Debbie Herbst, dentolegal adviser at the DDU, discusses how to manage inappropriate patient behaviour and avoid blurring the lines with patient relationships.
Maintaining patient boundaries is one of the most sensitive ethical issues a dentist can face. The COVID-19 pandemic has resulted in increased use of remote and online technology used to communicate with patients.
While most people are familiar with using this technology to communicate with family and friends, it is important to remember a key rule. In communicating in such a way with patients, appropriate ethical and professional standards must be maintained. So how can dentists maintain boundaries with their patients?
How to manage inappropriate behaviour from a patient
In its guidance Standards for the dental team (2013), the GDC states that dentists should ‘Make sure your personal behaviour maintains patients’ confidence in you and the dental profession’ (Principle 9). The GDC also asserts that patients expect:
- That all members of the dental team will maintain appropriate personal and professional behaviour
- That they can trust and have confidence in you as a dental professional
- That they can trust and have confidence in the dental profession.
Boundaries within patient relationships
It is inappropriate to pursue a sexual or close emotional relationship with a patient or someone close to them. It’s important to be alert to signs that the dentist-patient professional boundary is becoming blurred for a patient. This could include flirtatious direct messages, texts or calls; invitations to meet socially on platforms such as Zoom or sending gifts.
Principle 9.1.4 of Standards for the dental team states that ‘You must maintain appropriate boundaries in the relationships you have with patients. You must not take advantage of your position as a dental professional in your relationships with patients.’
So if you’re concerned about the patient’s motives, don’t ignore inappropriate behaviour or accept gifts. It could be taken as encouragement. Explain that you expect the relationship to remain at a professional level. If this is not possible, that you may have to transfer their care to another dental professional. Seek advice from the DDU or your dental defence organisation if you’re unsure about what to say or if the patient doesn’t seem to have heeded your request.
Keep a record of the conversation and follow it up in writing. Also, keep a log of all contact from the patient. If the patient continues to behave inappropriately, seek out advice on how to proceed. This could be helpful if you were ever asked to justify your decision to remove them, or in the event of a future complaint.
Keeping safe
In very rare circumstances, a patient’s behaviour may threaten your safety or that of others. In this situation, you should contact the police, making sure you obtain an incident number. However, you should not disclose confidential information about the patient without their consent.
Only unless this could be justified as being in the public interest. It is advisable to contact the DDU or your dental defence organisation if you have concerns.
Boundaries when using social media
Social media can be an effective tool for communicating with other dental professionals online. However, it is important to follow the GDC’s guidance in this regard.
Principle 4.2.3 of Standards for the dental team explains that: ‘You must not post any information or comments about patients on social networking or blogging sites. If you use professional social media to discuss anonymised cases for the purpose of discussing best practice you must be careful that the patient or patients cannot be identified.’
Social media can also be a platform on which professional boundaries may become blurred. The nature of the relationship between a dentist and a patient compromised.
Below are some practical tips to prevent the blurring of boundaries on social media:
- Don’t accept friend requests from patients
- Don’t discuss dental care and treatment with patients via social media
- Avoid sharing sensitive personal information online
- Regularly review the privacy settings for each of your social media profiles.
Reporting inappropriate behaviour by colleagues
It is important that dentists maintain appropriate boundaries with patients and to raise any concerns where a patient may be at risk.
When reporting concerns you should respect patient confidentiality and, if necessary, seek the patient’s consent to disclose relevant information. If consent is withheld, you can make a disclosure if it is in the public interest but you must inform the patient.
Principle 8.1.1 of Standards for the dental team states that ‘You must raise any concern that patients might be at risk due to the health, behaviour or professional performance of a colleague [or] someone asking you to do something that you think conflicts with your duties to put patients interests first and act to protect them.’
The GDC continues ‘You must raise a concern even if you are not in a position to control or influence your working environment. Your duty to raise concerns overrides any personal and professional loyalties or concerns you might have.’
Contact the DDU or your dento-defence organisation in the first instance if you have any questions about raising concerns about a colleague.
For more information, visit www.theddu.com, follow the DDU on Twitter @the_ddu or call 0800 374 626.
This article first appeared in Young Dentist magazine. Read more from Young Dentist magazine at magazine.youngdentist.co.uk.
