What are the ethical considerations of using video social media platforms such as TikTok in your dental practice?

Abstract

Q: Some of my colleagues are using social media platforms like TikTok to create short videos to appeal to a larger patient population, to build their practice bases, and to educate patients. Some of these videos can be shared in the form of duets whereby other dentists can opine on the post. So, if 1 dentist posts a video of their treatments, a second dentist can repost the video and comment if this feature is enabled by the content creator, giving their “professional” opinion, without the full knowledge of the patient’s dental history, consent, or specific case details. These “TikTok Dentists” are providing generalized treatment recommendations and have no specifics of the patient in question. I do not want to be left behind, but I wonder what the ethical considerations of this social media platform are in the world of modern dentistry. A: Social media video applications offer free and potentially viral forms of communication that appeal to everyone, from Generation Z to baby boomers. In addition to reaching new audiences with generalized and viral video content, this form of communication also allows users to duet other content creators’ videos and share their own opinions or advice on the topic. When videos on platforms like TikTok are liked or viewed, the platform’s algorithm fills the user’s feed with similar videos based on the topics with which they have interacted.1Hermann J. How TikTok is rewriting the world. New York Times. March 10, 2019. Accessed September 8, 2021. https://www.nytimes.com/2019/03/10/style/what-is-tik-tok.htmlGoogle Scholar For example, if you are an avid reader and watch videos about book reviews, you will be targeted with content created by creators who also love books. Some users dub these genres as BookTok, DentalTok, and so on, depending on the topic of videos viewed regularly. Social media is used widely among both patients and providers. TikTok, in particular, seems to be gaining momentum and, like other forms of social media use, presents both risks and opportunities. In recognition of that, consideration of some of the ethical parameters of dentists using TikTok are worthy of consideration. The Introduction to the American Dental Association Principles of Ethics and Code of Professional Conduct (ADA Code) states that “the profession makes a commitment to society that its members will adhere to high ethical standards of conduct.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar Furthermore, the Preamble to the ADA Code states that “dentists should possess … traits of character that foster adherence to ethical principles. Qualities of honesty, compassion, kindness, integrity, fairness … help to define the true professional.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar Although these sections were developed long before the advent of TikTok and other social media applications, the message they convey is still applicable and relevant. The ADA Code Section 1 addresses Patient Autonomy (“self-governance”), including the patient’s privacy and confidentiality of their information. “The dentist has a duty to respect the patient’s rights to self-determination and confidentiality.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar Dental care professionals who post videos that are meant to influence and educate patients about particular treatments without knowing the patient's history or specific information about the patient may be unduly influencing patients in their decision making and therefore interfering with true self-determination. Care also must be taken to protect the confidentiality of patients when using a case history or patient’s images in these videos. In fact, in sharing this information, the dentist must be aware of not only potential ethical implications but legal implications as well, including applicability of the Health Insurance Portability and Accountability Act3Health Insurance Portability and Accountability Act, 42 USC § 201 et seq. (42 U.S.C. 1320d-2) (1996).Google Scholar and any relevant state laws regarding patient privacy. Furthermore, Section 2 of the ADA Code, Nonmaleficence (“do no harm”), states, “The dentist has a duty to refrain from harming the patient.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar Specifically, Section 2.G., Personal Relationships With Patients, may apply when a dentist posts a video that includes a particular patient. This may “risk the possibility of exploiting the confidence placed in them by a patient” if the dental care professional posts videos in instances that could be considered unprofessional or questionable or that might portray the patient in an unfavorable light.2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar Again, the dentist, if using a video regarding a specific patient, must be sure that the patient has provided their informed consent in adherence with the principle of Patient Autonomy. The dentist also must be mindful of not potentially harming other patients. When the information in the video is used in a generalizable way, without sufficient acknowledgment that each patient’s circumstances may differ, it is potentially harmful to other patients. The dentist viewing the TikTok should be mindful that although the material may have some educational benefit to how they might manage a similar situation, what is presented on TikTok is general and should not replace sound professional judgment. Section 3, Beneficence (“do good”), is also applicable. “The dentist has a duty to promote the patient’s welfare.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar This directive may support use of social media platforms if the information is educational. These types of social media platforms could be used to provide a community service such as encouraging dental health, dental education, or overall community service. The ADA Code obligates dentists to “use their skills, knowledge and experience for the improvement of the dental health of the public.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar However, we must always keep in mind that “dentists in such service shall conduct themselves in such a manner as to maintain or elevate the esteem of the profession.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar So, when using a platform like TikTok, the dentist should be careful to be accurate, truthful, and protective of individualized patient information. The principle of Justice (“fairness”) obligates dentists “to treat people fairly.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar This obligation of dentists is not only toward patients but peers and the dental team as well. Section 4.C., Justifiable Criticism, might be applicable in the context of dueting. Any dentist commenting on or responding to the recommendations and work of another dentist should be careful to not disparage another dentist publicly. “Dentists issuing a public statement with respect to the profession shall have a reasonable basis to believe that the comments made are true.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar If critical of the work of another dentist, airing that criticism in a public forum such as TikTok may not be appropriate without first addressing the concern with the dentist in question or, if necessary, discussing with one’s constituent or component society. Finally, Section 5, Veracity, addresses issues related to “truthfulness”: “The dentist has a duty to communicate truthfully.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar Specifically, dentists are responsible for “communicating truthfully and without deception, and maintaining intellectual integrity.”2American Dental Association American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to November 2020.https://www.ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conductDate accessed: September 8, 2021Google Scholar For example, making unsubstantiated recommendations would be considered unethical as would any type of advertising or marketing that is false or misleading. Social media platforms are here to stay. They are an effective method of communication for existing and prospective patient engagement. A 2021 article by Zenone and colleagues4Zenone M. Ow N. Barbic S. TikTok and public health: a proposed research agenda.BMJ Global Health. 2021; 6e007648Crossref PubMed Scopus (5) Google Scholar acknowledges that “public health is served by paying urgent attention to the potential health-related implications and opportunities of TikTok” and suggests “a research agenda to inform decision-makers, health providers, researchers and the public.” Dentists should be mindful of these questions. The ethical dentist and, by extension, auxiliary dental staff members must take measures to ensure adherence to the ADA Code in day-to-day practice as well as when engaging in social media in their professional capacity. Although giving generalized oral health care tips may be beneficial to social media users, specific treatment recommendations should be made only once a dentist-patient relationship has been established. In addition, dentists engaging with the social media of another dentist must be sure to avoid unjustifiable criticism of peers, protect patient privacy, and maintain the integrity of the profession as a whole. Dr. Nichols practices general dentistry in Lubbock, TX, and is a member of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs.