Can We Ask Patients to Send in Photographs of their Physical Concerns?

NHS Guidelines

Yes, you can. Clinicians may find that it is necessary to ask patients to send in photographs of areas of their body that are causing concerns or have a remote consultation to review the relevant area of the body. Whilst this can be important for healthcare purposes to ensure patients are still receiving the care they need whilst maintaining virtual consultations as much as possible it is necessary for clinicians to determine on a case by case basis whether such requests are necessary and justified.  

  

Therefore, practices can ask patients to take a photograph of the area of their body. This can be uploaded to the patient’s medical record as it allows clinicians to maintain factual information upon which decisions were made. When determining whether to keep any photograph, a clinician should undertake a brief risk-benefit evaluation to determine whether the risk to any future distress is outweighed by the need to retain a particular image in order to understand why they gave the advice they did.You do not need patient consent, but you should let the patient know a record will be kept. If there are any identifiable features within the photograph, where possible, these should be cropped out before it is added to the patients record.  

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Additionally, where a photograph of an intimate area is required that may cause more harm if a breach were to occur, practices may wish to destroy these particular images and write a detailed description in the records, similar to how it might have been done with a face to face consultation.  For intimate areas it is unlikely the need to retain would outweigh the risk to future distress which is why we advise deleting these once a detailed description is taken.  

 

Whilst you do not need consent to store an image, if a patient expresses in a remote consultation that they do not want an image added to their medical record this should not mean the consultation should end. Detailed description can be achieved in a similar way to face to face consultations. Alternatively, you could ask to have a photo to examine and then delete as opposed to adding to the record.  

  

We advise that where possible a secure method such as AccuRx, TPP Airmid App or other reviewed apps such as Hospify are used to ensure the information is encrypted in transit. Where this is not possible, patients can be asked to email in the photograph, however they must be made aware there is a risk of interception due to the email not being encrypted. 

  

We advise that, in order to minimise the risk of identification in the event of interception, patients should be asked to only include their NHS number in the subject line / body of the email. They should not provide their name, DOB and / or address as identifying means. 

Practices should avoid having photographs sent to a shared inbox where possible. Once photographs have been processed, they should be deleted from the inbox.

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Additionally, practices should add the following to their privacy policy and direct patients to this when asking for the photograph: 

  

During COVID-19 we may ask you to send a photograph of you bruise / skin condition that you are concerned about whilst we conduct virtual consultations. This photograph will be used by the clinician to determine any medical treatment necessary and may be added to your medical record where it is deemed necessary.  

Please note that, where this is sent via email, it may not be secure we therefore we ask that you only include your NHS number alongside your photograph in the email. The photograph should only be of the area requested and no other person should be visible in the shot. 

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