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Dental Web sites are becoming more and more common, and I think I need to be online to compete in today’s dental marketplace. I’ve been getting advice from so many Web consultants, I’m getting confused. I’ve looked at my state’s dental practice act and the ADA Principles of Ethics and the Code of Professional Conduct, but they often don’t seem to jibe with what these companies are trying to sell me. Help, please!
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You already have figured out that since you, not the Web consultant, are responsible—legally and ethically—for your online Web sites and other advertisements, you need to be actively involved in their design and content. Many Web consultants do not have the necessary background knowledge of the ADA Principles of Ethics and the Code of Professional Conduct,1 and many know little of the state statutes that also govern your ad.
The most important thing you need to remember is that advertising is advertising is advertising, whether it is online, in the telephone book, in the local newspaper, or on radio and TV. Just as importantly, you must remember that the same ethical principles govern all forms of advertising, whether published in print, electronic or other media.
Your state practice act will give you the legal boundaries for your advertising campaign. However, no matter how you advertise, the ethical guide is always truthfulness. The ADA Code says it this way:
Principle 5: Veracity ("truthfulness"). The dentist has a duty to communicate truthfully.
This principle expresses the concept that professionals have a duty to be honest and trustworthy in their dealings with people. Under this principle, the dentist’s primary obligations include respecting the position of trust inherent in the dentist-patient relationship, communicating truthfully and without deception, and maintaining intellectual integrity.
Code Section 5.F. Advertising. Although any dentist may advertise, no dentist shall advertise or solicit patients in any form of communication in a manner that is false or misleading in any material respect.
Statements that are untrue obviously are out of bounds, so most of the time, the real question—as with any other advertisement—is whether the information is "false or misleading in any material respect." The Advisory Opinions of the Code give many examples that are applicable to any advertising location. (You can download the current revision of the Code at "www.ada.org/prof/prac/law/code/index.asp".)
Some issues that might be seen as misleading seem to be more common than others in the Internet ads and Web sites that I have visited. The ADA Code addresses some of these in Section 5.I, General Practitioner Announcement of Services. One is the representation, either express or implied, that the site owner specializes in an area that is not an ADA-recognized specialty. This is not to say that a general practitioner cannot advertise the services he or she offers. The general practitioner also should disclose that he or she is a general dentist, as Advisory Opinion 5.I.1 requires.
Another subject could be the use of unearned and non–health-related degrees, which is addressed in Advisory Opinion 5.I.2. Fellowships that designate association rather than formal academic training may be misleading because of the likelihood that they will indicate to the public attainment of education or skill in the field of dentistry when this is not the case. The same applies if your master’s or doctorate degree is in a nonmedical or nondental field. Again, this is an area in which unsuspecting patients may be misled into thinking they are being treated by a specialist though they are not.
Code Section 5.F.2, Examples of "False or Misleading," addresses another subject of potential concern: claims of superiority. Ad content sometimes is seen that could "c) be intended or be likely to create an unjustified expectation about results the dentist can achieve, [or] d) contain a material, objective representation, whether express or implied, that the advertised services are superior in quality to those of other dentists, if that representation is not subject to reasonable substantiation."
One other concern, aside from those related to advertising, that could arise in Web-based applications is addressed in ADA Code section 1.B.2, Confidentiality of Patient Records. If you accept appointments online through your server or can access your practice software from a remote computer, you need to be careful to have adequate safeguards in place to protect your patients’ information from hackers.
You are right in being concerned about both the legal and the ethical ramifications of your Internet involvement. Advertising is advertising, no matter the place, and one of the hallmarks of a profession is self-regulation. Web sites may be the wave of the future, but I doubt they ever will take the place of a good recommendation from a satisfied patient.
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