becomes more complex, especially when money has already changed hands. Dentists may feel pressure to perform the procedure to appease the patient or to increase practice income. In such cases, dentists are not serving the best interests of the patients. Several states, such as Illinois and California, have recently issued regulations enabling healthcare providers to use social coupons without violating ethical obligations. Some of the stipulations that must be satisfied in order to be able to advertise dental services through a social coupon include incorporating into the advertisement a description of the discounted price in comparison to the actual cost of the service, disclosing that not all purchasers may be eligible for the advertised service and Dual relationships and digital communication One of the major ethical pitfalls of digital communication between the dental provider and patient is the problem of “dual relationships.” Dual relationships are not just a problem of the electronic age, but the electronic age has made it easier for them to occur. Dual relationships in dental practice happen when a dental professional enters into or is inherently involved in a second, nonprofessional relationship with a patient be it friendship, business associate, family member or sexual partner (Haddad and Purtilo, 2019). An example of this is when a dentist or dental hygienist provides dental care to a friend or family member. The dual relationship exists because the person is both a patient on a professional level and a friend or family member on a personal level. Thus, the two relationships exist simultaneously. As stated previously, the professional relationship that occurs between the dental provider and the patient is one based on trust and on the premise that the provider places the patient’s supreme interest before his or her own interests. Conflicts arise in dual relationships when roles become blurred or the provider fails to place the patient’s supreme interest above his or her own interests, either consciously or unconsciously. The following scenario provides an example of a dual relationship: Rebecca is a casual acquaintance of Dr. Hayes. They see each other often at their children’s softball games and occasionally attend the same social events at the homes of mutual friends. Rebecca has a missing tooth and would like it replaced. Dr. Hayes provides treatment options that include a removable partial denture, a fixed bridge, or an implant. When they discuss costs, Dr. Hayes informs Rebecca that the least expensive option is the removable partial denture and the most expensive option is the implant, which is about three times as expensive as the partial denture. The cost of a fixed bridge falls in between, but Rebecca does not want to cut two perfectly good teeth to replace one. Rebecca really wants the removable partial denture because that is all she can comfortably afford right now; however, she chooses the implant because she does not want Dr. Hayes to think she is a cheapskate. She has many more softball games to attend in the near future. As a result, she is paying considerably more money for a procedure she really does not want just to please Dr. Hayes. In this scenario, the final outcome does not honor Rebecca’s supreme interest. Even though Dr. Hayes has provided several Privacy issues The Internet is a very public place. Dental professionals must therefore think before they post. Privacy is another major concern with social media use, both for patients and providers. The strict regulations of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 protect patients’ personal health information. According to the HHS (n.d.b): The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; the HIPAA Breach Notification Rule, which
that professional consultation will be required to determine appropriate care, and providing a full refund if the purchaser is not a candidate for the purchased service or does not claim the service (California Dental Association, 2016). Referring back to the commercial versus care model patients cannot fairly compete in the marketplace (Prasad, et al., 2019). They trust their dental professionals to be honest in business. Advertising online can be a worthwhile endeavor and, some may argue, a necessity these days. However, dental providers should consult the ADA Code and their state dental association to ensure ethical and legal compliance before deciding to use social coupons to promote a dental practice or when engaging in a new marketing endeavor that involves the latest trend. options and Rebecca has made the decision on her own, the dual relationship of patient and acquaintance influenced her choice. This is just one example. Dentists and patients in dual relationships may also encounter problems with the disclosure of sensitive medical information and the ability of the dentist to remaining objective about the development of treatment options for their patient can be compromised (Haddad and Purtilo, 2019). Because patients in such hybrid relationships are being asked to disclose information to both their dentist and friend (or family member), they might not be willing to tell the truth about their condition. If a patient has a serious medical condition or takes a medication that could affect dental treatment and he or she does not disclose the information, both the patient’s health and the dental provider’s ability to practice safe dentistry are jeopardized. Conversely, if a provider learns sensitive information from a friend while the friend is in the patient role, information obtained in one role may not be ethically usable in the other role. Role conflicts blur the burden of responsibilities within each role. For example, suppose a patient or friend tells a dentist that he is HIV-positive but in the next breath admits that he has not yet told his wife. His wife is also the dentist’s friend. This is an awkward situation and a very difficult dilemma to solve. Digital communication has exponentially increased the potential for dual relationships between patients and professionals of all types. Social media websites such as Facebook, Instagram, and Twitter are great communication and marketing tools but inherently create dual relationships the moment a provider and patient connect in that way . Dental providers who choose to engage in these activities should be mindful to respect the boundaries of the professional-patient relationship in accordance with professional ethical codes and guidelines to the greatest extent possible. These boundaries promote a safe space where patients can trust, respect and feel confident about their dental health provider and the care that they are receiving. Online communication can blur the distinction between the dental provider’s professional and personal life. Providers should be particularly careful about giving dental advice to people online. If they do so, they may create a cyber-dental professional- patient relationship they never intended. A “friend” request received from a patient can create a challenging situation. It has been suggested that dental providers keep their personal and professional content separate (Howley, 2019). requires covered entities and business associates to provide notification following a breach of unsecured protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety. Also to be considered is the ethical obligation under dental professional codes to maintain patient confidentiality. Both the ADA Code (Section 1.B.2, Confidentiality of Patient Records) and the ADHA Code (Section 6, Core Values) address privacy
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