Peter A Clarke

The Fairfax press and the ABC have reported on the disturbing practice of doctors and nurses using cameras to take photos of their handiwork without getting consent of their patients or properly protecting the photos.

The ABC report provides:

ELIZABETH JACKSON: For years doctors have taken photos of their patients’ ailments for their records, but now doctors are being warned against the use of smart phones for this purpose.

New Australian research has found doctors and nurses are increasingly using smart phones to take photos, but those digital photos are at risk of ending up in the wrong hands.

Samantha Donovan reports.

SAMANTHA DONOVAN: Most of us like to be looking our best in photos.

But doctors and nurses capture images of patients at their worst, mainly to keep on file or for teaching purposes.

The patient is often in surgery under anaesthetic.

Researchers at RMIT (Royal Melbourne Institute of Technology) University and the Menzies School of Health Research has just published a paper examining medical photography practices in 13 wards of one hospital.

The chief executive of the Australian Health Care and Hospitals Association, Alison Verhoeven, says hospitals are taking the emerging issue seriously.

ALISON VERHOEVEN: What they’ve found is that whereas in the past, a medical photographer might have been engaged to take clinical photos, now doctors and other clinicians are taking photos themselves, and they’re using their own mobile phones or digital cameras to do that.

SAMANTHA DONOVAN: The researchers found 48 per cent of medical staff took photos of their patient’s conditions when they thought it would be useful.

Most of them used hospital-owned cameras, but a fifth of them reported using their own mobile phones and many stored the images on personal devices.

The Australian Health Care and Hospitals Association’s Alison Verhoeven says doctors and nurses need a proper record of the patient’s consent before taking a photo.

ALISON VERHOEVEN: There seems to be a perception that asking for verbal consent to take a photo is sufficient, and that neither protects doctor or the patient. So I guess an issue to think about there is actually collecting consent in a written form so that it’s actually something to store with the image.

But the other issue is also how the image is stored long-term, because as you know, a digital image can be stored almost in perpetuity. So there’ obviously got to be conditions recorded somewhere to manage that such that that it meets the needs of the individual.

SAMANTHA DONOVAN: What are the other risks that researchers found are associated with digital medical photos?

ALISON VERHOEVEN: Well clearly, if they’re not transferred from the apparatus that they’re taken on to some sort of storage software, there’s an issue around potentially the camera or the mobile phone being lost and misused. So what we’d want to see I think is that any photos taken in any form of digital photography actually stored in an appropriate digital asset management software system in a medical image database that’s properly managed, where the records around consent and conditions around storage are managed by the hospitals.

SAMANTHA DONOVAN: The research has been published in The Australian Health Review.

ELIZABETH JACKSON: Samantha Donovan.

The Sydney Morning Herald article provides:

We’ve all heard the urban legend of the patient who turns up in hospital emergency with something inserted where it shouldn’t be.

But is the easy availability of camera phones encouraging doctors and nurses to take a souvenir snap of the occasion?

A study of one big Australian hospital has found about half of all doctors and nurses take photos of patients in hospital – and one in five using their personal smartphone.

Study author and researcher at RMIT University in Melbourne Kara Burns said the easy availability of camera phones was improving patient care and medical training, but raised serious privacy issues.

“Everybody that you talk to that works in healthcare will have an experience of seeing a doctor pulling out a phone, or even being the patient who is being photographed,” said Ms Burns, a medical photographer. “Doctors definitely feel that it is part of good practice to document a patient’s condition.”

Yet nearly 40 per cent of doctors and nurses surveyed did not always obtain consent for their photos. And “non-compliance with written consent requirements … was endemic”, she wrote in the journal Australian Health Review.

She said the photos were overwhelmingly taken for inclusion in a patient’s file, or for medical education, but it was clear there was also immense public interest in medical photographs.

A recent story in The Canberra Times documenting a medical report of a 70-year-old man who had a fork stuck in his penis was shared more than 21,000 times on Facebook.

And the respected New England Journal of Medicine runs a popular “Image Challenge” on its website where viewers can guess what caused often gruesome medical conditions.

Fairfax Media is not suggesting these images violate patient consent or privacy.

Australian Medical Association head Steve Hambleton said it was taking the issue extremely seriously, with three committees now developing guidelines for doctors.

“These new technologies have been really great for helping patients,” he said. “For example, if a patient has a fracture, that can be photographed and transferred to [other doctors] and that makes the job of deciding who comes in and what sort of care is required much more simple.”

He said if images were used for teaching or medical case reports, doctors went to great lengths to ensure the patient could not be identified. But doctors needed guidance on how best to protect images they took.

“Does it go straight to the patient’s medical file, or does it stay on the phone, and does the phone have the right level of security?” he said. “Doctors need to be aware of the magnitude of the risk”.

 Data held by health professionals needs to be secured in an appropriate fashion.  Keeping a photo of highly sensitive information on a smart phone does not qualify.  And that doesn’t even address the issue of consent.  Whipping out a phone and taking a shot of a particularly good suture may seem a good idea at the time but ignores the rights of the patients.  And what if the photo is not of the pinky finger but the groin or breast or some other part of the body of which the owner is  particularly sensitive.  There is a role for taking photographs for teaching and record purposes.  The patient should consent before a doctor or nurse becomes a shutter bug.