“Click first, care second” photography

To the Editor: Burns and Belton’s negative, alarmist approach to clinical photography1 is at odds with our clinical experiences and the attitudes of our patients.

Camera phone use in Australian hand trauma assessment was first described in 2004.2 Smartphones are now ubiquitous and young doctors commonly send images via smartphones as an adjunct to diagnosis and management. Our patients are increasingly taking smartphone photographs of their injuries, postoperative wounds and x-rays. Photographs are an accepted adjunct in telemedicine, conveying what words cannot. They can permit immediate decision making by an off-site specialist, facilitating timely and appropriate management. In paediatric patients dressing removal can be a traumatic experience for the patient, parents and clinical staff. Photography can prevent the distress of repeated preoperative examinations.

We recently presented initial results of our 2012 study of 140 hand surgery patients on attitudes to the use of camera phone images for clinical communication in hospitals. Ethics approval for the study was granted by the Hunter New England Research Ethics and Governance Unit. Hand surgery patients completing confidential survey forms in outpatient clinics were overwhelmingly positive about the use of camera phone photography in their clinical care and for audit and teaching purposes.

Ninety-seven per cent of patients agreed or strongly agreed that such use of images may improve the accuracy of communication. No patients disagreed or strongly disagreed with the practice of sending a photograph of a wound or x-ray from the emergency department to the on-call hand specialist, nor with the use of clinical photographs in audit meetings and teaching, nor of intraoperative photos taken to assist with planning of future treatment. Our patients are as accepting of the transmission and display of clinical hand photographs in these situations as they are of the transmission and display of radiological images.

We agree with Burns and Belton that there are practical, legal and ethical issues for clinicians who take medical photographs. However, “Click first, care second” prioritises theoretical and potential problems of clinical photography. As clinicians, we make patient care our first priority. Our research demonstrates that we have the support of our patients in doing so.