Scroll through a dental social media group or search a dental hashtag on a picture sharing app and you will be instantly presented with clinical images accompanied by the phrase 'permission to post'.
But does the clinician really have adequate consent from the patient? Do they have the permission of the practice to use patient information in this way? Are their marketing posts appropriate and mindful of the advertising standards?
This article highlights the important considerations dental professionals should make before marketing dental services online.
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Marketing dental services
The marketing of dental services has evolved dramatically in the age of the internet. Gone are the days where window signs and flyposting were enough to draw in patients, and practices must now engage with a generation who increasingly depend on technology to manage their dental care.
The vast majority of dental practices now have websites, with many using search engine optimisation (SEO) to try and be first in an online search. However, websites are themselves becoming old news, and the next generation of dental professionals are embracing the power of social media.
Practitioners can now target adverts straight into the social feeds of prospective patients using the inbuilt marketing features of the various platforms available. Patients can also actively or passively participate in the marketing of dental services by simply liking or sharing posts. They can even review and recommend practices and services (both positively and negatively).
These sites and apps have also given rise to dental social media influencers. This tech-savvy generation of dentists have started to separate themselves from practice marketing and have set up their own profiles to showcase their work and invite patient enquiries directly.
The benefits of all this instant exposure are vast. But with all this visibility comes significant risk, especially to inexperienced practitioners who do not have a solid grounding in the laws and ethics that apply.
Who is liable?
Whether you're advertising your practice or your own services, you could be liable to sanctions under the laws that govern advertising, data protection or clinical negligence. The professional status of any dental registrant is also at risk if the GDC have cause for concern.
When advertising the services of your practice, it is important to ensure that all marketing material is legal and does not risk the reputation of the business or the professional status of team members.
When considering self-promotion, such as becoming an influencer, you must understand the liabilities you adopt when you separate yourself from practice entities. Much of the law around advertising, data protection and consent can just as easily be applied to an individual as it could be to a business. You must also be mindful of the contracts you have in place with the practices you work in, ensuring you do not breach your terms of employment or associate agreement.
What the GDC says about websites and social media
The GDC has produced a guide to advertising dental services and have provided a check list that features the following key points.
- The GDC gives clear guidance about what information must be included in marketing - such as GDC number and contact details for the practice where the services are provided.
- The GDC is explicit about the use of titles and would take a very dim view of registrants who misrepresent their qualifications or abilities.
- Registrants who fall below the standards expected of them risk their professional status.
Dental professionals have a duty to advertise their services in accordance with standards set by the Advertising Standards Authority (ASA) and Committee of Advertising Practice (CAP).
ASA requirements state that all advertisements must be legal, decent, honest and truthful. They must not mislead, harm or offend. The ASA has the power to remove any advert that they feel is unsuitable and refer persistent offenders who advertise inappropriately to other bodies, such as Trading Standards.
Last year the GDC highlighted an ASA enforcement notice on advertising Botox and other botulinum toxin injections on social media. This is because it is illegal to advertise prescription-only medicines (PoMs).
Furthermore, it makes clear that it is unacceptable to use the term 'anti-wrinkle injections' or anything that might be seen to imply the use of a PoM to achieve aesthetic results. Even very general statements such as 'wrinkle reduction treatments' are at risk of becoming euphemistic and may therefore catch the eye of the ASA.
Much of the law around advertising, data protection and consent can just as easily be applied to an individual as it could be to a business.
In our experience, the majority of patient complaints arise from failures to manage expectations. It is often tempting to use attention-grabbing phrases to draw in business, but the patients who are drawn in by exaggerated claims are often those with the highest expectations.
For example, it would be unwise to make claims such as 'perfect smiles guaranteed,' as perfection is in itself subjective.
- "If you promote your services on marketing or social networking websites…you must make clear that the treatment advertised may not be appropriate for every patient and that it is conditional on a satisfactory assessment being carried out. You must assess the patient, obtain appropriate consent, obtain a medical history and explain all the options before carrying out any work." GDC Guidance on Advertising (2013).
Using patient information
GDPR and the Data Protection Act 2018 both built on the existing law around the handling and storage of confidential patient information. Within any dental practice environment there will usually be one or more individuals registered with the Information Commissioner's Office (ICO) as data controllers.
This role carries significant liability such as severe fines should there be breaches of data protection law. It is therefore likely that most team members will adopt the less vulnerable role of data processors. The DDU has extensive guidance on protecting patient data, including advice on cloud storage.
A written authority, such as a consent form, can be extremely useful in evidencing that dental professionals have gained consent to use patient images for an agreed purpose. The GDC would expect such a patient consent to be very specific, to be obtained by the person or body who will use the material, and to detail what will be used, where, and for what purpose.
- Consent for the use of confidential patient information in marketing material should be contemporaneous and specific.
- Patients need to understand precisely what information is retained, displayed or published, where and when, who will see it and the likely consequences.
- Don't use identifiable patient material unless absolutely necessary, and obtain consent in every instance. Let the patient know that they can withdraw their consent at any time.
Patients should be made aware that once an image is shared online, although the original post can be removed, the clinician loses control over any copies that are made.
Contracts and associate agreements
If you have a professional social media presence separate to that of your practice, it is important to make sure you don't breach any of your contractual obligations.
Some employment contracts and associate agreements contain clauses relating to the appropriate use of social media, mainly in relation to professionalism, but some go so far as to set limitations on personal marketing. Breaches may threaten your position within the practice. Also, contracts often refer to data protection policies, which have strict rules about how patient information is used and stored.
Most internal disputes arise out of differences in interpretation of contractual clauses. It's therefore best to discuss any ambiguities before signing a new agreement. If you would like assistance in decoding the clauses, the DDU has a free contract checking service for members. Principal members have free access to employment law advice.
Recommendations and reviews
As practices and practitioners are increasing visible online, they are increasingly likely to be tagged in recommendations or reviews on social media or review platforms, both positive and negative.
We advise caution and restraint when responding to online criticism. Negative reviews can be something of a hydra - demand one is removed and another three take its place. It might be better to accept the feedback and respond in a professional manner.
Most readers are wise enough to take such comments in the context of the other positive reviews, and will be impressed by a professional response. You can thank the author for highlighting their concerns (without giving away any confidential information) and invite them to contact the practice directly.
Photo credit: iStock
The following examples are fictional, but based on common themes among DDU case files.
- A patient makes a complaint that their tooth whitening treatment hasn't worked. In the complaint letter, they quote text from a practice Facebook post that stated 'guaranteed white teeth in two weeks.'
It's important to make sure patient expectations are carefully managed. You should avoid statements or claims that are intended to or are likely to create an unjustified expectation about the results you can achieve.
In this case the practice offered the patient a full refund as a gesture of good will, apologising to the patient, with a firm commitment to remove the misleading advert.
- An associate dentist has become a social media influencer and has been posting 'before and after' pictures of their cases, using photos they have been taking on their phone in surgery. The practice principal found out some months later and called the DDU advice line for advice on data protection.
Dental professionals who store or process clinical photos on personal devices would be considered data controllers by the ICO, and must register as such. This carries the risk of significant fines if the images are lost or misused.
It's safer to use the practice equipment and follow existing data handling policies, gaining appropriate consent from the patients for use online. The dentist may also have breached the terms of their associate agreement in failing to follow practice policy.
In this case, the practice principal was advised to review the practice data protection policy and bring this to the attention of all team members. They gave specific direction prohibiting the use of personal devices to store or process patient information such as clinical imagery.
- All dental professionals, whether marketing their business or their individual services, should be aware of the applicable law and professional standards.
- In order to use imagery and testimonials, patients need to understand precisely what information is retained, displayed or published, where and when, who will see it and the likely consequences.
- The Advertising Standards Authority could pursue dental professionals who advertise prescription-only medicines such as botulinum toxin online.
- The GDC take a very dim view of professionals who misrepresent their qualifications and are actively pursuing registrants who knowingly use exaggerated or inappropriately use 'specialist' titles.
- Dental professionals are vulnerable to complaints where patient expectations are unmet and should avoid making exaggerated claims about treatment outcomes online.
Members who would like more advice on the dento-legal considerations for online marketing and consent can contact our free advice line on 0800 374626.