|LETTER TO THE EDITOR
|Year : 2018 | Volume
| Issue : 1 | Page : 15-16
Clinical photography and video recordings in plastic surgery: Beyond patient autonomy and informed consent
Olayinka A Olawoye
Department of Surgery, College of Medicine, University of Ibadan; Department of Plastic, Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan, Nigeria
|Date of Web Publication||10-Aug-2018|
Dr. Olayinka A Olawoye
Department of Surgery, College of Medicine, University of Ibadan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Olawoye OA. Clinical photography and video recordings in plastic surgery: Beyond patient autonomy and informed consent. Nigerian J Plast Surg 2018;14:15-6
|How to cite this URL:|
Olawoye OA. Clinical photography and video recordings in plastic surgery: Beyond patient autonomy and informed consent. Nigerian J Plast Surg [serial online] 2018 [cited 2019 May 20];14:15-6. Available from: http://www.njps.org/text.asp?2018/14/1/15/238814
The issues surrounding clinical photography are pertinent especially for the plastic, reconstructive and aesthetic specialty, and they cannot be overflogged. The authors of the article “Clinical photography and video recordings in plastic surgery: Patient autonomy and informed consent in an era of smartphone technology and social media in sub-Saharan Africa” rightly laid appropriate credence to this fact and the challenges that abound in our clime, especially with the proliferation of mobile devices and increasing access to online social platforms.
The challenges, however, go far beyond those of autonomy and consent to other germane issues such as the privacy rights of the patient, the ethical discipline of the practitioners, and institutional responsibilities. For instance, when a resident is reviewing a patient on behalf of a consultant in the emergency department, the resident takes several pictures of a hand injury, for instance, with a personal mobile device and sends the photos via one of the messaging applications such as WhatsApp to the consultant for evaluation. The resident could have done this solely for information purpose or as part of an evaluation process in which he expects some input from the consultant on the evaluation and diagnosis of the case. Can that process be accepted as part of a diagnostic evaluation akin to physical examination? Is it mandatory for informed consents to be routinely obtained for such purposes? Is it possible that other persons apart from the intended consultant or attending staff, on whose behalf the patient was seen, get holds of such pictures in the process of their dissemination through a messaging platform or other means? If that happens, has the patients’ privacy rights been breached? Should consent for clinical photograph be verbal or written? All these are pertinent questions that demand answers.
The issue of consent is no longer simply whether a clinical photograph may be created but now includes permission to use the photograph and the means of transmission of the pictures, especially if the institution does not have secure sites for the transmission of medical records and digital images, which is a pressing challenge in many hospitals in sub-Sahara Africa. The clinical photographs are valuable to all involved but are arguably most important to the patient, who has the most to lose if the photographs are released to the public.,
The concern is that, as technology advances and increased connectivity facilitates the exchange of digital images, the creation of such digital photos may threaten a patient’s right to privacy and confidentiality. With such a risk in mind, the patient should be informed not only regarding the intended use(s) of the photographs but also of the possible endangerment of his/her confidentiality. It is the primary responsibility of the doctor to explain all the confounding issues to the patient or client while seeking consent for clinical photographs.
Another obvious challenge in many of our operating rooms in the subregion is the poor institutional control and unfettered access to different cadre of theater workers and medical as well as nursing students into any operating room while operations are ongoing. Many of such persons may not see any wrong in taking pictures and even recording video of an ongoing procedure without seeking the permission of the lead surgeon who may be oblivious of such acts.
Even when due consent for clinical photography has been obtained by the managing team, pictures taken by any other person outside the team under whatever pretense would constitute a breach of the patient or client’s privacy. Sometimes pictures taken under such circumstances may find their way to social media platforms without the knowledge of the attending staff. Should litigation arise from such exposures, will the surgeon’s claim of ignorance be tenable, or can the institution be exonerated from culpability? This calls for greater diligence, discipline, and discretion on the part of all the participants and observers in the operating room and better scrutiny and control on theater access by the institution.
In clinical photography, personal identifiable information (PII) is defined as any physical feature that might easily distinguish a patient, such as facial features, birthmarks, and tattoos. It is important that clinicians adhere strictly to the terms of the consent obtained. For instance, PII should be appropriately masked whenever possible if the pictures will be used for presentations or publications. This may not be feasible for facial cosmetic surgeries such as blepharoplasty and rhytidectomy, and this must be expressly explained to the client when consent is being obtained.
Lastly, it is important that clinicians maintain high standards for clinical photography by dedicating specific and good quality cameras for the purpose. Standard and appropriate views must be taken pre- and postoperation for proper comparison and documentation. Natural lighting should be used as much as possible with an appropriate background. For intraoperative photographs, the field should be devoid of bloodstains and unnecessary instruments. It is important that written consent is obtained for clinical photographs for the purpose of documentation.
With increasing number of personal mobile devices used in the workplace, widening access to social network platforms, and expanding technical capabilities, capturing pictures of clients and patients for clinical and educational purposes can present greater ethical challenges. Professionalism on the part of the practitioners and sound corporate governance and responsiveness on the part of the institutions should help in maintaining patients’ privacy and confidentiality for clinical photo documentation, which is a sine qua non during surgery related to the plastic, reconstructive and aesthetic specialty.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ibrahim A, Abubakar LM, Maina DJ, Adebayo WO, Kabir AM. Clinical photography and video recordings in plastic surgery: Patient autonomy and informed consent in an era of smartphone technology and social media in sub-Saharan Africa. Niger J Plastic Surg 2017;13:35-9.
Berle I. Clinical photography and patient rights: The need for orthopraxy. J Med Ethics 2008;34:89-92.
Hood CA, Hope T, Dove P. Videos, photographs, and patient consent. BMJ 1998;316:1009-11.