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Ethical considerations of clinical photography in an area of emerging technology and smartphones
  1. Rhys Van der Rijt,
  2. Stuart Hoffman
  1. St Vincent Hospital, Sydney, New South Wales, Australia
  1. Correspondence to Dr Rhys Van der Rijt, 390 Victoria Street, Darlinghurst, NSW 2010, Australia; rvdr15{at}gmail.com

Abstract

Recent advances in digital technology including internet, email and smartphones has revolutionised clinical photography and medical record data storage. The use of smartphones is becoming ubiquitous among medical professionals and the use of clinical photography has become an integral component of the management of patients in a variety of visually orientated specialties. Although clinical photography has its benefits, with this evolving technology also emerge new ethical, legal and social issues, which clinicians must be aware of.

  • Clinical Ethics
  • Ethics
  • Informed Consent
  • Law
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In many areas of medicine and surgery clinical photography has become an essential component of patient care.1 In recent times the increasing use of evolving technology has lead to the widespread use of clinical photographs as a communication tool for patient management. Although clinical photography has its undoubted benefits, with this evolving technology also emerge new ethical, legal and social issues, which clinicians must be aware of.

Recent advances in digital technology including internet, email and smartphones has revolutionised clinical photography and the potential for rapid transmission of data, and medical record data storage. The use of smartphones is becoming ubiquitous among medical professionals and the use of clinical photography has become an integral component of the management of patients in a variety of visually orientated specialties, including dermatology,1 orthopaedics,2 neurosurgery3 and ophthalmology4 among others.

Clinical photography is widely used to convey an immediate visual assessment of pathology or injury. It is also used to document changes over time of evolving pathology or a healing process. Clinical photography aids the clinician in making a timely diagnosis and is essential as a communication tool when distance is an issue.

In many circumstances clinical photographs may be the most accurate tool in medical record taking as photographs can often portray things that words cannot. While there may be many reasons not to take clinical photographs, keeping accurate medical records is a cornerstone of good medical practice. In many aspects of surgery it is useful to prevent unnecessary dressing changes that are costly and may have detrimental consequences to the patients’ physical and psychological health. Furthermore, clinical photography is frequently used as a teaching tool and for research purposes.

As a clinician, the patient's interest is of utmost importance. The clinician's obligations to respect the patient's rights of autonomy and confidentiality must be balanced against the benefits of clinical photography in each case. Patients may be indifferent to the use of clinical photography while being cared for, however, frequently patients may feel uncomfortable being photographed particularly when it involves the face or other specific body parts.

The rapid increase in available devices to take photographs and the growing complexities of storage devices along with an exponential increase in social networking sites has lead to an increasing concern from some patients regarding the possible unlawful distribution of images outside the realms of their care.5

On the contrary, a survey conducted by Tominlinson et al on 140 hand-surgery patients indicated that the vast majority of patients were extremely positive about cameraphone photography as an adjunct to their clinical care. According to the survey 97% of patients agreed or strongly agreed that the use of such imagery could improve communication. No patient disagreed or strongly disagreed with the practice of sending a clinical photograph from the ward or the emergency department to the on-call hand specialist.6

The unscrupulous use of clinical photography may affect the doctor-patient relationship, breach ethical codes of conduct or have legal ramifications for the clinician. In some countries medical indemnity companies have flagged clinical photography as a rising medicolegal risk for clinicians.7 However, unduly enforcing rigid hospital policies and disallowing clinicians to take photographs disrupts an efficient tool for communication and compromises patient care.

There is no blueprint for obtaining consent for clinical photography particularly given that specific laws differ in each state, province or country, if they exist at all. This is further complicated by the wide variety of clinical situations in which clinical photography can be used.

There are, however, several ‘good practice’ points that should be followed.8 It is imperative that consent for clinical photography be carried out in a professional manner before any photographs are taken. Consent should be specific as to what the photo will be used for and whom it will be disclosed to. Consent can be withdrawn at anytime. When taking the photograph, the minimum possible area of the body required should be photographed and all measures should be taken to de-indentify the patient. All images must be stored in a safe environment with controlled access.

Hospital networks should develop clear, written protocols for consent for clinical photography which can aid the clinician in gaining consent, with a signature required to consent for every possible use of the image.9 Suggestions have been made that healthcare professionals have a deficiency of knowledge regarding legal considerations of clinical photography.1 At induction to a new hospital network new clinicians should be educated on hospital protocols and guidelines for taking clinical photographs.

Clinicians should be aware of the relevant health record legislation in the state, territory or country in which they are working. Clinical photographs may, and frequently are, considered part of a medical record and in some countries clinicians may be obligated to keep the photos for up to several years.7 The after care, storage and management of the stored data is best managed by a central unit, such as the medical records or photography department of a hospital. The development of clinical guidelines for safety surrounding electronic records could facilitate this.10

Photos from personal devices should have strict electronic security and should be deleted as soon as possible if they are not used for patient records. Personal devices with cloud storage abilities should have this turned off. Some hospitals are providing specific clinicians with work mobile phones to aid in the security of photographs and to ensure correct storage and disposal.

The increasing use of smartphones and associated technology has lead to the widespread use of clinical photography in patient care. Advances in data storage have lead to opportunities for clinical photographs to be routinely part of medical records. With advances in modern technology emerge new ethical, legal and social issues that the clinician must consider. With correct guidance, clinical photographs can continue to be an extremely useful adjunct to patient care.

References

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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