Sharing Patient Images for Medical Purposes
Patient images may only be shared for medical purposes after obtaining explicit informed consent that specifies each intended use (medical record, teaching, publication, or social media), and patients must be informed that refusal will not affect their medical care. 1
Mandatory Consent Requirements
All medical photographs require informed consent regardless of whether the patient is identifiable from the image. 2 This applies to:
- Medical record documentation 2
- Teaching materials and presentations 1
- Publication in journals or online platforms 1
- Social media posting 3
The American College of Medical Genetics emphasizes that consent must be obtained for each specific use separately, as patients may consent to one use but not another. 1
Essential Elements of the Informed Consent Process
The consent discussion must explicitly address all intended uses of the image, particularly electronic publication that may reach wider audiences than traditional medical texts. 2 Key requirements include:
- Show patients the specific images that will be used before any sharing or publication 2
- Explain that electronic publication places images permanently in the public domain and they cannot be completely removed once published 2
- Provide a copy of the consent form with contact information for future withdrawal of consent 1
- Explicitly state that refusing photography or requesting image removal will not affect medical care 2
Critical Warnings About Social Media
If considering social media posting, be aware that State Medical Boards have taken disciplinary action in 56% of cases involving online professionalism violations, and 14% of UK General Medical Council investigations resulted in suspended or restricted registrations. 3
Even seemingly anonymous information can constitute HIPAA violations when combined with date of service, institution, or geographic information. 3 The combination of timing, location, and unique clinical features can allow patient identification. 3
Patient Rights and Withdrawal of Consent
Patients have the absolute right to withdraw consent at any time, requiring immediate removal of images from displays, teaching files, or internet sites. 1 However, critical limitations exist:
- Digital images can be removed from most formats 1
- Print media images cannot be retracted 1
- Clinicians cannot control further use of images downloaded by others from internet sites 1
These limitations must be clearly explained during the consent process. 2
Special Populations
For adult patients (18 years or older), only their own consent is required. 2
For minors (7-18 years), both parental permission and child assent must be obtained. 2
For patients with developmental disabilities, guardian consent with patient assent when possible is required. 2
Common Pitfalls to Avoid
Failing to obtain consent for each specific use of the image compromises patient trust and violates ethical standards. 2 Additional pitfalls include:
- Not explaining that electronic publication is permanent and irrevocable 2, 3
- Neglecting to provide patients with a copy of their consent form 2
- Assuming anonymous images don't require consent - guidelines recommend consent for all clinical photographs regardless of identifiability 2
- Posting on social media without understanding that content is permanent with no control over dissemination to unintended audiences 3
Consequences of Violations
HIPAA violations from improper image sharing can result in medical license restriction, suspension, or revocation, along with fines, litigation exposure, and potential criminal penalties. 3 Professional reputation damage and loss of patient trust are additional serious consequences. 3
Immediate Action if Posted Without Consent
If images were shared without proper consent, delete the post immediately and consult your hospital's risk management and ethics committee to assess potential HIPAA violations. 3 When patients or family members request post withdrawal, their wishes must be respected immediately. 3