7 Approach to the Patient
This chapter discusses practical concerns related to interacting with patients during the medical photography process. The informed consent process is detailed, and important considerations for maximizing patient comfort with the photography process are explained. Appropriate attire, hairstyle, and makeup are delineated, as are concerns when dealing with cultural issues and patients from potentially vulnerable populations. Procedures for discussing and sharing images with patients are explicated.
approach to the patient, clothing, cultural sensitivity, expression, hair, informed consent, makeup, pose, vulnerable populations
Preparation for the Shoot
It is helpful to approach taking photographs as a “surgical procedure” of its own, with its own risk and invasiveness profile. Prior to taking any pictures, the process should be explained, focusing on the rationale for taking pictures as well as the differences between artistic portraiture and medical photography. While photographs of the head and neck typically do not require the patient to disrobe, they still have the risk of making the patient feel very vulnerable and exposed, especially as they are not allowed to hide behind a mask of a flattering pose, expression, and lighting. Additionally, while the patient’s identity is often hidden in medical photographs of the body (by framing so that the face is not visible), this is not possible with photographs of the face. In the past, many have advocated use of black bars over the eyes, or selectively blurring certain features. This is not recommended as it not only fails to obscure the patient’s identity, but also distracts from the purpose of the image and can obscure useful landmarks and relationships.
It is often useful to warn the patients in advance of the visit that you will be taking photographs, or to schedule a separate visit just for that purpose (Fig. 7.1). Give yourself and the patient enough time to be comfortable and not be rushed, and to ensure that the equipment is functioning properly prior to and periodically during use.
Most patients are very cooperative and willing to have their photograph taken. However, this may not be true for certain populations such as children, the elderly, or those with disabilities. In the case of the uncooperative child, it is probably better to take suboptimal images with a minimum of fighting as opposed to struggling for “perfect” pictures while angering the patient, their family, and the photographer in the process.
For most images, the patient can either sit or stand, but it is usually easiest and most comfortable for both the patient and the photographer to sit on rolling, swiveling stools. If a chair with a back is used, ensure that it is of low profile, such that it does not appear within the image.
Consent and Image Sharing
Informed, written consent should always be obtained, and how the images will be used, shared, and protected must be discussed. A separate photography consent form is best, and it is highly recommended to have a lawyer from your institution’s legal team review the consent form prior to use. If a patient objects to any terms of the consent form, they can be selectively lined out. This most often occurs with patients who do not want their images shared with other physicians or publications, and the patient’s wishes in this regard must be respected. If a patient completely refuses to consent, or wants the critical elements of the consent lined out, their photograph should not be taken and if necessary they should be referred elsewhere for care.