The concept of social networking can get tricky for dental practitioners, so how do we maintain professionalism in a world where such platforms are now considered mainstream communication tools? Anita Kemp, Case Manager at Dental Protection, looks at the facts

These days, many dental practices rely on social media platforms to attract and maintain their patient base. The challenge with social media is that it is egalitarian in its concept, giving the illusion that it is permissible for us to be connected; yet how do we maintain the essential boundaries between ourselves and our patients without causing offence?

Definitions keep us safe

According to the Oxford Dictionary, the definition of social media is: “Websites and applications that enable users to create and share content or to participate in social networking.”

Let’s take a closer look at social networking. I like the definition by Investopedia, which states that:

“Social networking is the use of Internet-based social media sites to stay connected with friends, family, colleagues, customers, or clients. Social networking can have a social purpose, a business purpose, or both, through sites like Facebook, Twitter, LinkedIn, and Instagram.”

These definitions help us to set the scene by beginning to tease out concepts such as what is social vs professional, allowing us to explore the social relationship vs the therapeutic relationship. When we exchange the word “professional” for “therapeutic” the boundaries of our practice become clearly defined, which we will explore later.

Blurred lines

Often patients feel it is appropriate to contact their health practitioners about their health issues through social media, whether via a post on their practice page or direct messaging. Consequently, research indicates that health professionals and dental practitioners are experiencing an increase in friend requests from their patients, to connect not only professionally but personally as well.

In fact, for many patients sending their dental practitioner a friend request seems like a reasonable and acceptable thing to do. Yet, in most cases, it would be fair to assume that patients may not appreciate or comprehend the professional ramifications of extending a friend request, or for that matter the personal and professional boundary breaches that could occur. The challenge for practitioners is to balance these privacy and boundary requirements, by knowing where and when to draw the line between their professional profile and their personal profile.

Boundary breaches

According to the DBA Code of Conduct, health professionals are “expected to display a standard of behaviour that warrants trust and respect of the community” and “this includes observing and practising the principles of ethical conduct”.

Broadly, professional boundaries are defined as limits or borders that exist to protect that space between professional power and client vulnerability “enabling practitioner and patient to engage safely and effectively in a therapeutic relationship”.

Due to the power imbalance inherent in the practitioner-patient relationship, the preservation of professional boundaries is key to preventing abuse of this relationship, promoting good care for the patient or client, and protecting both parties.

The value of the therapeutic relationship

The overarching purpose and nature of any relationship between a dental practitioner and their patients is one that is therapeutic. Which begs the question, does accepting a friend request add to the therapeutic relationship? The therapeutic lens enables distance from egalitarian norms that pervade social media and allows for preservation of the patient-practitioner relationship. A response to personal online requests can be as simple as saying: “As a clinician I cannot accept personal requests as it affects the therapeutic relationship.” This allows the practitioner to maintain their professional boundaries, while also acknowledging that the patient’s wellbeing and care is at the centre of practice.

Case scenario

Let’s think about a possible scenario, which could potentially breach these boundaries.

You accept a friend request from a patient, who has a high caries rate, and you notice that they are constantly posting photos of themselves consuming high sugar content and acidic drinks. When asked previously in conversations around diet, they denied these behaviours, stating they preferred to drink water.

Would it be appropriate to bring these posts up with them during their next appointment; would this be viewed by the patient as confrontational? And on the flipside, as their dental practitioner is it appropriate to ignore these posts and not instigate a conversation around diet and caries?

What if they didn’t intend for you to see the images? Would bringing it up affect your therapeutic relationship? Would this be considered crossing professional boundaries?

Professional integrity and reputation

Accepting friend requests can be an avenue into your colleagues’ and friends’ personal worlds where they feel safe posting their personal views and content. If content shared on your profile is not to the patient’s liking or conflicts with their values, they are likely to shift their perspective and view you as professional in power, not as a ‘friend’, and hold you to a higher accountability. In effect accepting from a patient what presents as a benign invitation becomes a privacy issue for your friends and colleagues.

The very real fact that posted information is seen, liked and shared by others, beyond the original intended recipients, could have unintended consequences and potential ethical repercussions for your friends and colleagues, not just you. Likewise, if your friends and colleagues are unaware that you are online friends with your patients, and by consequence provide access (although limited) to comments made on your profile by them, could you inadvertently be breaching their privacy?

Although we often share personal information with our patients around common interests, shared experiences and funny stories, the purpose is intentional with the design to build rapport; these conversations are often shared with some degree of discretion and in a clinical setting. Excessive disclosure through unfiltered access is unlikely to be of benefit to the therapeutic relationship and consequently could lead to boundary breaches.

Furthermore, dental professionals, like most people, share information on their personal social media accounts that includes personal information, photos, links to websites, likes and at times off the cuff comments shared between friends, family and colleagues. Whilst made under the premise of personal interaction, any comment made by a practitioner that expresses their personal beliefs that patients may find contrary to their own vulnerabilities or personal sensitivities (eg politics, religion, immunisation) could inadvertently breach the code of conduct.

Navigating your way out of the friend request

If you do find yourself in a position of receiving a friend or other social media request, you might on one hand feel flattered, while on the other hand feel uncomfortable, concerned that not accepting their request might prove awkward.

However, as health professionals we are not held to the same standard as our patients. As a profession we are afforded special privileges that are not extended to our patients or society in general, and in return we are expected to uphold these high ethical standards, which includes maintaining professional boundaries, preserving the therapeutic relationship, and placing our patients’ wellbeing and care above any concerns, beliefs or feeling of our own.

With this in mind, it would be prudent to interact with patients over social media in a professional capacity, through a professional page.

Practical tips to preserve the therapeutic relationship

As mentioned earlier, patients may not fully understand the professional ramifications of extending a friend request.

Consider separating professional, practice and personal profiles on social media platforms, and adjust your privacy settings. Change your name to a pseudonym, making it challenging for patients to access your personal page.

Speak to your patient – explain that as a health professional you are governed by codes, guidelines and standards that set out the expectations regarding our professional behaviours and boundaries regarding personal relationships with patients, which state it is “usually inappropriate to form personal relationships with patients”.

You could send a polite message explaining that the practice has a professional policy not to accept patient friend requests or establish online friendships with patients – this sets the tone and expectation for the patient.

Conclusion

Because all forms of social media have become so entwined with our social fabric, managing social media on both a personal and professional level has become increasingly important. Similarly, 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.

In a situation where a practitioner’s professional behaviour or conduct was to come under review because of boundary breaches relating to interactions over social media, please know that it is irrelevant if the breach was inadvertently remiss, altruistic or well meaning. It is still a boundary breach and effectively a breach of the DBA code of conduct, which often carries with it far-reaching consequences for the practitioner.

So, if in any doubt, err on the side of caution – choose to maintain the “therapeutic relationship” and not the “friendship”.