Smartphones, doctors and the risk to patient privacy

Do you want pictures of your weird mole or gory surgical procedure on your doctor’s phone next to their baby pictures and selfies?

That’s what’s happening — at least according to a survey by Calgary plastic surgeons of colleagues across the country.

Nearly all used cellphones to take clinical images. Almost threequarters then mixed them with other personal images on their phones. One-quarter had accidentally shown them to friends or family.

The results were “shocking,” said Dr. Matthew Bromwich, a surgeon at CHEO and founder of Clearwater Clinical, which creates devices and apps that harness the power of physicians’ smartphones.

“Twenty-five per of the physicians admitted to having accidentally disclosed other people’s medical pictures — there’s Johnny, there’s the birthday party, oh, there’s somebody’s neck dissection.”

“Which, in my view, is completely unacceptable. I understand why that happens,” he said. "It speaks to the very powerful benefits of mobile technology.”

Doctors want to take and share photos because they’re so clinically useful, he said.

“In my hands alone, it has saved the lives of at least three people I can think of off the top of my head, where the ability to rapidly communicate, share information and get to the crux of the matter and deal with it has been essentially through a cellphone. “So that’s why people do it.” But patients shouldn’t have to pick between speedy treatment and privacy, he said.

Clearwater’s Modica app was created to address those kind of patient privacy issues.

It has a detailed, in-app consent form, separates medical images from other photos in an encrypted camera roll and stores them in the cloud, stripping the data from the phone if it was every lost or shared.

Of course, there’s worse than carelessness. A Victoria urologist snapped a picture of the spot where he’d just attached a urinary catheter as the patient lay unconscious then sent it as a joke to a friend.

University of Calgary bioethicist Dr. Juliet Guichon, who is working on her own research on the issue, cites that as an example of the “heightened scrutiny” that’s needed when doctors bring their own smartphones into the special relationship of trust between doctor and patient.

“If the patient gets more timely access to health care, that’s a benefit,” she said. “But it alters the way that patients interact with their physicians when the physician is taking the pictures on his or her own mobile devices.

“They have to trust — always — but usually there are checks and balances in systems and chances are there aren’t checks and balances on somebody’s phone. Most doctors are trustworthy, but institutions have systems to protect patients from the very rare case where someone is not.”

She points to comprehensive new guidelines from the Australian Medical Association about clinical images and the use of mobile technology, along with advocacy for the health system to come up with a way to securely upload images to patient records.

While three-quarters of the surgeons in the Calgary study said they thought verbal consent to snap a picture sufficed, Guichon argues that patients should be asked whether they consent to their images being used for treatment, teaching or research purposes. A neutral third party should be asking for consent so the patient feels freer to refuse, she said.

The image must be stripped of anything that could identify the subject, such as a distinctive tattoo, she said. And once the doctor takes an image for a specified purposes and with consent, it should move to the public systems that manage health records and be attached to a file that the patient can later review.

“Who has control?” Guichon asked. “It shouldn’t be one person, an individual. It’s not the property of an individual, the person who took the picture. It’s the property of the patient.”