship’.


These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits Dental Protection members enjoy as part of their subscription. 
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