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“Click first, care second” photography

Rahul Chakrabarti and Chandrashan M Perera
Med J Aust 2013; 198 (1): 21. || doi: 10.5694/mja12.11401
Published online: 21 January 2013

To the Editor: We read with great interest the article by Burns and Belton regarding the deficiencies in knowledge and attitudes of health professionals towards understanding legal considerations of photographic ownership, storage and disposal.1 This article is timely, given the escalation of smartphone use among clinicians in daily practice. However, we feel that no practical advice was offered to clinicians.

The advent of smartphones capable of acquiring and rapidly transferring clinical images has facilitated new opportunities for improved patient care. The potential for timely diagnosis and management using smartphone photography has been shown in an increasing number of specialties, including orthopaedics,2 ophthalmology3 and neurosurgery.4 This is most relevant to patients in rural and remote areas where access to specialist services may be limited and accurate diagnosis and timely referral of emergent pathology is required.

Based on the existing standards for medical photography, there are several pertinent “good practice” points that clinicians must follow.5 Clearly, the principles of informed consent and confidentiality are required at all times and, when possible, this must be documented in the notes. Patients must be clearly informed of the purpose and intended audience of the photograph. Photos of the face and features that may easily identify an individual must be avoided unless clinically relevant. Importantly, images must be securely stored. This is particularly important if the patient wishes to obtain a copy of that photograph at a later stage. It is advisable to delete photographs from personal devices at the earliest opportunity to avoid the potential for unsolicited distribution and access to images.

Clinicians must be aware that the same ethical and legal protocols apply to images of patients taken on personal digital devices as those applying to any medical record. We agree with the authors that further education is required for health care professionals. This may be facilitated with guidelines in the broader context of clinical safety governance for electronic health records.6 With appropriate guidance, smartphone photography will be a useful adjunct to enhance patient care.

  • Rahul Chakrabarti1
  • Chandrashan M Perera2

  • 1 Centre for Eye Research Australia, Melbourne, VIC.
  • 2 Department of Neurosurgery, Austin Health, Melbourne, VIC.


Acknowledgements: 

We thank Prasanna Venkarataman for legal consultation.

Competing interests:

We are co-editors-in-chief of the Journal of Mobile Technology in Medicine.

  • 1. Burns K, Belton S. “Click first, care second” photography. Med J Aust 2012; 197: 265. <MJA full text>
  • 2. Padmasekara G, Nazarian N, Wall C. The reliability of mobile multimedia messaging (MMS) for decision making in distal radius fractures: an effective alternative. J Mobile Technolog Med 2012; 1: 8-12. http://www.journalmtm.com/2012/the-reliability-of-mobile-multimedia-messaging-mms-for-decision-making-in-distal-radius-fractures-an-effective-alternative/ (accessed Dec 2012).
  • 3. Lamirel C, Bruce BB, Wright DW, et al. Nonmydriatic digital ocular fundus photography on the iPhone 3G: the FOTO-ED study. Arch Ophthalmol 2012; 130: 939-940.
  • 4. Demaerschalk BM, Vargas JE, Channer DD, et al. Smartphone teleradiology application is successfully incorporated into a telestroke network environment. Stroke 2012; 43: 3098-3101.
  • 5. Creighton S, Alderson J, Brown S, Minto CL. Medical photography: ethics, consent and the intersex patient. BJU Int 2002: 89: 67-71; discussion 71-72.
  • 6. Coiera EW, Kidd MR, Haikerwal MC. A call for national e-health clinical safety governance. Med J Aust 2012; 196: 430-431. <MJA full text>

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