‘Friending’ patients: What are the potential ethical considerations?

Q: As caring, compassionate, and friendly practitioners, we naturally care and are curious about our patients and their lives. We certainly garner information on many of our patients’ typical family activities, vacations, purchases, life changes, and other events as a part of interacting with them in a treatment setting.

In fact, this is often how we best display our concern for them beyond perceiving them as merely dental cases needing treatment. However, in recent history, we are faced with another entirely new way to interact with patients, and that is the various social media sites that are so common now. One of the most prominent is, of course, Facebook. For the sake of simplicity, we will consider Facebook here as our example case. The question is whether “friending” patients on Facebook is ethical. Some ethical issues include the following: Should you have a “Practice Only” page that you link and share with patients? Is it appropriate to link your personal page to their pages?

A: Among the issues to consider with social media is the very real fact that posted information is seen and shared by others. It can be shared beyond the original intended recipients. This can have unintended consequences and potential ethical repercussions.

There are consequences to consider, such as patients’ viewing something on your personal page that is embarrassing or somehow compromising, thereby exposing risk to your professional and community reputation. Perhaps those family gatherings or a recent college reunion bash and all their related posted pictures are not such a great idea to share with the public and your patients. Is it not preferable to separate social relationships from professional relationships? Is this not related to the reason why it is considered ethically problematic to have personal relationships with patients?1

The Introduction and Preamble of the American Dental Association’s Principles of Ethics and Code of Professional Conduct (ADA Code) state, “The dental profession holds a special position of trust within society. As a consequence, society affords the profession certain privileges that are not available to members of the public-at-large. In return, the profession makes a commitment to society that its members will adhere to high ethical standards of conduct,” and that dentists will “follow high ethical standards which have the benefit of the patient as their primary goal.”1

These sections of the ADA Code make it clear that as professionals we are obligated to adhere to the highest possible ethical standards and to place our patients’ well-being above any concerns of our own.

Bearing this mandate in mind, perhaps it is wisest to interact with patients on Facebook only via maintaining the professional relationship through a professional page. Sharing your personal activities and exploits with patients seems more than a bit removed from providing any benefit to the patients. It would seem it is a benefit you enjoy, as you wish to share your fun, activities, and good fortune with them for your own reasons.

What is the benefit to the patients in such a social relationship? How does the fact that you have access to their personal lives benefit them? You might enjoy the knowledge, but our goal is to benefit the patients. An argument could be made that sharing more about yourself might benefit the patients by making you more of a “real person” rather than their “dentist.” However, a practice-based site can provide this information in a more professional and controlled manner.

What are the consequences of knowledge gained through this connection that exists outside the dentist-patient relationship? There are potential dangers and complications associated with knowledge you might gain from the patients’ personal pages. What if you learn they abuse drugs or alcohol? What if you learn teens are smoking or engaging in other behaviors they deny or that their parents might not know about?

In Section 2, the principle Nonmaleficence (“do no harm”) explains, “The dentist has a duty to refrain from harming the patient.”1 Furthermore, the principle “expresses the concept that professionals have a duty to protect the patient from harm.”1 Under this principle, the dentist’s primary obligation includes doing nothing that is harmful to the patient. It seems wise to be aware that getting too involved in patients’ personal business offers more chances for harm than it does for any benefit.

Section 2.G, Personal Relationships With Patients, explains, “Dentists should avoid interpersonal relationships that could impair their professional judgment or risk the possibility of exploiting the confidence placed in them by a patient.”1 This section certainly seems to apply here. A personal connection on social media seems ripe for any number of hazards that this section is designed to protect against.

In Section 5, the principle Veracity (“truthfulness”) states that “The dentist has a duty to communicate truthfully.” The section explains,

This principle expresses the concept that professionals have a duty to be honest and trustworthy in their dealings with people. Under this principle, the dentist’s primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity.1

As we work to preserve the trust and integrity of the profession in the eyes of the public, it does not seem helpful to offer simultaneously online material that conceivably could undermine that same trust and integrity. Postings that are visible to our patients that may seem appropriate in a social setting are often inappropriate in a professional relationship.

Finally, Section 5.F.6, Websites and Search Engine Optimization, seems to be a summary of this issue in that it states, “Many dentists employ an Internet web site to announce their practices, introduce viewers to the professionals and staff in the office, describe practice philosophies and impart oral health care information to the public.”1 Although this is not unethical, “Dentists have an ethical obligation to ensure that their web sites, like their other professional announcements, are truthful and do not present information in a manner that is false and misleading in a material respect.”1

The bottom line is that your online sites and actions should comport with the ADA Code and its important guidance for behaving ethically and professionally.

In the old days, it was easier to separate a professional relationship from a personal one. The boundaries were clearer and easier to maintain. Caution should be the watchword, and, if in doubt, err on the side of being the “professional” and not the “friend.”

When patients entered into a dentist-patient relationship, they did not automatically agree to a personal relationship or to be your “friend.” There can be a feeling of undue pressure from them to accept your friend request because of your position of authority in the relationship. You should also be cautious about accepting any friend request initiated by the patients.

Be extremely careful about what you post and share. Much like negative reviews posted online, the information is there to stay whether you like it or not.

This article, written by Dr. Tom Howley, originally appeared in the June 2019 issue of the Journal of the American Dental Association. Dr. Howley is retired from practicing general dentistry in North Wales, PA, and is a member of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs.

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