Clinical images – don’t let diagnostic snaps be your downfall

Clinial Images

Asking for advice on a diagnostic photo is as simple as snap, click, send. But what is the purpose of taking the photo? Did you seek the patient’s permission? How can you maintain confidentiality once you hit send? 

Doctors are now able to connect and collaborate with medical colleagues all around the world. This is a game changer for those in a rural area, doctors on call at night, or simply those seeking expertise and advice from a trusted specialist.

With access to a camera on our smartphone literally at our fingertips, the ability to share a clinical image can have enormous diagnostic potential. Medical professionals are using their smartphones to document patient history, take a sequence of snaps of a changing lesion, or share an x-ray for a colleague’s opinion. However, no matter how well-intentioned you may be, it is important to consider practical, legal and ethical issues before taking or sending clinical images of your patients to others.

Let’s consider the following example:

Patient A presented to the ED with his right leg broken in three places. The intern on call sought permission to photograph his x-rays to send to the offsite specialist for advice. Patient A gave his consent. However, the intern also posted the photo on his graduate intern social media group – “the unicorn of breaks”, something to brag about.

In the scenario above, the intern has started off correctly by seeking permission from his patient to share the image for diagnostic advice. In this case, the patient had no idea that the picture would end up online. Was it ethical to share the photo online, even if de-identified? What was the purpose of the image for which the intern sought the patient’s permission and did the patient give permission for it to be distributed to the intern’s classmates?

Recent UK research has found that online discussions by doctors on a difficult to diagnose case, tend to provide a better outcome for the patient.

When taking and share a clinical image of a patient:

  • consider the purpose of the image
  • explain to the patient the reasons for taking the image, how it would be used and who would see it
  • document the patient’s consent (or refusal) in their medical records
  • ensure images don’t auto-upload to any social media networks or back up sites
  • password protect the device you are taking the photo on
  • delete the image after saving it in the patient’s medical record.

Clinical images are “health information” under the law and are to be treated with the same confidentiality as any other health record.

More information:

AHPRA: Social Media Policy
AMA: Social Media and the Medical Profession
AMA: Clinical Images and the Use of Personal Mobile Devices
Medical Board of Australia: Good Practice Guide