This article addresses a common ethical dilemma in modern surgical practice: sharing clinical photographs via mobile devices. To help surgeons and surgeons in training better understand
and address the ethical considerations surrounding
the exchange of clinical photographs with colleagues,
the authors examine the following: the level of consent physicians should seek in these scenarios, how
photographs may infringe upon patient rights to privacy and confidentiality, physician responsibility to
uphold patient privacy, and security issues associated
with the clinical use of mobile devices.
This article describes a common scenario in
which a resident is seeking the advice of an on-call
surgeon to consult on a patient case and is asked to
share a photograph of the patient’s injury. Possible
approaches to this dilemma are described, as are the
ethical issues that need to be considered in choosing
one option over another.
The case and alternative approaches
Consider the following example: A fifth-year surgical resident working in the clinic evaluates an adult
male construction worker with moderate hand trauma.
The resident believes a consultation with a plastic and
reconstructive surgeon (PRS) is necessary and contacts
the on-call surgeon in that department. The resident
gives the on-call PRS the history and physical exam
details over the phone. The PRS consultant then asks
the resident to send him a photo of the hand trauma
via text message to get a better understanding of the
extent of the injury, the underlying damage, and the
urgency of the case. This institution has no guidelines
or policies in place regarding transmission of patient
photography via a personal mobile device.
Some possible responses to this situation include
•Option 1: The resident takes several photos of the hand
injury with a personal mobile device and sends the
photos via text message to the PRS.
•Option 2: The resident obtains informed consent from
the patient and continues to carry out the steps outlined
in Option 1.
•Option 3: The resident obtains informed consent, takes
several photos with a personal mobile device, and e-mails
the photos to the PRS using a secure hospital e-mail
• Option 4: The resident tells the PRS that he is uncertain
regarding the risks associated with photographing the
patient and does not want to cause any unintended harm
to the patient, hospital, or himself.
A closer look at the options
Option 1: The resident takes several photos of the
hand injury with his personal mobile device and
sends the photos via photo text message to the PRS.
The primary issue in Option 1 is whether the resident
should obtain consent to take and share the clinical
photographs that the consulting surgeon has requested.
In current clinical practice, the spectrum of patient consent ranges from patients being completely unaware of
the care decisions their treating physician is making to
participating in shared decision making. Between these
alternatives are several variations. For example, the
physician might make the patient aware of the plan of
care, offering limited but sufficient information, and/
or an opportunity to object or ask questions. 1 No single
variation on the spectrum is inherently or categorically
more correct than another.
Physicians acting at any point along the spectrum
may be practicing ethical medicine, but their actions
must be justified by the clinical context. For example,
a number of everyday tasks, such as ordering a complete blood count, often are performed without much
patient discussion. These types of clinical tasks are typically low-risk, routine hospital orders. On the other
hand, when several management alternatives could
Arguments that clinical photos are part
of the private medical record also raise
the question of who owns the photos:
the hospital, physician, or patient?