Perspectives
Ethics History and humanities
Volume 197 - Issue 5

“Click first, care second” photography

Authors:  Kara Burns and Suzanne Belton

Med J Aust 2012; 197 (5): 265. || doi: 10.5694/mja12.10638
Published online: 3 September 2012
Policies to prevent medical photography being performed unethically and unlawfully are critical in the digital ageIn the era of easily obtainable, easy-to-use digital cameras, any owner of a camera can be a “medical photographer”. Yet professionalism in obtaining medical photographs is much more than the sum of one’s equipment. Digital cameras, especially the ones in smartphones, give clinicians a high degree of autonomy in taking ...
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Policies to prevent medical photography being performed unethically and unlawfully are critical in the digital age

In the era of easily obtainable, easy-to-use digital cameras, any owner of a camera can be a “medical photographer”. Yet professionalism in obtaining medical photographs is much more than the sum of one’s equipment. Digital cameras, especially the ones in smartphones, give clinicians a high degree of autonomy in taking medical photos. Photos taken by clinicians aid diagnosis and teaching, but no matter how well intentioned, clinicians who take medical photos have practical, legal and ethical issues to negotiate. As the distribution of electronic data through the internet, social media and mobile devices becomes easier, appropriate collection, consent and use of medical imagery is essential.1 Lawful image security, storage and disposal practices, mandated by state and territory information acts and records disposal schedules, are paramount to the safe and ethical use of photographic information.

Medical photography often illustrates what people would prefer to keep private,2 is practised when people are vulnerable,3 and departs from other imaging by providing a permanent record of an undignified experience that can identify a patient.2,3 Patients who undergo clinician-taken medical photography can become an unequal partner with their doctor, believing they need to comply with photography as part of their treatment and care.3 In the best-case scenario, medical photos, properly executed in the context of clinical care, can inform distant specialists, record presentations of disease for teaching, and alert clinicians to transient or rarely seen symptoms. At worst, a photo can become a doctor’s memento, in which a patient’s experience is replayed through a morbid show-and-tell for curiosity and entertainment. Revealing an intimate area for examination is one thing; but having the area captured on a smartphone may contravene professional standards. This may be occurring in hospitals around Australia.

A survey of doctors and nurses in August 2010, from 17 wards in an Australian tertiary hospital, explored the prevalence of medical photography, image use, quality of consent, cameras and technology, confidentiality, and data storage and security. Of the 170 staff surveyed, 48% had taken medical photos in the past year. Most used hospital-owned cameras, but one-fifth used a personal mobile phone. Junior surgical staff noted the efficacy of taking mobile phone images to show consultants later, yet they retained the images after the cases had concluded.4

Consent practices were more alarming, with non-compliance with hospital consent policy widespread. Of clinicians taking photos for patient files, 65% used verbal rather than written consent, and of clinicians taking them for educational purposes, 59% used only verbal consent.

Copyright issues were generally misunderstood; only 33 out of 71 health professionals understood that clinician-taken medical photos were owned by the health department. Many believed that taking an image meant owning an image. Labelling, storage and disposal practices were irregular, with 10% of clinicians compromising the security of patient information by storing images on personal devices.4

Are clinicians choosing to ignore ethical standards and best practice in relation to medical photography, or are they simply unaware of the pitfalls? In our study, the tertiary hospital did not have a policy that covered the use of emerging technologies, and few heeded the existing privacy policy. How effective is an outdated, unknown, unpoliced policy?

No Australian legal precedent exists about medical photography misuse, but in 2010, a Malaysian high court awarded a patient damages against a colorectal surgeon who took before-and-after photos of haemorrhoid surgery. The photos were intended as a patient education aid, yet without informed consent, the courts deemed the act of photography an invasion of privacy. In the United Kingdom, unauthorised publication of medical photos has caused psychological harm to patients and the potential for legal recourse.5 No single authority has grappled with the concept that misdiagnosis may occur through a poorly taken photo, yet this is a real possibility. The failure to properly manage the rise of this “click first, care second” culture could lead to the trampling of patients’ dignity, their information being distributed in the public domain where it cannot be retracted, and to a potential quagmire of privacy and copyright issues. This may in turn raise the spectre of medical malpractice litigation. These will be pressing issues for any Australian hospital network without the foresight to develop responsive policy for the digital age.

Authors

  • Kara Burns BSci(AppSci)(Hons)1
  • Suzanne Belton PhD2
  • 1. RMIT University, Melbourne, VIC.
  • 2. Menzies School of Health Research, Melbourne, VIC.

Correspondence: kb@karaburns.com

Competing interests

No relevant disclosures.

References

Provenance: <p>Not commissioned; not externally peer reviewed.</p>

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