eMJA     The Medical Journal of Australia

Home | Issues | eMJA shop | My account | Classifieds | Contact | More... | Topics | Search   

Abstract

Documentation is ideal for comparison before and after surgery, or for monitoring the progress of certain diseases. In gynaecological practice, the documentation of normal findings is particularly useful, especially when investigating pelvic pain.

Image capture is useful for validating the operative procedure. When images are shown at the postoperative visit, the patient has no doubt that the planned procedure has been performed, that all areas under suspicion have been thoroughly inspected and that the appropriate findings have been recorded.

Apart from some historical reports,^1-7 the usefulness and acceptability of intraoperative photography have not been addressed in the current medical literature. We aimed to assess the views of patients, doctors and nurses about intraoperative photographic documentation.

Medical and nursing staff were surveyed by postal questionnaire. Patients were shown their photographs at a postoperative visit and then sent a postal questionnaire one week later. The questionnaire included the questions shown in Box 2, and participants were invited to provide free-text commentary on any related issues.

Informed consent was obtained from all patients for their opinions to be published.

All patients surveyed believed operative images were valuable in helping them understand their disease, or their normal findings, and most specialists, GPs and nurses also believed that operative images assist patients in understanding their condition. Importantly, nearly all patients denied that operative images would create anxiety, and specialists, general practitioners and nurses also felt that they would not cause such a problem. Free-text responses from patients highlighted the option of seeking a second opinion when the initial surgical procedure was well documented photographically.

Our survey showed that all groups surveyed had a positive attitude towards having operative images included in the medical record.

Seventy-eight per cent of general practitioners expressed a desire to receive operative images. It was apparent that GPs found the photographs useful for patient counselling; a considerable number of free-text responses suggested:

• operative imaging is useful as proof of operation and proof of communication;

• operative imaging may be useful in a medicolegal setting; and

• operative imaging is good, but the most important requirement is for comprehensive and timely written communication about a patient's admission.

However, almost half of the nursing staff surveyed thought that general practitioners should not receive photographic images.

There was considerable variation in attitudes towards patients' being given the images to keep in their possession. Almost 90% of patients wanted them, while nearly 70% of general practitioners believed they should not have them. There was some concern among the health professionals about the potential for operative images to lead to medicolegal problems for the surgeon. A number of respondents expressed the belief that operative images would be supportive rather than detrimental in a medicolegal setting.

The fact that many of the nursing staff surveyed thought that general practitioners should not receive photographic images may reflect a poor understanding of the relationship between general practitioners and specialists.

We agree with the comment of a number of GPs that the most important requirement is for comprehensive and timely written communication about a patient's admission, and believe that operative imaging should always be regarded as an adjunct to conventional communication.

Photographic recording of operative procedures is useful as part of routine documentation, and is regarded as valuable by both referring doctors and their patients. Patients, in particular, find photographs useful in the understanding of their disease.

1. Estes JW. To become pregnant. In: Carmichael AG, Ratzan RM, editors. Medicine in literature and art. Köln: Könemann Verlagsgesellschaft GmbH, 1991: 31-33.
2. Estes JW. Surgical problems and solutions. The medical skills of ancient Egypt. Canton, MA: Science History Publications, 1989.
3. McFall K. A notable anniversary in the history of medical illustration. J Audiov Media Med 1997; 20: 5-10.
4. Burns SB. The nude in medical photography: a historical perspective, with modern legal ramifications. J Biol Photogr 1996; 64: 15-26.
5. Nordentoeft S. Uber Endoskopie Geschlossener Cavitaten mittels eines Trokar-Endoskops. Verh Dtsch Ges Chir 1912; 41: 412.
6. Cohen MR, Guterman HS. A pelvic photoscope. Obstet Gynecol 1953; 1: 544.
7. Clyman MJ. A new panduldoscope -- diagnostic, photographic, operative aspects. Obstet Gynecol 1963; 21: 343.

Authors' details

Reprints will not be available from the authors.
Correspondence: Dr G D Reid, Division of Women's and Child Health, Locked Bag 7103, Liverpool BC, NSW 1871.
rejoyceATbigpond.com

©MJA 2001
Make a comment