The Power of Images.

Images have the power to inform us, surprise us, and move us.

[Ethical aspects of taking and using photographs in pediatric medical practice]. / Aspectos éticos de la toma y el uso de la fotografía en la práctica pediátrica.

From the beginning of medicine, the reproduction of patients' images, initially as drawings, either for didactic purposes or to share experiences, were common in medical practice. Photography greatly facilitated and generalized this practice within health teams. The images of the affected patients need the same consents and guarantees of confidentiality as any other parts of the medical record, so the importance of obtaining informed consent is highlighted. Beyond ethical aspects, professionals have to take into account the legal responsibility involved in carrying out this act.

Desde los inicios de la medicina, la reproducción de imágenes de pacientes, ya sea con fines didácticos o de compartir experiencias, fue considerada una práctica habitual en el quehacer médico. La aparición de la fotografía facilitó y generalizó enormemente esta práctica dentro de los equipos de salud. Las imágenes de los pacientes requieren el mismo consentimiento y garantías de confidencialidad que otras partes del registro médico. Se remarca la importancia del consentimiento informado. Se considera la responsabilidad legal de estos actos.

Implicaciones bioéticas y médico-legales del uso de la fotografía en dermatología / Use of Photography in Dermatology: Ethical and Legal Implications

El uso de la fotografía, necesario en el ejercicio de la dermatología, conlleva unas implicaciones médico-legales y bioéticas que deben conocerse y cumplirse. Éticamente destacan los principios de autonomía y de no maleficencia. Jurídicamente deben diferenciarse 2 sustratos distintos de protección: el derecho a la propia imagen y la protección de los datos de carácter personal, donde ha habido recientemente modificaciones legislativas que condicionan la actuación ante la obtención y exhibición de fotografías. En la obtención no se plantean dudas jurídicas dado que la fotografía es un elemento más en la historia clínica del paciente, recomendándose únicamente informar al respecto. Para la exhibición docente o científica de fotografías debe distinguirse si la fotografía permite o no identificar al paciente. Solo si el paciente puede ser identificado es necesario disponer de una autorización expresa y específica para dicha exhibición. Se recomienda un uso prudente de la fotografía médica en redes sociales

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

On the Epistemic Status of Prenatal Ultrasound: Are Ultrasound Scans Photographic Pictures?

Medical imaging is predominantly a visual field. In this context, prenatal ultrasound images assume intense social, ethical, and psychological significance by virtue of the subject they represent: the fetus. This feature, along with the sophistication introduced by three-dimensional (3D) ultrasound imaging that allows improved visualization of the fetus, has contributed to the common impression that prenatal ultrasound scans are like photographs of the fetus. In this article we discuss the consistency of such a comparison. First, we investigate the epistemic role of both analogic and digital photographic images as visual information-providing representations holding a high degree of objectivity. Second, we examine the structure and process of production of ultrasound scans and argue that a comparison between two-dimensional (2D) ultrasound and photography is justified. This is in contrast to 3D ultrasound images that, due to the intensive mathematical processing involved in their production, present some structural issues that obfuscate their ontological and epistemic status.

Use of Photography in Dermatology: Ethical and Legal Implications. / Implicaciones bioéticas y médico-legales del uso de la fotografía en dermatología.

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.

Medical Videography Using a Mobile App: Retrospective Analysis.

BACKGROUND: As mobile devices and apps grow in popularity, they are increasingly being used by health care providers to aid clinical care. At our institution, we developed and implemented a point-of-care clinical photography app that also permitted the capture of video recordings; however, the clinical findings it was used to capture and the outcomes that resulted following video recording were unclear. OBJECTIVE: The study aimed to assess the use of a mobile clinical video recording app at our institution and its impact on clinical care. METHODS: A single reviewer retrospectively reviewed video recordings captured between April 2016 and July 2017, associated metadata, and patient records. RESULTS: We identified 362 video recordings that were eligible for inclusion. Most video recordings (54.1%; 190/351) were captured by attending physicians. Specialties recording a high number of video recordings included orthopedic surgery (33.7%; 122/362), neurology (21.3%; 77/362), and ophthalmology (15.2%; 55/362). Consent was clearly documented in the medical record in less than one-third (31.8%; 115/362) of the records. People other than the patient were incidentally captured in 29.6% (107/362) of video recordings. Although video recordings were infrequently referenced in notes corresponding to the clinical encounter (12.2%; 44/362), 7.7% (22/286) of patients were video recorded in subsequent clinical encounters, with 82% (18/22) of these corresponding to the same finding seen in the index video. Store-and-forward telemedicine was documented in clinical notes in only 2 cases (0.5%; 2/362). Videos appeared to be of acceptable quality for clinical purposes. CONCLUSIONS: Video recordings were captured in a variety of clinical settings. Documentation of consent was inconsistent, and other individuals were incidentally included in videos. Although clinical impact was not always clearly evident through retrospective review because of limited documentation, potential uses include documentation for future reference and store-and-forward telemedicine. Repeat video recordings of the same finding provide evidence of use to track the findings over time. Clinical video recordings have the potential to support clinical care; however, documentation of consent requires standardization.

The Ethics and Legality of Using Personal Smartphones to take Medical Photographs.

Photography in the medical profession is an asset that may help during patients' follow-up, monitoring the progression of diseases, getting a second opinion and in medical educational activities. Advances in technology, specifically smartphones, have enabled medical professionals to obtain high-quality photographs with minimal effort and photography experience. This article discusses the ethics and legality of using personal smartphones in a medical professional setting for medical photography. Written informed consent should always be obtained from the patient and should include details about how the photographs will be used.

Ethical dangers of facial phenotyping through photography in psychiatric genomics studies.

Psychiatric genomics research protocols are increasingly incorporating tools of deep phenotyping to observe and examine phenotypic abnormalities among individuals with neurodevelopmental disorders. In particular, photography and the use of two-dimensional and three-dimensional facial analysis is thought to shed further light on the phenotypic expression of the genes underlying neurodevelopmental disorders, as well as provide potential diagnostic tools for clinicians. In this paper, I argue that the research use of photography to aid facial phenotyping raises deeply fraught issues from an ethical point of view. First, the process of objectification through photographic imagery and facial analysis could potentially worsen the stigmatisation of persons with neurodevelopmental disorders. Second, the use of photography for facial phenotyping has worrying parallels with the historical misuse of photography to advance positive and negative eugenics around race, ethnicity and intellectual disability. The paper recommends ethical caution in the use of photography and facial phenotyping in psychiatric genomics studies exploring neurodevelopmental disorders, outlining certain necessary safeguards, such as a critical awareness of the history of anthropometric photography use among scientists, as well as the exploration of photographic methodologies that could potentially empower individuals with disabilities.

Ethics of Global Health Photography: A Focus on Being More Human.

This article explores the relationship between ethics and the production of global health photographic images. Through the text, we emphasize the need for greater awareness of potential ethical pitfalls, not just in relationship to the finished product of the image but also throughout the full photographic process. In order to do so, we present and explore three vignettes detailing our personal global health photographic experiences. Using these examples of the process of photographic production, we argue that the ethical emphasis needs to fall as much on the way of making and circulating the images as on the resulting images and their content. In showing that ethics starts long before the decision to publish a photograph, we engage global health photography as a relationship built of unequal power dynamics, where agency is held (albeit lopsidedly) by all of those around the camera-the subject, the photographer, and the bystanders or actors who exist beyond the photograph's composition. By following the concept of "encouraging people to do what is best given certain circumstances and constraints," we as photographers and global health workers advocate for a more fully human interaction through conscious, careful global health visual policy and humane photographic deliberation.

Instructional design of a clinical photography course for undergraduate dental students.

Clinical and dental photography is an acquired skill. It is learned, developed and practised at post-graduate level by medical photographers across the U.K. But where does the medical photography profession stand in terms of transmitting slowly acquired skills to a wider clinical audience? If some or all skills need to be passed on, how and to whom should they be taught? This paper considers how dental practitioners may benefit from training in specific aspects of clinical photography and suggests a tried and tested model of instructional design for a clinical photography course utilised and implemented for undergraduate dental students studying at the University of Leeds. The authors found a course of this nature demanded skills and theoretical understanding of cognitive architecture beyond the purview of most clinical field experts. A collaborative approach to instructional design between a field expert and clinical educator was implemented, which allowed the design of a dental photography course that worked effectively by linking new to prior knowledge.

Patient perceptions regarding the use of smart devices for medical photography: results of a patient-based survey.

AIM: To assess patient perceptions regarding medical photography and the use of smart devices, namely mobile phones and tablets for medical photography. METHODS: A questionnaire-based survey was conducted among 280 consecutive adult patients who presented to the oculoplastics clinic at a tertiary eye care centre. The responses were tabulated and analysed. RESULTS: Of the 280 patients surveyed, 68% felt that medical photography had a positive impact on their understanding of their illnesses and 72% felt that the use of smartphones for medical photography was acceptable. Respondents below the age of 40 years were more likely to approve of the use of mobile phones for photography as compared to those over 40. Most patients (74%) preferred a doctor to be the person photographing them. While a majority approved of doctors and trainee physicians having access to their photographs, they felt non-physician healthcare personnel should not have access to clinical photographs. Also, 72% of the respondents felt that the patient's consent should be taken before using their photographs. It was noted that patient identification and breach of confidentiality could be some of the potential issues with using smart devices as cameras in the clinic. CONCLUSIONS: Clinical photography in general and, specifically, using smart devices for clinical photographs have gained acceptance among patients. The outcomes of this study may be utilized to create policy guidelines for the use of smart devices as photography tools in the clinics. The findings of this survey can also help to create standardized, uniform patient consent forms for clinical photography.

Ethical Considerations of Medical Photography in the Management of Breast Disease.

BACKGROUND: Medical photography has become an important component of the evaluation and management of patients across many specialties. It is increasingly utilized in contemporary practice with modern smartphones and enhanced digital media. Photography can enhance and improve treatment plans and communication between providers and patients. Additionally, photography supplements education, research, and marketing in both print and social media. Ethical and medicolegal standards for medical photography, specifically for patients with breast disease, have not been formally developed to guide medical providers. PURPOSE: To provide guidelines for breast care physicians using medical photography, the Ethics Committee of the American Society of Breast Surgeons presents an updated review of the literature and recommendations for ethical and practical use of photography in patient care. METHODS: An extensive PubMed review of articles in English was performed to identify studies and articles published prior to 2018 investigating the use of medical photography in patient care and the ethics of medical photography. After review of the literature, members of the Ethics Committee convened a panel discussion to identify best practices for the use of medical photography in the breast care setting. Results of the literature and panel discussion were then incorporated to provide the content of this article. CONCLUSION: The Ethics Committee of the American Society of Breast Surgeons acknowledges that photography of the breast has become an invaluable tool in the delivery of state-of-the-art care to our patients with breast disease, and we encourage the use of this important medium. Physicians must be well informed regarding the concerns associated with medical photography of the breast to optimize its safe and ethical use in clinical practice.

Photovoice Ethics: Critical Reflections From Men's Mental Health Research.

As photovoice continues to grow as a method for researching health and illness, there is a need for rigorous discussions about ethical considerations. In this article, we discuss three key ethical issues arising from a recent photovoice study investigating men's depression and suicide. The first issue, indelible images, details the complexity of consent and copyright when participant-produced photographs are shown at exhibitions and online where they can be copied and disseminated beyond the original scope of the research. The second issue, representation, explores the ethical implications that can arise when participants and others have discordant views about the deceased. The third, vicarious trauma, offers insights into the potenial for triggering mental health issues among researchers and viewers of the participant-produced photographs. Through a discussion of these ethical issues, we offer suggestions to guide the work of health researchers who use, or are considering the use of, photovoice.

The Value of a Photobook in Informing Families About the Cosmetic Results of Surgery in Craniosynostosis.

This paper outlines the development and evaluation of a photobook resource to support parents' decision making regarding potential craniofacial surgery for their child. The photobook was developed at a UK Craniofacial Unit and consisted of preoperative and postoperative photographs of patients with craniosynostosis. It was intended to act as a visual adjunct to detailed verbal discussion of surgical treatment options. No changes in the uptake rate of surgery were detected following the introduction of the photobook. An evaluation of parents' views of the photobook indicates that families generally welcomed the resource and did not report any adverse responses. Ethical considerations of the use of such a resource cannot be discounted, and careful presentation of such a resource in the context of a specialist team is recommended.