Q1: I noticed that Marketing Standard 2(g) includes a ban on testimonials, including before and after photos. What is the rationale for this?
Use of testimonials in practice goes against the Code of Ethics, as it prioritizes the interest of the dietitian over the client’s and creates the following risks:
- selection bias: testimonials are not representative of all clients’ experience and opinion of services received. Dietitians can select which testimonials to publish, which may focus on positive testimonials and leave out less flattering ones.
- professional boundaries not being maintained: clients may feel pressured to agree to leave a positive review to maintain a good therapeutic relationship with the dietitian. Similarly, for before and after photos, clients may feel pressured to give consent to participate to this activity.
- misleading the public: both testimonials and before and after photos can give the false impression that members of the public could achieve the same results as the ones shared in testimonials and before and after pictures.
- breaching client privacy: depending on the amount of information in the testimonial, it could make the client recognizable to others. This is also applicable in the example of before and after photos.
The CDBC has developed a Position Statement on Testimonials. You are encouraged to review it.
Q2: Isn’t banning testimonials giving unregulated nutrition related practitioners an unfair advantage? They can promote each other and accept promotion from the public.
See the rationale in Q11 for background.
Dietitians in BC are regulated health professionals and are held to the same high standards as other health professions governed by the Health Professions Act. There are no standards for unregulated professions with respect to marketing, advertising, standards of care and ethical practice. Therefore, in BC, nutritionists (RHN etc.) and Registered Dietitians cannot be compared equally.
CDBC consulted with the BC Public Advisory Network (BC PAN) on the Testimonial Position Statement and the Social Media Guidelines. The BC PAN advisors are members of the public who have varying levels of experience with the health care system. They represent different demographics in the population, such as gender, age, ethnicity, and geographic location within the province.
The response to the Testimonial Position Statement and Social Media Guidelines was overwhelmingly positive. The group cited a feeling of vulnerability when accessing healthcare, including the sense that they could easily be taken advantage of. This is especially apparent when discussing the imbalance of power in the therapeutic relationship and the fact that testimonials can be seen as inauthentic and one-sided.
Testimonials have historically been discouraged by the CDBC. However, given the move of many regulatory colleges in BC and Canada to prohibit testimonials among regulated health care professions, the CDBC is taking the same stance.
The Board approved the Testimonial Position Statement and the Social Media Guidelines after the public consultation process and the professional consultation process. In short, as a dietitian, you have a responsibility to look out for the best interest of your clients, over your own. Testimonials benefit the practitioner and not the client.
Q3: What should I do with any reviews or testimonials I receive that are unsolicited. If I can’t publish them, how are they of value to me?
It is always great to receive positive feedback or a good review. You are encouraged to save them in your professional portfolio. You may even choose to use them when listing your Learning Activities for CCP goals if they are applicable and have demonstrated a level of interaction (such as in a communication goal) where they demonstrate a new skill or improvement of practice.
Q4: Is it acceptable as a standard practice to ask all clients at the end of service to invite them to share their experience on Google review, without knowing what their feedback will be?
It is true that this method may be perceived as preventing selection bias or “cherry picking” reviews. However, the action of asking clients to write a review increases the risk of blurring professional boundaries by making the client feel pressured to leave a positive review. The purpose of the Testimonial Position Statement is to avoid soliciting a client for a testimonial, even if the client is at the end of their therapeutic relationship with you.
Consider:
- You asked a client whom you thought was ending their therapeutic relationship with you, to provide you with a google review, which the client provided, and then proceeded to continue seeing you in a follow-up appointment. The client is an active client until they leave your office after the last appointment. You are effectively soliciting an existing client for a testimonial, which the Testimonial Position Statement’s development is attempting to avoid. If a current or former client wants to leave you a review, it should be with their own intention.
- If you have a less than ideal interaction with a client and determine that they are unlikely to come back to you, how certain are you that you will ask for a review, knowing that the likelihood of a bad review is high?
The bottom line is to avoid soliciting client, past or current, for testimonials. The intention to leave a review needs to come from clients themselves. In addition to the wording in the Testimonial Position Statement, Social Media Guideline 4j is worded well, with the use of “unsolicited” reviews being permitted.