Social MediaEthical decisions

Background.—Many issues arise when the develop-ments in technology and social media are applied to dentalpractices. The changes faced by dental practices in theseareas must be assessed, keeping in mind dentistry’scommitment to ethical practices.

Ethical Measures.—To make ethical decisions indentistry, a set of principles can be applied. These includethe principles of veracity, beneficience, nonmaleficence,and justice. In addition, the confidentiality of the patient’srecords is paramount. These principles should be honoredand not violated. Decision-making can also be based on autilitarian, value-maximizing approach, with interestsweighed, noting the good and the harm that can accom-pany the choices. Ethical decision-making can result fromthe application of central values for the profession. In thisapproach, higher values trump lower ones. The key centralvalues are (1) the patient’s life and general health, (2) thepatient’s oral health, (3) the patient’s autonomy, (4) thedentist’s preferred practice patterns, (5) esthetic values,and (6) the efficient use of resources. The rank of the valuesindicates which are most important and would trumplower-ranked values.

It is important to maintain a professionalismthroughout the decision-making process. Professionalsare defined by their performance of an important servicefor those who are in vulnerable positions and unable toassess the service by themselves. Patients’ trust in dentistsand what they say and do is a vital component. If dentistsmake decisions to act in a way that patients can trustwhat they say and do, there is no need for government tointervene and regulate the profession.

It is equally important for dentists to appear profes-sional and seem trustworthy. Engaging in a practice thathas the appearance of being misleading or deceptive influ-ences patients’ view of the dentist, even if what he or shedoes is not in itself unethical. Accompanying this percep-tion is the central importance of the dentist’s identity.This question of identity is important when the dentist facesthe choice of participating or not participating in emergingmarketing methods. Decisions that are focused on promot-ing his or her own short- or long-term interests at theexpense of the profession violate the dentist’s professionalidentity. Dental marketing should be distinguished frommarketplace marketing.

Business Concerns.—Dentistry is a business but it isalso more than a business and it is not ordinary. Clear,

irreconcilable differences exist between the competitive dy-namics of commercial enterprises and the cooperativeethics of health care practices. Patients do not generally un-derstand what a dentist is doing in their mouths. They mustbe able to trust dentists, their explanations, and theiradvice. If they cannot trust dentists, they take on the char-acteristics of consumers rather than patients and placethemselves in a competitive arena where they must protectthemselves. Commercial sellers try to create a need in theminds of consumers. Patients in the role of consumersmake marketplace decisions and see dentists as trying tomake a sale rather than giving expert clinical advice. The pa-tient may then shop around for dentists, base their deci-sions purely on price, and distrust what they are told. Toavoid turning dental care into a commodity, dentists mustnot compromise or do things that would lead to a loss oftrust on the part of patients.

Professional advertising is constrained legally to neverassert professional superiority in a public forum, to offerguarantees, or to claim to perform painless dentistry. Anyadvertisement about fees must be accurate and complete,including fees for all necessary procedures and services.Discounts must include specific qualifications for who willqualify for them.

Referrals to other dentists or specialists should bedone only in the best interests of the patient. Legallythere is a ‘‘reasonable duty to refer’’ standard. If a reason-ably careful dentist in the same situation would refer to aspecialist, the patient should be referred. If the patientwas treated with as much skill and care as a reasonablespecialist would perform, no negligence is present. Splitfees and rebates are also prohibited by ethics codes andlegal measures.

Recommendations.—All dentists must recognize theinevitable need to interact with social media and newtechnologies. Both opportunities and dangers must befaced. New graduates and experienced practitionersboth need to engage in these methods, but in a waythat maintains professionalism that is beneficial to boththe patient and the doctor. However, personal relation-ships and word-of-mouth probably always will matter,although their results will not be seen as quickly as withsocial media. Clear guidelines and group pressure willhelp to influence members of organized dentistry tomake good decisions (Fig 1). Dental schools must alsochange their curriculum to embrace cultural changes

Volume 59 � Issue 2 � 2014 e37

Fig 1.—Ethics checklist for engagement with social or digital media in dental practice. (Courtesy of Peltier B, Curley A: The ethics of socialmedia in dental practice: Ethical tools and professional responses. Calif Dent Assoc J 41:507-513, 2013.)

while maintaining a practice environment that adheres toethical and legal requirements.

e3

Clinical Significance.—Digital and socialmedia offer the opportunity to educate patients,develop and enhance certain relationships, andprovide an inexpensive, streamlined way tocommunicate and perform transactions. Profes-

8 Dental Abstracts

sionals must ensure that their presence in thesenew ventures does more good than harm.

Peltier B, Curley A: The ethics of social media in dental practice:Ethical tools and professional responses. Calif Dent Assoc J41:507-513, 2013

Reprints available from B Peltier; e-mail: bpeltier@pacific.edu