MyHealthMatters: Medical Defence Union: Doctors warned against sharing photos online

24 June 2013

The Medical Defence Union (MDU) is today reminding doctors of the risks of sharing photographs and other recordings of patients through photo sharing apps and websites, following recent news that one such app has been launched specifically aimed at doctors who wish to share clinical photos.

The MDU, which is the UK's leading medical defence body, has revealed it has received over 100 calls in the last five years from members seeking advice about taking and sharing photographs, audio and video recordings of patients. In some cases the members have received complaints from patients as a result of taking photographs or recordings. The calls received included:

Members who have taken photographs of rare or interesting conditions seeking advice on whether they could share them online for medical colleagues to see.
Specialists wanting to use clinical images for teaching purposes.
Doctors who have been asked to take part in television documentaries, concerned over protecting the confidentiality of patients.

Dr Mike Devlin, head of advisory services at the MDU says,

"There are many circumstances where doctors feel it may be beneficial to take a photograph of a patient’s clinical signs or record a consultation. However, it is important that they have the patient's informed consent before doing so and they must follow GMC guidance on making and using visual and audio recordings of patients.

"If photographs are taken of patients being treated in an NHS setting then it is essential that any applicable hospital trust policies and procedures are followed. This may mean that only clinical photographers are permitted to take photographs of patients. Similar procedures may apply in private hospitals and the onus is on the doctor to find out if there are any relevant policies."

"Where a photograph of a patient is taken and then stored on a smart phone, camera or other digital device it will need to be protected in the same way as would apply to other clinical records or recordings. We advise that such devices used for this purpose are encrypted and if they are not, that the images are immediately downloaded to a device that is and the original image permanently deleted.

"With many doctors now owning smart phones which have access to the internet, the temptation may be to make use of popular or more niche file sharing apps and websites, in order to share photographs with medical colleagues. Although sharing photos in this way may seem like a useful way to gain opinion or discuss medical conditions with like-minded medical professionals, it comes with many risks which are likely to outweigh the benefits. With this in mind, the MDU advises doctors that they should be very cautious about sharing photographs of patients online. If a doctor is considering doing so, they should contact their medical defence organisation for advice on specific cases."

The MDU has published the following advice to members who wish to take photographs or recordings of patients:

When seeking specific consent to record patients as part of their care, explain why it is needed, how it may be used and stored.
If you wish to use it for secondary purposes, such as in anonymised form for teaching, research or other healthcare purposes, this must be explained to patients and their specific consent obtained, making a note of the discussion in the patient’s records.
Specific consent is not necessary to record certain clinical images such as x-rays and images of pathology slides but doctors should explain to patients, where practical, what is involved when seeking consent for the examination, including that this recording may be used in anonymised form for other healthcare purposes such as teaching.
Think carefully before using a mobile phone or tablet computer to take and store clinical images. If the image should ever fall into the wrong hands it is unlikely that you will be able to argue that you had taken all reasonable steps to protect its security given it contains confidential patient information. Such devices should be protected with encryption software.
If you do decide to take a photograph or recording with a mobile phone or tablet computer, make sure your settings do not allow images to be uploaded to the internet automatically through photo sharing apps and websites.
Guard against improper disclosure of recordings made as part of patient care in the same way as you would medical records.
If patients lack capacity, you must obtain permission from someone with authority to act on their behalf for recordings which form part of clinical care. For other recordings, you and the person with proper authority should be satisfied the recording is necessary, in the patient's best interests and that the purpose cannot be achieved another way. There are some exceptions, such as for clinical research, and doctors should seek further advice in these circumstances.
Children with the necessary maturity and understanding can usually consent to recordings as part of their care or for secondary reasons but you should encourage them to involve their parents. Otherwise, you should obtain authority from the person with parental responsibility but you may need to check whether recordings can be used for secondary purposes as young patients mature and attain the capacity to consent themselves. Be prepared to stop recording if a child shows any signs of distress.
Specific consent is usually needed to disclose recordings in which the patient is identifiable, unless disclosure is required by law or can be justified in the public interest such as to prevent a serious crime.
Covert recording of patients is rarely justified and can only be considered with specific authorisation and in line with the law.
Where a patient has died, you should follow their known wishes about recordings made while they were alive although if the patient is identifiable in the recording, you may need to consider obtaining further authority from their executor or family before it appears in the public domain.
Be cautious about agreeing to take part in television or radio programmes involving patients, or to appear in print or on the internet. As well as satisfying yourself that the patients have given their consent, you should check they understand the implications and be prepared to raise concerns and even withdraw your cooperation if you believe the recording is unduly intrusive or damaging to them.