Informed Consent, Use, and Storage of Digital Photography Among Mohs Surgeons in the United States

A practical guide to clinical photography prior to skin biopsy: key tips and proposed workflow

High-quality clinical photography has become an integral part of dermatology in the context of patient evaluation and monitoring, clinical teaching, and research. Technological advancements in smartphones have allowed dermatologists to incorporate photography in workflows; however, acquiring quality photos poses its own challenges. Outlining a best practice approach to image capture prior to biopsy will facilitate establishing a team-based approach for the implementation of clinical photography in workflow. We propose this guide with the intent of improving patient care though photography in the clinical setting and the goal of integrating high-quality photography into routine clinical practice.

Legal Ramifications of Publishing Patient Photographs: A Review of Legal Cases

The use of photography in plastic surgery has become standard of practice in recent years. Patient photographs have diverse utility and can be used to visualize medical progression, and as an educational and marketing tool. With increased publication of patient photographs outside the healthcare records, it is important to understand patient privacy rights and how they pertain to images. Additionally, it is valuable to understand the legal consequences associated with dissemination of patient photographs without proper consent.

Methods

A retrospective analysis of the Lexis+ legal database was conducted to obtain cases that involved the improper dissemination of patient photographs or videos by surgeons. Inclusion criteria included civil cases in which the defendant was a surgeon being sued for the improper use of patient photographs. Criminal cases were excluded from analysis.

Results

A total of 23 cases met the inclusion criteria for our study. On average, 2.13 defendants were listed per case, often including the accused surgeon and their employer. Prior photographic consent was obtained in 69.57% (n = 16) of cases. In the remaining seven cases, the defendant did not obtain consent. In all seven of these cases, either the court ruled in favor of the plaintiff or both parties reached a settlement outside court.

Conclusions

To mitigate risk, surgeons should maintain two separate photographic consent forms for internal and external use. Additionally, a formal audit process should be established to ensure proper consent has been established before publishing patient photographs external to the electronic medical records.

Publishing Identifiable Patient Photographs in Scientific Journals: Scoping Review of Policies and Practices

BACKGROUND

Publishing identifiable patient data in scientific journals may jeopardize patient privacy and confidentiality if best ethical practices are not followed. Current journal practices show considerable diversity in the publication of identifiable patient photographs, and different stakeholders may have different opinions of and practices in publishing patient photographs.

OBJECTIVE

This scoping review aimed to identify existing evidence and map knowledge gaps in medical research on the policies and practices of publishing identifiable photographs in scientific articles.

METHODS

We performed a comprehensive search of the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL with Full Text, Database of Abstracts of Reviews of Effects, Ovid MEDLINE, and Scopus. The Open Science Framework, PROSPERO, BASE, Google Scholar, OpenGrey, ClinicalTrials.gov, the Campbell Collaboration Library, and Science.gov were also searched.

RESULTS

After screening the initial 15,949 titles and abstracts, 98 (0.61%) publications were assessed for eligibility at the full-text level, and 30 (0.19%) publications were included in this review. The studies were published between 1994 and 2020; most had a cross-sectional design and were published in journals covering different medical disciplines. We identified 3 main topics. The first included ethical aspects of the use of facial photographs in publications. In different clinical settings, the consent process was not conducted properly, and health professionals did not recognize the importance of obtaining written patient consent for taking and using patient medical photographs. They often considered verbal consent sufficient or even used the photographs without consent. The second topic included studies that investigated the practices and use of medical photography in publishing. Both patients and doctors asked for confidential storage and maintenance of medical photographs. Patients preferred to be photographed by their physicians using an institutional camera and preferred nonidentifiable medical photographs not only for publication but also in general. Conventional methods of deidentification of facial photographs concealing the eye area were recognized as unsuccessful in protecting patient privacy. The third topic emerged from studies investigating medical photography in journal articles. These studies showed great diversity in publishing practices regarding consent for publication of medical photographs. Journal policies regarding the consent process and consent forms were insufficient, and existing ethical professional guidelines were not fully implemented in actual practices. Patients' photographs from open-access medical journals were found on public web-based platforms.

CONCLUSIONS

This scoping review showed a diversity of practices in publishing identifiable patient photographs and an unsatisfactory level of knowledge of this issue among different stakeholders despite existing standards. Emerging issues include the availability of patients' photographs from open-access journals or preprints in the digital environment. There is a need to improve standards and processes to obtain proper consent to fully protect the privacy of patients in published articles.

Use of medical photography among dermatologists and plastic surgeons in Saudi Arabia

This study aimed to evaluate the use of medical photography among dermatologists and plastic surgeons in Saudi Arabia. This cross-sectional study was conducted on 63 physicians (43 dermatologists, 20 plastic surgeons) using 36-item multiple choice questionnaire on the use of medical photography. Data were analysed using descriptive statistics, and two-tailed, Chi-square and Exact tests. Medical photography was used by most of dermatologists (90.7%) and plastic surgeons (95%). More than three-fourths of them agreed that medical photography aids in enhancing clinical effectiveness and standard of care. Photography was done mostly to track disease progression for dermatologists (87.2%), and for research and/or future publications for plastic surgeons (89.5%). The primary reason for exchange of photographs via email or text messages was for seeking second opinion and further recommendations from colleagues. Consent from patients before photographing was obtained by majority of both groups. Medical photography is commonly used both in clinical and academic practices for diagnostic, treatment and teaching purposes. Its value in enhancing medical care is agreed upon and the existence of workplace medical photography protocol is important. Consent from patients must be always acquired and stressed upon even with the absence of clear grounding regulations and protocols.

Use of Photography in Dermatology: Ethical and Legal Implications

Photographs are necessary in the clinical practice of dermatology, but there are ethical implications to consider. Moreover, dermatologists must be aware of and comply with certain legal requirements affecting the use of photographs. The main ethical principles are respect for patient autonomy and the physician's obligation to do no harm. The law differentiates between 2 bases for protection: one concerns the photographed person's rights over the image and the other protects personal data. Recent legislation places restrictions on taking photographs and exhibiting them. Photographs taken to be stored with a medical history have not been called into question, but the physician is recommended to inform the patient that they exist. When a photograph is exhibited for the purpose of teaching or illustrating concepts, it is necessary to determine whether or not the patient can be identified. If the answer is yes, the patient must give explicit permission. Caution should be exercised when publishing medical photographs on social media.

Patients, pictures, and privacy: managing clinical photographs in the smartphone era

It is easy to capture and share clinical photographs and x-ray images using modern smartphones. This technology affords health-care providers the ability to rapidly collaborate and facilitate care for their patients. This improvement, however, has increased concerns regarding patient privacy and the safeguarding of protected health information. Health-care providers should understand the deidentification process for patient photographs because this process fundamentally changes the expectations and requirements for how providers are to handle this information. Properly deidentified patient photographs (and other data) are no longer considered identifiable protected health information and are not subject to the handling requirements mandated by the Health Insurance Portability and Accountability Act. This article addresses patient privacy concerns attendant to the acquisition, transmission, and sharing of clinical photographs among health-care providers. It provides guidelines for providers seeking to minimize the risk of noncompliance with privacy requirements as they adopt these new technologies into their practices.

Use of medical photography among dermatologists: a nationwide online survey study

BACKGROUND

Medical photography enhances patient care, medical education and research. Despite medical photography's widespread use, little is known about how dermatologists choose to implement photography in routine clinical practice, and how they approach issues of image storage, image security and patient consent.

OBJECTIVE

To characterize dermatologists' medical photography habits and opinions.

METHODS

A 32-item anonymous, multiple-choice SurveyMonkey questionnaire about medical photography practices was emailed to programme directors of the 117 United States (US) dermatology residency programmes between May and August 2015, with a request to forward to faculty and affiliated dermatologists. Only board-certified dermatologists practicing in the United States were eligible. The Institutional Review Board exempted our study from full review.

RESULTS

Our survey included 153 board-certified dermatologists, primarily representing the north-east (43.1%) and identifying as academic dermatologists (75.5%). Medical photography is prevalent: 61.8% report everyday use and 21.7% photograph every patient. Those reporting rare use (3.3%) were, on average, 20 years older. Dermatologists most commonly use photography to mark biopsy sites (87.5%), track disease (82.9%) and for education/teaching (72.4%). Nearly half (46%) use smartphone cameras. Emailing and texting photographs with patients or colleagues are common (69.1%). Most dermatologists (75.7%) always request patient consent for photographs. Only 23.7% adhere to a photography protocol and 73.9% desire more training opportunities.

CONCLUSION

Dermatologists value medical photography. While patterns of image acquisition, storage and consent are noted, a variety of methods and preferences exist. Clearer photography guidelines and increased educational resources are likely to improve image quality, exchangeability and confidentiality.