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Privacy at stake as doctors use smartphone photos

smartphoneTORONTO – Across Canada, many physicians are now using their smartphones to take photos of patients and their medical conditions as part of their day-to-day practice. The pictures are easy to share with colleagues for second opinions, and in some cases, they’ve saved lives. However, in the absence of guidelines for protecting the privacy of patient images, there can also be abuses.

For example, as his patient lay unconscious on a surgical gurney, a Victoria, B.C. urologist took out his smartphone and photographed the location where he’d just attached a urinary catheter. Then, as a “joke,” the doctor texted the image of his patient’s genitals to various friends and acquaintances. The ethical lapse ended up costing the specialist $20,000 in fines and a six-month suspension from medical practice last summer.

As the National Post reported earlier this month, the growing use of smartphones to capture medical images amounts to a revolution in healthcare. It’s one, however, that is raising serious issues about privacy and consent.

When plastic surgeons in Alberta surveyed colleagues throughout the country, they discovered that almost three quarters keep patient photos next to vacation snaps, pet pictures and other personal images on their phones.

And a quarter have accidentally shown the patient shots to friends or family, a newly published study by the Calgary specialists concluded.

An Ottawa ear, nose and throat surgeon did a similar survey of 258 members of his specialty – yet to be published – and more than 50 percent said they suspected their families could find patient photos on their phones.

“So now you’re saying sensitive – sometimes very sensitive – pictures of other people’s bodies are on your phone, and half the time they could be accessed by your kids,” Dr. Matthew Bromwich told the National Post. “That is not a good situation.”

To tackle the growing ethical “conundrum,” Dr. Bromwich’s company, Clearwater Clinical, recently launched a government-approved app that automatically stores clinical pictures in an encrypted cloud service, and includes a detailed consent form that patients complete on screen.

In the meantime, it is unclear to what extent doctors are actually obtaining consent for photography – and whether patients know exactly how the picture will be used.

“Imagine this on the consent form … ‘Do you agree to your photograph – the photograph of your newly reconstructed face, for example – being in the phone beside your physician’s baby photos?” said Juliet Guichon, a University of Calgary bioethicist who is preparing her own research paper on the issue. “How many would say ‘Yes?’”

In fact, of the 147 surgeons who responded to the Calgary study, just published in the journal Plastic Surgery, 75 percent said getting simple verbal consent for photos was good enough. And the images can be extremely delicate. Police investigating a Maryland doctor for drug trafficking found several photos of female patients’ genitals on the physician’s phone. But it was not some nascent pornography business: He maintained the pictures were taken for clinical reasons – documenting a novel vaginal-reconstruction procedure – and was never prosecuted over them.

As a sign of how ubiquitous photography in the clinic has become, the Canadian mobile-phone app called Figure 1 – a photo-sharing program for health professionals – now has more than a million users worldwide, and its medical images have been viewed 1.5 billion times.

Phone cameras seem to be used primarily in surgery, dermatology and wound care, helping with diagnosis, monitoring the course of an illness and teaching, says Guichon.

Dr. Bromwich said he’s been involved in a number of cases where the pictures headed off disaster. A doctor at another hospital thought he had a patient with a coin embedded in the esophagus, a situation that could be safely addressed the following day. Just to be sure, the Ottawa ENT specialist had his colleague text a smartphone photo of the X-ray.

It turned out the child had swallowed a watch battery, which if not removed promptly could have led to a “horrible death.”

In another case, Dr. Bromwich was so perplexed by a patient’s odd skin lesions, he texted a photo to a dermatologist, who identified Von Zumbusch psoriasis, a rare condition that can also kill unless treated rapidly.

Regardless of their medical benefit, those photos are ending up stored like any other picture on doctors’ phones, suggests the minimal research conducted on the issue. The kind of accidental sharing of patient photos with friends or family that was reported in the Calgary study is “clearly at odds with ethical conduct,” the authors say.

And while Figure 1 automatically blanks out faces and otherwise strives to anonymize pictures, in normal practice photos are often identifiable, said Dr. Bromwich.

Guichon says medicine should consider seriously whether the practice is appropriate, citing a 2009 British study that found most patients opposed doctors using personal phones to capture images, though they were agreeable to medical photography generally.

But Dr. Lori d’Agincourt-Canning, a University of British Columbia bioethicist who studied smartphone photography at the B.C. Children and Women’s Health Centre, believes the answer is imposing stricter safeguards. The convenience of using a phone to visually document health problems, and the benefit to patients, make banning the practice out of the question, she argues.

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