Back @ the EPR Arms: July 2016 Medical Images


'Jimmy come over here and join my selfie'.

A crowd from the hospital gathered around another smiling leaver - Jimmy Rainsford. They were dropping like flies these days. All ‘Boomers’ ready to start their new life of bliss and pensions. Lucky blighters.

'Here Mate,' he said to me, 'can you take us a selfie'
'Hardly a selfie then eh?'
'Arms ain't long enough Bud'
'OK. Right. Now then. Say ‘Cheese!'’ I frame them all in the viewfinder.

Norm, the uni lecturer who knows everything there is to know about anything, sauntered over to me.

'Do you know, saying ‘cheese’ makes your mouth smile for the camera, but in Spain they say Patatas (Potato), in Argentina it is the English word - whisky and Bulgaria its Zele (Cabbage). (For more of these see )

'Ta Bud!’ said Jimmy. ‘I'll Fb you the photo unless you wanna Bluetoof now'

Fb? Bluetoof? Another language. Another lifetime. Another beer.

'Another beer Norm?' I asked tilting my near empty glass his way.

'I'll just 'ave half thanks.' he said following me to the bar pointing at the middle tap. 'That one. Leafy Dock. New. Sounds good. Nettle after taste. 5.5% will do for me'

'It's another world Norm: Selfies. Instantly up there on Facebook or Instagram or Twitter. Another world. And it’s caused a real ‘stooshi across the road’

'At the hospital?’ he asked, ‘in what way?’ licking the nettley froth from where Bill the barman had been sloppy. 'With patients or staff?'

'Staff - of patients. It's a bit easy isn't it?’ I continued, ‘See a rash or a bed sore. Click. Done. Don't bother the Medical Illustration Department – even if you had one. No need to wait. Click. E-mailed to yourself. Sorted.’

‘And the problem is……………?’

'There isn’t A problem Norm. There’s loads of problems’ said a voice which belonged to a pretty woman entering our drinking space.

‘Lucy!’ said Norm.
‘Lucy?’ I queried
‘She’s the Medical Photographer over at my Uni hospital up in the City.’ continued Norm.

‘Yes there’s confidentiality issues- how do you control who is looking at the photo. There’s consent issues: is the patient happy to have their photo taken and how can it be used. Then there’s quality issues. I mean, you can’t just take a photo – SNAP! - and that’s it can you? Are you getting the drinks in Norm? Lime and Soda for me – I’m driving. And don’t get me started on videos.’
‘Videos ?’ I asked, thinking Blockbuster had made a comeback.

Stooshie – A Scottish word for row or commotion or fracas.

‘Surgeons videoing operations. A&E videoing Trauma events. Physios videoing before and after hip ops. The list goes on.’

‘Wow, I’d not really thought about all of this. I just assumed it would all be locked down and managed.’ I said.

Lucy continued ‘You see, many Trusts have got rid of their Medical Illustration Department and that seems to have left a real issue - a vacuum, which it appears is being filled by staff using their own cameras and phones. No-one is responsible for the management of these images and to be honest, most of them are of rubbish quality. Remember, these may have to be used as evidence in court. Out of focus is no good. And then there’s confidentiality’.

‘But hasn’t that already been sorted with your X-Rays? Can’t you simply adopt the same rules?’ I asked as Norm returned with a Lime & Soda

‘Not the same. You can’t identify someone from an X-Ray. Well not easily. There are photos in hospitals floating around the ‘ether’ or on personal cameras or worse still by mobile phones, which are not being managed. Photographs are taken in Dermatology, by staff, of patients. Taking them on the member of staff’s personal camera and saved onto their desk-top. Dental/Orthodontists take photographs of patients’ jaws/head. Podiatrists and Diabetologists take photographs of feet. Community nurses have been given smart phones to take photographs of patients in their own homes with bed sores. The list is endless. No control. No management.’

‘OK. So I see there is an issue. What would a good hospital actually do if they had a Medical Illustration Department? I mean, what does ‘good practice’ look like Lucy?

‘Well,, there is no official guidance from the NHS but there is guidance from the Institute of Medical Illustrators‘

‘The Institute of what?’
‘It’s our professional body.’

‘Go on then – run it by me’ asked Norm taking another sip of his beer.

‘Well, it is recommended that medical photography/illustration departments have a policy/protocol covering the handling of confidential material. It also goes on to say that clinical photographers should only obtain those illustrations that have been requested by the clinician and which the patient has consented to, and no others.

‘That’s seems sensible,’ as Norm drained the last of his nettles.

‘There’s more’ continued Lucy, ‘All digital images must be correctly identified and stored in an image database protected by passwords in accordance with local policy. Data should be regularly backed up to maintain its integrity and should be clearly marked with the level of consent given by the patient.’

‘Different levels of consent?’ I asked. ‘What do you mean?’

‘Well, you may be happy to share your photo for diagnostic purposes but not for teaching. Or for publication. Or anonymised for publication but not as part of your record.These images have many uses and not simply there as part of the diagnostic record. It’s complicated.’

I continued ‘,,,,,but looking at it from the other side Lucy, I can see why a doctor who is seeing a patient thinks he may as well take a photo rather than get the patient to come again to see you or your colleague with all those parking problems and getting time off work and all’.

‘Yes but even if the photo is a good, well taken one, there MUST be rules about gaining consent and they MUST be stored correctly and the quality MUST be appropriate and admissable in court. I can sew but it doesn’t make me a good surgeon does it?’

‘And those rules can be found at?’

‘The Institute of Medical Illustrators here

‘I need another drink. A full pint’ said Norm. ‘And less nettles this time. I think I’ll give the Deadly Nightshade a go. A dark mild if I’m not mistaken - four point eighter’.

‘Cheese!’ came the cry from the group at the bar as another memory was taken to be lost for all time – or worse still, not.

How does YOUR organisation look after clinical images in YOUR place of work? Isn’t this something we should be getting alarmed about? Isn’t this something which needs some top-down rules and guidance? Or do you think it is not an issue. Please email your thoughts to This email address is being protected from spambots. You need JavaScript enabled to view it.

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