The online dentist

SOCIAL media is part and parcel of our daily lives, serving as a useful source of information and entertainment as well as a means of global communication for millions. Dentists are no exception to this trend and sites such as Facebook and Twitter have become valuable platforms for sharing tips, ideas and innovations. But our duty to maintain professional standards – both online and offline – means there are added risks to consider before logging on.

Social commentary

Gone are the days when the only form of online communication was the humble email. In addition to the two big ones mentioned above, there are now countless networking sites available including Instagram, LinkedIn, Google+ and Pinterest, not to mention various other blogs and forums. I think the majority of us, especially younger dentists, would admit to having accounts on at least two or more of these.

In November 2014 the British Dental Journal published the findings of a US study into social media usage amongst dental students which revealed a massive 91 per cent used Facebook. And one of the greatest barriers to usage cited by respondents was privacy concerns.

Social sites are effective avenues for communicating professionally and personally, however it has become a much more exposed place where information is instantly available for all to see. It is easy to make an impulsive negative comment that we may later regret (or not actually believe at all). While spoken words can be quickly forgotten, the same does not apply online where it is much more difficult to entirely erase written comments. They often linger in a search history cache or may even have been captured in a screenshot.

A good example of the potential risks is shown in the case of a dental nurse who, in July 2015, posted a Facebook message that indirectly supported an act of sectarian violence. The comment made no mention of her job but resulted in a complaint to the General Dental Council (GDC). She was called before the Professional Conduct Committee (PCC), who decided that her post violated the GDC standard 9.1.3: "You should not publish anything that could affect patients’ and the public’s confidence in you, or the dental profession, in any public media". The nurse’s fitness to practise was found to be impaired and she was given a reprimand.

The latest GDC guidance on using social media (tinyurl.com/jpgjvzr), published in June 2016, echoes this stance, advising that "you should not post any information, including personal views, or photographs and videos, which could damage public confidence in you as a dental professional."

Some social sites, including Facebook and Instagram, do allow users to modify privacy settings around who can see your posts or uploads. However, this does not eliminate risks entirely. Posts will still be accessible to your existing contacts and, as already mentioned, it only needs one person to take a screenshot for that information to spread more widely. Likewise, posting anonymously or under an assumed name is also no guarantee of protection.

A recommended approach is to assume that everything we post could potentially be viewed by anyone – including patients, colleagues, patients, employers and regulators. So, if you wouldn’t say it to them directly, then don’t say it online.

Confidentiality

Online forums have become a popular means for professionals to discuss best current practice and clinical cases. This generally takes place within private login-only sites that require some kind of dental credentials. But despite the supposed private nature of such sites, information may still fall into the wrong hands. Clinicians should take great care regarding patient confidentiality and only share anonymised information unless the patient has given their explicit consent otherwise. This would apply to the likes of clinical records, radiographs, photographs, video and audio recordings.

The GDC advises: "If you are sharing anonymised patient information, you must also take all possible precautions to make sure that the patient cannot be identified. Although individual pieces of information may not breach a patient’s confidentiality on their own, a number of pieces of patient information published online could be enough to identify them or someone close to them."

Before considering publishing identifiable information, familiarise yourself with the GDC’s Standards guidance on confidentiality (Standard 4.2) and proceed with extreme caution. Broadly, when gaining patient consent to share their information, it is important the patient fully understands:

1. The content being released and how it may be used

2. The reason for sharing the information

3. Where the information will exist

4. The likely outcomes of releasing the information.

A record should also be made of whether or not the patient gave their permission.

Patient dialogue

Many dental practices set up corporate accounts on the likes of Facebook or Twitter as a means to post relevant patient announcements or other useful information, with some also inviting patient feedback. Any practice account of this kind should state clearly that social media is not an appropriate means for patients to seek clinical help, and instructions for doing so (i.e. the practice phone number) should be posted prominently to avoid confusion.

While inviting patient views may prove useful, bear in mind that this can generate both positive and negative comments. Any dental professional unfortunate enough to receive an online patient complaint should think carefully before responding and it is advisable to first contact your dental defence organisation for advice.

Patient friend request

Another important question for dentists using social media is: "What do you do if a patient sends you a Facebook friend request?" Or if they want to engage with you on any form of social media? A recent poll by GDPUK looking at the use of Facebook amongst dentists found that 72 per cent of them had a personal account. Of those, 47 per cent said their profile was public or only partially private and 31 per cent admitted to accepting one or more patient friend requests.

The GDC advise: "You must maintain appropriate boundaries in the relationships you have with patients. You must not take advantage of your position as a dental professional in your relationships with patients." They say dentists should "think carefully" before accepting friend requests from patients. MDDUS Head of Dental Division Aubrey Craig goes one step further and advises dentists to "politely decline" any such request, explaining the need to maintain professional boundaries.

As before, use your profile privacy settings to make your account as secure as possible. Facebook allows users to block their profile from public searches which may help reduce contacts from patients.

Social media will continue to be an inseparable and positive part of all of our lives. We should think carefully before acting online, in order that we maintain our patient’s trust in us as dentists and in our profession as a whole.

Sameera Teli is a dentist and editor of SoundBite