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Advances in digital technology have made use of digital images increasingly common for the purposes of medical education.1 The high turnover of patients in the emergency department, many of whom have striking visual signs makes this an ideal location for digital photography. These images may eventually be used for the purposes of medical education in presentations, and in book or journal format.2,3 As a consequence patients’ images may be seen by the general public on the internet, as many journals now have open access internet sites. From an ethical and legal standpoint it is vital that patients give informed consent for use of images in medical photography, and are aware that such images may be published on the world wide web.4
The aim of this pilot study was to investigate patient’s attitudes toward medical photography as a guide to consent and usage of digital photography within the emergency department. A patient survey questionnaire was designed to answer whether patients would consent to their image being taken, which part(s) of their body they would consent to being photographed, and whether they would allow these images to be published in a medical book, journal, and/or on the internet.
All patients attending the minors section of an inner city emergency department between 1st January 2004 and 30th April 2004 were eligible for the study. Patients were included if aged over 18 and having a Glasgow coma score of 15. Patients were excluded if in moderate or untreated pain, needed urgent treatment, or were unable to read or understand the questionnaire. All patients were informed that the questionnaire was anonymous and would not affect their treatment. Data was collected by emergency department Senior House Officers and Emergency Nurse Practitioners.
100 patients completed the questionnaire. The results are summarised below:
Q1 Would you consent to a photograph being taken in the Emergency Department of you/part of your body for the purposes of medical education?Yes 84%, No 16%21% replied Yes to all forms of consent, 16% replied No to all forms of consent, while 63% replied Yes with reservations for particular forms of consent.Q2 Would you consent the following body part(s) to be photographed (head, chest, abdomen, limbs and/or genitalia)?The majority of patients consented for all body areas to be photographed except for genitalia (41% Yes, 59% No) citing invasion of privacy and embarrassment.Q3 Would you consent to your photo being published in a medical journal, book or internet site?The majority of patients gave consent for publication of images in a medical journal (71%), book (70%), but were more likely to refuse consent for use of images on internet medical sites (47% Yes, 53% No or unsure).
In determining the attitudes of patients presenting in an inner city London emergency department regarding the usage of photography, we found that the majority of patients were amenable to having their images used for the purposes of medical education. The exceptions to this were the picturing of genitalia and the usage of any images on internet medical sites/journals.
The findings of this pilot study are limited to data collection in a single emergency department in central London. A particular flaw of this survey is the lack of correlation between age, sex, ethnicity, and consent for photography. Further study is ongoing to investigate this.
There have been no studies published about patients’ opinions regarding medical photography to date. The importance of obtaining consent for publication of patient images and concealment of identifying features has been stressed previously.5 This questionnaire study emphasises the need to investigate patients’ beliefs and concerns prior to consent.