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Medicine and the community
Operative photography in gynaecological endosurgeryGeoffrey D Reid and Adelyn Leong
MJA 2001; 174: 285-287
Abstract -
Methods -
Results -
Discussion -
References -
Authors' details
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More articles on Surgery
Abstract |
Objectives: To define the attitude of patients,
doctors and nurses to operative photographs captured at
gynaecological endosurgery, and to determine the value of these
photographs in patient education. Design and setting: Postal questionnaire survey of specialists, general practitioners, nurses and patients at a tertiary referral hospital in south-west Sydney. Participants: All patients who underwent endoscopic gynaecological surgery between 1 February and 1 May 1998, and for whom good quality operative photographs were available, and medical and nursing staff randomly selected from lists of practitioners within the Southwest Sydney Area Health Service. Main outcome measures: Opinions on whether operative photodocumentation assists patients in understanding their condition; the value to patients of these records; whether operative photographs assist referring doctors in subsequent management of patients; the use of operative photographs in medical records or as personal records for patients; whether photographs may lead to anxiety or be used in medicolegal action. Results: All patients believed operative images were valuable in helping them understand their condition. 19 of 20 specialists (95%), 85 of 123 general practitioners (69%) and 23 of 28 nursing staff (82%) also believed that operative images assist patients in understanding their disease. Nearly all patients denied that operative images would create anxiety, and specialists, general practitioners and nurses also felt that the photographs would not cause anxiety. 78% of general practitioners expressed a desire to receive operative images. Conclusions: Photographic records of operative procedures are regarded as valuable by both referring doctors and their patients. Patients find photographs useful in understanding their disease. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Intraoperative photography is now widely available, but is
underused by referring practitioners and consulting specialists.
The essential value of intraoperative photography is that it
provides accurate records of clinical findings (examples are shown
in Box 1). However, its role may extend to providing documentation for
personal records, to communication with referring practitioners
and to complementing operative or legal reports. Images may be
particularly useful in situations where multiple treatment options
exist (eg, where infertility caused by tubal disease can be managed by
tubal surgery or assisted reproductive technologies).
Photographic records may enable more appropriate decisions to be be
made after reflection or consultation.
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. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Methods |
We invited all 28 patients who underwent endoscopic surgery between 1
February and 1 May 1998 for whom good quality operative photographs
were available to participate in the study. Medical and nursing staff
were randomly selected from lists of practitioners within the
Southwest Sydney Area Health Service. We approached 40 specialists
(20 gynaecologists and 20 anaesthetists), 200 general
practitioners and 40 nurses.
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. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Results |
Response rates were 50% (20 of 40) for specialists (12 gynaecologists
and eight anaesthetists), 61.5% (123 of 200) for general
practitioners, 70% (28 of 40) for nurses and 100% (all 28) for
patients. Our results are summarised in Box 2.
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:
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. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Discussion |
Our findings show that patients value operative images highly and are
not made anxious by photographs of their "insides". The vast majority
of participating patients appreciated open communication of
surgical findings. However, our questions were directed, and
whether these responses represent true appreciation of disease
pathology (or its absence) or a perceived increased level of care is
not clear.
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. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References |
(Received 10 Jul 2000, accepted 19 Jan 2001) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Authors' details | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Liverpool Hospital, Liverpool, NSW.
Geoffrey D Reid, MRCOG, FRACOG, Director of Gynaecological Endoscopy; Adelyn Leong, MB BS, MRACOG, Clinical Fellow.
Reprints will not be available from the authors. ©MJA 2001
Readers may print a single copy for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company. Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>". <URL: http://www.mja.com.au/> © 2001 Medical Journal of Australia. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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