I am a relative newcomer to the Facebook universe and, as such, I am having one of those “lifetime learning” experiences as I negotiate my way around the world of social networking. It would be an understatement to say I am overwhelmed. But as a dentist who has practiced for 40 years without incident, I enter into all new practice-altering relationships with a healthy dose of attention to risk. For today’s discussion, let's consider the hypothetical case of Dr. Mario, a dentist completely conversant with social networks and who, in order to protect himself appropriately, must ask himself the following questions:   

Question: What are the risks of staff members and patients becoming Facebook friends?  

Let's start with a case that I often share as a cautionary tale. It begins with a young dentist who bought a practice that included a patient who was in the midst of an extensive implant treatment plan. During the treatment plan, a chance meeting between the dentist's receptionist and the patient occurred in a social setting. This chance meeting, and the inappropriate health-related conversation which ensued, resulted in issues that culminated in a lawsuit with allegations of negligence.

If we fast forward to today's social scene, the same type of accidental meeting could still occur within the context of electronic social networking. Not only could such a meeting occur, but in the course of posting on a respective wall, a patient and a staff member might even discuss care-related issues such as potential treatment problems, fees, shared clinical experiences, complaints, or other comments that could potentially harm the practice. 

As a preventive measure against this kind of risk, it might be helpful to develop a social networking policy and to have employees sign a confidentiality agreement that specifies the kinds of information that may and may not be exchanged with patients outside the formal interactions of the office. This type of agreement should be written by an attorney and it should address the actions of employees, as well as the behaviors of former employees, regardless of whether they have left the practice of their own volition or their employment has been terminated. 

Question: What if I receive ‘friend requests’ from my patients on Facebook? 

I have been solicited for friendship by a few patients and friends of patients. Do I want to enter into anything less than a doctor-patient relationship with these folks? Is anything posted on a social networking site admissible in a court of law? Given that this is an evolving area of legal debate, it would be wise for anyone using social networking sites to assume that they are never private and that anything posted on them has the potential to be accessed by individuals who may have a dangerous agenda.  Thus, I am extremely careful about what I say and to whom I say it in a public forum such as Facebook, Twitter, MySpace, etc.

Would I advise you to do the same? Absolutely! Quite frankly, I see nothing but landmines for professionals who are careless with their personal and professional postings. Even a very innocent activity or comment can be taken out of context. Do you want one of your friends to post a picture of you at a party? Perhaps with an alcoholic beverage in hand? How about in a gambling casino?

A suitable alternative may be to create a professional page for the practice. This way, you do not need to outright reject a “friend,” but rather suggest that the potential friend visit your business page instead. Note too that THE NEXT DDS, which enables access only to validated dental students, may provide an option for professional exchange that is out of the public domain. However, having chosen either option does not, in any way, diminish the need to be vigilant about what is posted on both your personal or professional page.   

Question: What if staff members use the Internet and social networking sites to post information and pictures that involve office activities, staff, and doctors?  

There should be concern about possible revelations on a social networking site--including trade secrets, questionable office practices, patient care, the social shortcomings of the doctors, vacation schedules indicating when the office is empty, and more. For example, doctors and staff might be enthusiastic about posting pictures and activities from a continuing education trip to Hawaii. The intention of the post may be to indicate that the staff and doctor are zealous about staying current with new science and clinical skills. The post may even go a step further to announce to readers that they are now able to offer their patients a new procedure. It sounds very exciting, but remember how I said earlier that postings can often be misconstrued. The post might instead suggest to patients and prospective patients that the doctor is inexperienced in that modality, and thereby question the doctor's competence. The post may also give readers the impression that a practitioner who can afford a Hawaiian trip probably charges higher rates than other dentists. 

As a preventative measure against this kind of risk, it might be helpful to have a clearly-defined policy for all employees that restricts posting information and pictures about office activities on social networking sites and specifies the consequences for posting such information. In addition, if the office has its own business site, all items posted should be approved by the doctor or another individual who understands the risks involved.  

Risk Management Summary 

It is important that users of social media remain aware of issues such as good manners, safe behavior, and security. Because new protocols are still emerging, healthcare professional must be vigilant against aberrant behaviors that may include:

• Young people sending inappropriate photos or messages in social networks that may cause embarrassment and hamper their future careers.
• Employees of healthcare organizations taking inappropriate photos of patients (whose privacy is protected by ethical constraints as well as by federal regulations). These actions open the employees for job loss, professional disciplinary actions, federal fines, and, depending on the actions and motives, criminal charges.
• Professionals becoming tangled in a swirl of social "gossip" and then finding it difficult to extricate themselves when the actions of the group are unwelcome or inappropriate.
• Doctors and staff members who are lax in the way they manage their personal communications while on the job--or while communicating away from the office--may unintentionally allow non-employees a glimpse of protected information relative to the doctors, other members of the healthcare team, other providers, patients or former patients and families, or other clinically focused transactions.
• Employers, many university and graduate programs, law enforcement, and security monitors represent just a small sampling of observers of social network communication that may harm the senders, the individuals they "chat" about, and those who are part of the senders' networks. Sadly, those who have less-than-honorable intentions may also threaten the safety and security of networking individuals who are too casual in the amount of personal information they share about themselves, their colleagues, friends, or patients. 

Until the processes for social networking and instant electronic communication (e.g., Facebook, Twitter, SMS messages and photos) provide sound guidelines for good behavior, doctors and future caregivers must be vigilant about protecting the reputations of their practices and their employees, as well as the privacy and security of their patients' and employees' personal information.

Human Resources policies and procedures should address this subject from the perspective of 1) Employees' rights (not to be gossiped about, for example) as well as professional obligations (to protect patients); 2) Patients' rights to privacy and security, 3) The doctors' ethical and legal duties and boundaries, and 4) Compliance with federal, state, and professional guidelines. Clinicians can prevent inappropriate use of social networking and electronic media by setting an example of restraint in the use of these technologies and by requiring policy compliance by anyone associated with the practice, including part-time or temporary employees.