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Social Media Revisited by Donald E. Machen, DMD, MSD, MD, JD, MBA, CFA and Hollie A. Machen, Esq.

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Several recent highly publicized and potentially problematic instances of negative comments using social media illustrate the importance of a sound, systematic approach to this critical area of professional practice. In addition, they highlight the significant value of improved interpersonal relationships integrated with a practice style and philosophy, and meaningful communication.

In an earlier issue of Orthotown, I wrote at length about how social media has become a potential benefit to healthcare practitioners, including dentists. These benefits include personalized marketing, better communication and enhanced public relations. In the same article, however, I mentioned that with these benefits come the potential for devastatingly negative patient/parent comments and the possibility for a widespread, and almost viral reach. Finally, in that article, I suggested to the reader some of the mechanisms that might be used in the event that negative postings or comments were made, focusing mainly on defamatory comments posted by individuals.

Recently, in California, a situation arose that could have a dire effect on a pediatric dental practice. Although the treatments offered by orthodontists are not the same as those provided by pediatric dentists, it should be apparent that the specific treatment provided by the health-care practitioner is far less relevant than the underlying theme of patient/parent dissatisfaction in whether negative comments are made, posted, e-mailed, etc.

With regard to the recent California case, various sources, including News Channel have recounted the following, as described by Donna Domino, features editor of Dental Practice Management:

    Chris Cook of Bakersfield, California, created the “I Hate Dr. Edward Dove of Bakersfield” page last week, claiming that pediatric dentist Edward Dove, DDS, extracted his five-yearold son’s tooth on August 22 without anesthesia. Cook also claims his son vomited, screamed and urinated on himself while being held down by several assistants during the procedure. The page, which attracted more than 200 members in its first 48 hours, illustrates the power of social media and its potential to do harm as well as good.

    The dispute underscores how quickly consumers can mobilize online and the growing impact of such sites on dentists’ reputations. It also shows how powerless dentists and other professionals can be in responding to online complaints. “I think my reputation will be hurt a little bit, but right now I just want to calm down,” Dr. Dove said. “This guy is going ballistic, he’s trying to smear me, and I’m getting bullied.”

Numerous other news sources and Web sites have reported the scenario in a similar fashion, including some that have other parents of patients complaining about the same type of conduct by Dr. Dove. A few reports have favorable comments from parents about how well their children were treated. Television news programs have reported in two-minute segments mostly negative parent recounts including the video of picketing in front of the pediatric dentist’s office. In the video, parents expressed their intention to report Dr. Dove to the California Dental Board and about their desire to try to have his license suspended or revoked.

As with criminal charges made against health-care providers, such as sexual assault allegations by patients, once the publicity starts, many other people tend to come forward with similar allegations, founded or unfounded. This occurs for many reasons including the possibility of civil damages and monetary gains.

Although Dr. Dove believes that the damage is and perhaps will continue to be minimal, this is not always the case. On several occasions, practitioners have been falsely accused of various issues and the negative publicity storm that later occurred has cost them hundreds of thousands of dollars of lost income, practice value, legal fees, health issues from stress and on more than one occasion, they have had to close their practices.

Although there are many ways to both avoid and, if necessary, manage social media problems, based upon my legal and consulting experience with health-care practitioners, the following recommendations are offered for your consideration. Please note that this is a basic approach and is not meant to be inclusive of all possible methods. In addition, each practitioner must be comfortable with the style of his or her practice and all procedures and protocols and should not implement anything that does not fit well with that style.

First, each practitioner needs to decide what his or her own individual practice philosophy will be. It is preferable to make this decision before seeing patients, but it is better late than never. In the current and likely, the future world in which we live, more and more transparency will be required. This is true at all levels of our lives and especially true for health care. Patients/parents are entitled to make all decisions about their care. However, they are also entitled to all the information that is material to their care before being asked to make those decisions.

As with the situation mentioned above, pediatric dentists as well as orthodontists need to decide whether to allow parents to be present during treatment. They must also understand informed consent and its extent, both for legal reasons and for sensible public relations. This means that if a parent is to be allowed into the operatory for treatment, explaining to the patient and parents what to expect. However, if parents are not allowed into the treatment area, managing expectations becomes even more important. So, it starts with developing realistic expectations for the treatment methodology and the results to be expected. Sometimes showing photographs or a brief movie is all that is needed. However you choose to communicate with the patient/parents, everyone needs to be on the same page.

Along with transparency, as I have written in another prior Orthotown article, the most successful practices have leaders who demonstrate sincere humility. Humility, in contrast to arrogance, permits the practitioner to make wise and sensible decisions when potential adverse issues arise, as they will in all practices. They key factor though, is that relationships are far more easily created and maintained when the health-care practitioner has developed a positive relationship with the patient and/or parents, founded on transparency with open and regular communication and humility. During stressful situations, good relationships might be strained to some degree, but they generally will fare much better than those of lesser quality or those that are artificial or formal based upon position rather than mutual respect.

Open and transparent communication permits a two-way dialogue, which in many instances will facilitate concerns or complaints being expressed directly to the health-care provider. This is clearly preferable, precluding the type of social media nightmare that can occur when either the patient/parents are rebuffed or if the health-care provider relationship is non-existent and social media expression is sought in the first place.

Mea culpa. Why is it that people have such a hard time taking responsibility for their actions? That’s a rhetorical question. We just do. However, many malpractice cases would either have never been filed or would have been discontinued by the plaintiff if the health-care practitioner had said that he or she was sorry. Some of you might say, well isn’t that admitting that you were wrong? Not always. Acknowledging the situation or problem, and saying you are sorry (in a heartfelt manner) that the treatment didn’t work out or that the injury occurred isn’t the same as stating that you were negligent. It is demonstrating human compassion and humility, as opposed to arrogance. You will likely get at least one chance, and maybe more, to do so before the proverbial stuff hits the fan. Doing so will almost assuredly allow you to maintain the relationship or at least move on without the repercussions discussed above. Think about it and see what causes people to fail to do so.

In my prior article, I outlined numerous steps to take after an event of adverse comments and social media postings. These were offered as tactical solutions once the postings occur. In this article, we are laying the groundwork for avoiding such problems from occurring in the first place and giving some insight into the potential pitfalls that might be incurred with their use.

A recent instance of using a lawsuit for defamation against the parents of a patient and Yelp.com regarding negative reviews is illustrated in the following case. In another California case, Dr. Yvonne Wong of San Francisco apparently incurred the scorn of the parents of one of her patients. A main issue in the case is reported to be whether the review “stepped over the line from discussing a topic of public interest to defamation.” According to Ms. Domino of the Webbased Dental Practice Management:

    Dr. Wong appears to have won the initial court proceeding when the trial judge ruled that the case had sufficient merit to be tried. However, on appeal, the higher court found that consumers could post reviews of businesses on Web sites such as Yelp.com because they contribute to public discussion about controversial issues.
    Further, the appellate court found that the Web site was protected under California’s anti-SLAPP law, which preserves the right to speak out on public issues.
    The dentist had to pay various legal fees in the amount of $80,000, reduced from $113,620 to Yelp and the parents. Dr. Wong filed the defamation lawsuit against them after they made comments implying that she hadn’t informed the patient’s parents about the alternatives to amalgam restorations and for the use of nitrous oxide, as well as for allegedly failing to detect various carious lesions.
    The defamation actions against Yelp.com and the patient’s mother were dismissed but the suit against the father is still pending. Dr. Wong’s attorney believes that she will prevail at trial.

In this case, I would note that the expense and stress, not to mention the uncertainty and loss of production and productivity is difficult to fully appreciate or access.

The case has already been appealed and the appellate court seems to have agreed at least to this point. Many issues are at play in this action, however, some important takeaways are:

  • It might not matter that you are correct in your treatment, misunderstandings can still occur.
  • Careful, thorough, sincere and well-documented informed consent and transparent procedures and protocols can prevent these potential problems.
  • Good relationships will always give you an opportunity to cure the problem (mea culpa) before it reaches the point of no return.
  • Careful evaluation of your potential action choices, along with the possible responses and their probabilities and ramifications (reference to a lawsuit for defamation), is key to making sure that you don’t make a bad situation worse.
  • In the event that a situation appears to be escalating, in spite of a previous excellent relationship, good informed consent, a humble attitude, etc., it might be advisable to bring in the experts, including experienced consultants and public relations advisors.

There are many other aspects to the social media opportunity and as with learning other new areas and with continuing education, it never hurts to seek advice from experienced practitioners. The minimal cost and time that you will invest is far better than the potential disaster awaiting those who do not.

Reputation protection, preferably prior to (or contemporaneous with) such problems, can be helpful. There are several companies that work for health-care practitioners in guarding reputation attacks. Some of these are: Protection.com, Metamend.com, ReputationObserver.com and Smile Reminder.

If you believe, as some professionals do, that you can weather the storm similar to the cases described, understand that the likelihood or probability is low that you will do so. The more common scenario is that the negative publicity will be devastating! Further, defamation litigation, whether involving slander or libel, is very unpredictable and such cases are difficult to prove and damage recovery is not likely. Lawyers generally do not take them on a contingency fee basis so the health-care provider needs to fund the litigation himself, up front. These actions can be very expensive ranging into hundreds of thousands of dollars. Be careful. As you saw, it is possible that the doctor might be required to pay for the legal fees of the defendant and other assessments could be made. Some lawsuits are “throwing good money after bad.”

One final comment involves the use of “agreements to keep private or confidential” or “mutual agreement of confidentiality.” As you know, the health-care provider already has the duty of confidentiality. There are some exceptions, one of which is in court and some court filings. Legal counsel can fully discuss this with you. However, there is no exception permitting the discussion of confidential patient matters with the media or via social media, notwithstanding what the patient chooses to say and to whom. The patient owns the privilege and, unless specifically accepted, the health-care provider might not disclose any patient-related information. Furthermore, even asking a patient/parent to sign one of these agreements might likely send red flags waving and might even cost you to lose the patient and any referrals that they could recommend. It might even initiate negative comments about you concerning the requested agreement or other aspects of the practice, which is what you were trying to avoid. Be careful and think about any anticipated strategy before implementing it. This would be another topic to include for discussion with your expert advisors.

Finally, please understand that there are no winners when negative patient comments and social media postings occur. Damage control can be effective when managed properly. The strategy recommended is prevention by avoiding these situations in the first instance. The material presented can go far toward getting you started in implementing the procedures and protocols needed to do so.
Author’s Bio
Donald E. Machen, DMD, MSD, MD, JD, MBA, CFA, is the recognized authority on risk management in orthodontic practice having initiated the discipline in the mid-1980s. He developed, moderated and presented at the AAO’s first national risk management telecast to more than 2,600 orthodontists. He has represented orthodontists, dental specialists, general dentists and physicians in malpractice lawsuits and other legal matters as a trial lawyer and currently is a trial court judge in Pennsylvania, having served for more than 14 years. He is a board certified orthodontist maintaining a part-time practice and is on the orthodontic faculty of Case Western University Dental School and The University of Pittsburgh School of Dental Medicine. He is also an adjunct professor of Law at Duquesne University School of Law where he teaches malpractice litigation. Dr. Machen was the editor of the Legal Aspects of Orthodontic Practice column in the AJO, writing a monthly column and has authored columns in JCO and Ortho Tribune. He lectures extensively to orthodontic groups, both large and small, focusing on developing highly effective systems for eliminating lawsuits, optimizing patient care and increasing practice referrals. Dr. Machen is the author of Managing Risk in Orthodontic Practice and is managing director of Risk Management Consultants, LLC. He can be contacted at: drmachen@orthormc.com.

Hollie A. Bernstein Machen, Esq. – After graduating from the University of Pittsburgh School of Law, Hollie spent the early part of her legal career as a litigation associate and then partner of the Bernstein Law Firm, a multi-office firm specializing in creditors’ rights. After leaving that firm to raise her three children, Daniel, Lindsey and Roxanne, she began focusing on legal research and writing as a judicial law clerk in Pennsylvania and has remained active in that endeavor for more than 13 years. Additionally, she spent more than five years counseling clients on financial issues as a wealth management advisor at PNC Bank and National City Bank, earning various designations in the financial services profession including that of Certified Retirement Planning Counselor. Presently, in addition to working with clients at Risk Management Consultants, she spends time teaching online legal research skills to attorneys and judges as a research specialist for Westlaw and acts as practice manager for Dr. Machen’s part-time orthodontic practice.

Additional important material on managing risk in all aspects of orthodontic practice can also be found in his book, Managing Risk in Orthodontic Practice and details about receiving a copy can be found at www.orthormc.com.
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October 2025
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