While I agree having a patient photo in file will reduce the potential for fraud, I can only hope this doctor had the express permission of each person to post their picture and I don’t mean some disclaimer language buried in the fine print of the reams of papers we sign at the doctors office. If not a HIPAA violation then is at least unethical.
@Darlene Hi Darlene, If you mean the images in this story, they are not the patients...these are stock photos from Getty Images.
2
I went though two years of caring for my young husband with cancer. I find this article disgusting. Stop screwing around and find the cure for cancer instead of waxing sentimental about photos of people you don't know. They don't want to know you, I can assure you. You are only in our lives because you pretend to have a cure or answers. The jig is up - my five year old lost her dad. He was saving his smiles for his family not some idiot who thinks that his going 4 more years of school makes us impressed. Between my husband and myself we have Phd's and masters in math and science field. Not impressed.
4
Something not mentioned in the article or in the comments I have read is that these pictures can serve as a security feature. One of my family members had their identity stolen, and this person use the stolen ID to register as my family member for medical care in another office of the very same physician practice. The picture in the chart would have exposed this fraud immediately. As it turned out, the fraud was exposed when the real family member came in for care and was asked about visits she had no knowledge of.
3
Why not just have frank and open communication with each and every one instead of maintaining a distance trying to divine their individual humanity? What is good bedside manner that a patient needs from a doctor? It seems like you are intellectualizing a sort of wistful interpretive not-knowing. How do you deal with the real eventuality of a patient’s death and then their actual death?
I know a physician who planned to be a pediatrician, but became an ophthalmologist after losing a young patient.
3
Thank you for the sharing. I found interesting and thought provoking.
4
Shame! Requesting pictures of those who are perhaps at a most down and out place in their whole life? Talk about insensitive! We’re not robots!
8
@MIMA These people are in it for the money and prestige. When my astro-physicist husband, from Germany came for treatment at the end of life - he told them what he thought - Where is the cure? and that it was disgusting that after 15 years of surviving cancer he was getting the same treatment- chemo. He saved his smiles for our four year old, not some ...... in a $300 suit trying to act like he / she cared. Most medical people were obnoxious, vain, and a joke.
1
I find pictures like this to be highly intrusive and I hope you ask for permission before taking them, much less publicizing them.
I refuse to be photographed this way.
9
@Another Human Being, that ER doctor and medical resident violated HIPPA laws and put themselves at risk for losing their licenses, being fined, and imprisoned. Everyone who works in any medical facility goes through annual training on HIPPA and its implications for practice and privacy. What that doctor did was unethical and illegal.
3
Indeed it was grossly improper. As are the clinicians who discuss clients, without names, but with plenty of details, while sitting in a cafe with colleagues -- and, unbeknownst to them, but predictably if they bothered to consider it -- a coworker, neighbor, and family member of the client, who knew enough about the client to figure out whom the clinicians were discussing, but still learned quite a lot by listening to parts of the conversation, much to the detriment of all involved.
Similarly, the clinician who leaves client files in unlocked cabinets, drawers, or containers, thinking that locking a front door to an office is enough security but forgetting that the cleaning crews have unsupervised access, as would anyone else gaining access to the office, lawfully or not. And similarly clinicians who do not segregate and encrypt individual electronic folders for each client-patient, rather than clump the records of numerous clients-patients in one "Records" folder. Or who neglect to write a "professional will" that instructs family and executors to refrain from opening or looking at clinical records, including billing records, but instead hand them to a designated professional colleague who is also bound by the laws and responsibility of guarding privileged information which, in some fields, includes even acknowledging to third parties that the patient is known to the clinician unless the patient has consented to such. If photos are in the files, the risk is higher.
2
Yes, people working in healthcare settings receive HIPPA training (except some private practitioners forget or neglect to train staff, including janitors) and sign a promise to follow its requirements. Unfortunately, in my experience, that does not stop some immature, over-curious, careless, and/or disgruntled or otherwise vindictive employees from revealing and even making fun of patients with fellow employees who have no legitimate need-to-know, with friends, family members, dates, or random acquaintances. If they also have seen photographs of the patient's face or other personally-identifying features, they will be empowered, if unethically, to point out exactly whom they are gossiping about.
Brrrrr, chilling. And have seen it happen. Too many times.
So many bitter, angry, distrustful letters here. It's very sad. I hope my patients trust me and my colleagues better than those writers seem to trust theirs. I care very much about my patients. So do my colleagues. I suspect my patients know it. I hope they do.
28
@Dan Urbach
I distrust you all.
1
@Ivy Thank you for having the courage to stand up to these idiots. I know several on a personal level and they have good memory skills but poor science skills. Half should not be in medicine.
2
The funniest picture in our EMR was a fake/test patient who had the picture of Gollum as their ID photo.
6
My husband’s Epic photo is a picture of his favorite cat.
1
There is a thing called physician burnout. We get tired of EMR getting rammed down our throats- this isn’t what we imagined we would be spending our time doing.
The photos are nice. When Im at home, on my own time, trying to finish my patients’ notes after my kids have gone to bed, the photos are nice. They are humanizing. ...They remind me why Im up late, on my own time, trying to finish my patients’ notes.
I think some may have misinterpreted the sentiment shared in the article. We didn’t decide to start putting the photos there. We, like our patients, are trying to make sense of this curious humanity that popped into the upper left corner of our digital toils. We’re thinking about that humanity. Concerned for it. As if we could will out a genuine smile. If only.
40
As a lawyer, I take photo ID at our first meeting. Could you imagine that I prepare a last will and testament for “Jane Jones,” but thee are not she? That said, I am troubled by use beyond the intended scope.,
4
What measures do you employ to ensure the photograph is not shared or accidentally revealed, including to staff, and including after a client is no longer yours? Both any printed photo and any digital remnant of it?
Furthermore, while a probate/wills and trusts practice (faithfully, accurately, and ethically engaged in by thousands of attorneys prior to the advent of photography and of the ease of digital photography) may not task you with keeping secret some truly endangering information, the practice of, for example, criminal law probably does.
I absolutely always go first to the snapshot picture in Epic when I first open the chart to review before meeting the patient preop. I find it incredibly valuable. Pictures tell a thousand words ....usually. Others may go directly to the labs. I helps me see the person so when I meet them I can begin to let people know that I've already been thinking about their life and their problems. Sherlock Holmes just needed to see your fingers. Henry Higgins needed to hear one word. Epic goes so much further because It shows their address, the various phone numbers they have or don't have , loved ones etc etc. Of course it helps to actually know your town or the surrounding places that refer. Lots of us complain about the way the EMR has seemingly hijacked medicine. But in this case I'm all in.
10
@Mrf
I do NOT want my picture in your records, or mine. Intrusive and a violation.
4
I recently started a new job as a provider in a system that routinely photographs my patients for their electronic record. I work in critical care and often times take my patients sicknesses and end of life issues home at the end of the day. I have found that these pictures are so bittersweet—they provide a snapshot of my patients during a better time, but are also a vivid reminder of their current complicated situation. Unfortunately it has had an emotional impact on me; I care about my patients deeply so I take my patients sicknesses and mental pictures home with me which makes it difficult to put work aside.
8
Facial Recognition matches are sold to who? This is not going to be as wholesome as this MD suggests. HIPAA or no...there is a profit model somewhere for these faces.
11
@WCT
Sold to google, if not already.
2
Heavens to Betsy! What an invasion of privacy - I have been appalled and consistently say "ummm - I think not" - as this over-stepping seems becoming pervasive. Yikes! What next?
11
These are HIPPA protected— cool the jets
Actually, health care fraud is a major expense and these photos reduce that issue.
5
@T
Actually, they can be stolen or sold.
4
@T
Healthcare fraud perpetrated by patients (as opposed to that perpetrated by healthcare providers or others such as pharmaceutical companies or medical billing agents, etc) doesn't tend to happen in smaller practices. Could it be that the trend toward conveyor-belt, corporate managed-care medicine has allowed or required practices to become so big and/or so impersonal that not only does identity-related fraud become more possible, but lower-quality care as well?
I'm a bald woman (no, not cancer) photographer and take photos of myself from the eyes up, with various things balanced on my perfectly smooth round head. Bored while waiting for my doctor one day I stretched a rubber glove over my head so I looked like a rooster and photographed from the eyes up. When my doctor saw the photo, after he finished laughing, he asked if he could make it my official medical record photo and I was glad to agree. It tells my doctors and medical staff that I'm a bit of a nut and have a sense of fun.
21
I’m so used to being photographed for liability purposes — at the med spa, at the dentist — that I probably look skeptical any time I am told to pose for a head shot for my file. I have a horror of being photographed anyway, for the same reasons the writer cites.
4
I am a physician and I love the photos of my patients. I am fortunate to have a great luxury of time with my patients, but still cannot do instant recall of who they are when answering a phone call or getting ready to see them in my office. My notes help but the picture gives me a memory of the person. I believe it is more humanizing not less. I have many patients with the same or similar names. I have patients who call me with a question two years later. And those are stock photos, none of my EHR photos come close to having such good lighting, central images, let alone greenery in the background
18
Fine, tell your patients how it helps you, maybe humanizing yourself by admitting to them your mild impairment remembering faces, and ask them if they would mind your having a headshot of them for your records - preferably kept separate, for security and privacy sake, from their actual, detailed medical record. Keep in a separate book or file of patient's names and pictures that you can reference when about to view their detailed record or meet them in clinic or OR.
But for the love of the Hypocratic Oath, don't use those photos for a pet research project or a publication or presentation (that, admit it, also functions as a form of self-promotion and/or promotion for your clinic or health care practice/system.). And most certainly, don't do it without their fully-informed and freely-given advanced consent.
10
I hope that all of those whose photos appear in this article agreed to have them printed.
I would not. The United States completely lacks sensible privacy standards, but in the face of overwhelming odds I value my privacy and anonymity, and would like to preserve it.
10
@ms The photos are from Getty Images, so they're stock photos. No actual patients represented.
18
@ms The photo credit is given to Getty Images, so it seems to be a stock photo. As a medical professional, that’s the first thing I looked at. HIPAA!
8
@ms, look at the credit at the bottom of the photo grid. It says “Getty Images.” That means those are stock photos.
5
For those afraid of their images somehow being the sole reason they are later turned down for health insurance or whatever - it wont' make any difference. Your vitals are what they want - not your mug shot.
I actually don't mind my photo being part of my medical files. I want my doctor, pathologist, radiologist and any other medical provider to know he/she is caring for a real person - not a list of ailments.
Funny - when I first began reading the article, I thought maybe the photos revealed something more about the patient. Maybe those photos can be used to shine some light on statistical outcomes. How do reactions to having one's photo taken shortly after diagnosis predict patient survival rates?
4
From your description, these patients consented to having their photograph taken and attached to their electronic medical records as a safety precaution meant to reduce the risk of risk of errors made to their charts (records), not as a tool or data source for research. Your use of their pictures for purposes other than those specifically consented to by each individual patient is in my opinion a violation of human-subjects research protocol and ethics.
I've worked in the oncology field and have numerous friends/family members who are or have been oncology patients. While your aim may be to further aid your patients, using, writing about, publishing articles about unauthorized use of photographs of them, without their detailed informed consent (which would include them signing off on an affirmative opt-in, not require them to pro-actively opt-out, and your stating in writing to them that their choice whether or not to participate in the specific research project will not in any way impact your relationship with or treatment of them) is problematic.
Your article's interesting, and your desire to better understand your patients' mentality about their physical condition is laudable. But you could easily and more accurately down so by speaking with and observing them in person. If you planned to publish or publicly discuss your findings - whether individual or group, anonymized or not - you ought to have respected the patients' dignity by getting informed consent first.
5
@Human Subjects Matter
I fail to see how this can be construed as "research."
2
@ John
"I found myself wondering whether these snapshots might give me further insight into how they viewed their medical conditions."
In other words, he was trying out his theory that his patient's photos relate to how they think/feel about their medical condition. Trying out a theory is another way of saying "research."
4
As a pathologist, I appreciate patient photographs very much. I don’t have a chance to meet my patients personally, but I care about them all the same. One of the hardest diagnoses I ever had to make was of an advanced cervical cancer in a young woman whose chart photograph showed her with her young child sitting on her lap.
Photographs humanize the medical chart and I do hope people continue to agree to have them taken.
46
One of the kindest physicians I came across while helping my dad through his cancer treatment was a pathologist whom I never met in person. We talked on the phone several times regarding a second opinion of my father’s diagnosis and he was very supportive and informative. I am forever grateful to him for his sympathy at a very difficult time.
Thank you for being so dedicated. It’s important. It made a difference to me.
15
Nope, you're not taking my photograph, then placing it in a system accessible by corporations who can determine my insurable status, employment desirability, etc. Will the school hire a teacher being treated for HIV? Will the bank lend to someone undergoing expensive caner treatments? Just imagine what advertisers would send to people if they knew the details of their health status. And don't tell me the data is at all confidential. It's available to anyone for a price.
46
This article reminds me a bit of a gathering I was at a few years ago, when out of the blue, an emergency room doctor present who had also been a family doctor in the past, whipped out his phone and started showing folks photos he'd taken of a patient's opened abdomen and gut, laughing and talking about how much it had smelled. The patient's (person's) name was not attached nor could the person's face be seen, but it still struck me as grossly disrespectful and a violation of privacy and dignity. It and in some way this article called to mind the incident of the doctor (a medical resident?) snapping and posting a picture of himself next to a female patient's spread legs and visible genitalia, and of the poor family who had to witness their husband's/father's last moments as he was rushed into the emergency room on a nationally-broadcast television series to which he nor they had explicitly agreed to participate in.
I get that the doctor writing this article is coming from a very different place, but did he bother to think that some of his patients might not feel comfortable having descriptions of their images publicly-shared?
I know I'll never feel the same as an emergency room patient ever again.
12
I hope the HIPAA police don't come after you for showing that montage of patient pictures.
We are getting hysterical about "privacy". Doctors have always respected the confidentiality of medical information, and we don't need a legally-imposed additional paperwork burden.
7
@Jonathan Katz I'm fairly certain those are stock images, as they all seem professionally lit. Can't imagine the author would use actual patient photos
35
@Jonathan Katz - If you right click on the image and search Google for that image, you will find that it comes from Getty Images and is a "stock photo" collage of human faces. The people whose faces are pictured are not the patients referenced in this article (unless by fantastic coincidence), but rather individuals who consented to have their photos taken for use and publication in stock images. I presume they were paid for modeling, but in any event they signed all needed consents for their images to be used for commercial, illustrative purposes, or you would not see the credit to Getty Images.
12
@C
I used to work at the Clinic and, believe it or not, the oncology department is in the basement of a modeling school...
1
I was startled to have my picture taken at a routine exam at the dermatologist. I allowed it but reluctantly. No reason given. I should have said No. I guess vaguely intimidated by white coats. Would not allow now.
21
A very important point -- about the subtle intimidation of the white coat. Healthcare professionals need to recognize and remember that they are in positions of power in relation to their patients and patients' families. Indeed, their patients' health, safety, and welfare, even their very lives, are substantially in the hands of their healthcare providers.
In my opinion, it is a violation to write about patients or to use information about them (including how they appear in photographs) without their direct and detailed, non-blanket, informed consent. (The author makes no mention of seeking or receiving specific informed consent with all the proper assurances to patients that they will suffer no harm if they decline to participate.)
How upsetting to patients or their survivors to discover descriptions of their (the patients) likeness published anywhere, let alone a major daily newspaper, and because the doctor-author's name and workplace appear with those descriptions, patients, families, even possibly neighbors or coworkers may well be able to figure out who is being or likely is being referred to in the article. This article could have a sort of chilling effect on patients, discouraging them from taking advantage of the alleged* safety benefits to patients of facial likenesses attached to medical records, and/or eroding their trust.
*Has it been proven -- has it been shown by rigorous, peer-reviewed research -- that such a practice is significantly safer for patients?
4
@MMAI
"How upsetting to patients or their survivors to discover descriptions of their (the patients) likeness published anywhere"
As has been noted by other commenters, the stock photo at the start of this article is from Getty Images - it is only there for illustrative purposes. No patients have been harmed by posting that photo here.
4
@ The Real...
MMAI did not refer to the photographs in the illustration, but to the written descriptions of patients and their physical appearance on the photographs the doctor keeps with their detailed health records.
1
As a senior technologist, I would refuse to have my photo taken and inserted into my records. I have no photos of myself on Facebook or any other social media.
Systems get hacked. Medical systems are particularly valuable to hackers. I don't want my searchable photo associated with medical history.
I also dislike that Driver's License photos are used by police and others to match with video footage on the streets. I'm not paranoid, just more realistic than most on how our privacy is ever-increasingly violated.
21
Much of the problem in the EHMR is the de-personalization inherent in gobs and gobs of data. Any little inking of humanity in this medical tower of babel is reassuring. As a physician, I often look at the pictures and what has been captured, at what moment and why. I have never been in a situation where I need that photo to make sure I have the right person or am in the right chart - the photos in a way are too tiny and obscured to make "facial identification" a thing.
8
@Littlephila
The electronic medical data are bad, misleading and inaccurate.
I am fortunate that I move often enough that they cannot catch up to me, and if asked I refuse.
This is beautiful. Your humanity and decency shine thru. More, please.
16
Huh. I found the doctor's little project and article about it a bit creepy.
The guy is an hematologist-oncologist, not his patients' therapist or social worker. And if he's truly interested in how his current or former patients think or feel about their condition, why doesn't he do the truly humane thing, and ask them? Why rely on guessing at the meaning of facial expressions in photographs taken for a completely different purpose?
If my doctor wants a pic of me to remember me by, he can ask me or, if I'm deceased, my next of kin, for one; and I might ask for one in return from someone who played/s such an important role in my health and life. Without that genuine respect and honest connection, I'd rather my doctor gaze long and hard at my test results and clinical observations and notes in my medical record, not gaze for extended periods at a perfunctorily-taken photo of my face. And rather than spend time and energy trying to guess at how I'm doing psychologically from such a photo, I'd rather my doctor spend the time and other resources studying up on my symptom constellation and existing and forthcoming medical literature and other information regarding whatever diagnosis those symptoms point to and how to treat it.
Otherwise, just "Eeeew"
7
It's nice to hear your thoughts on this from the other side, so to speak. I immediately swapped out the "registration desk photo" for something more personalized. I get comments on it now and then. I think it really does humanize me in someway. I didn't expect that..
13
Your piece highlights the essence of doctoring;
“How can I help YOU today?”
Even in these days of EHR HMO ACO MIPS
This is what a doctor does for sick and worried people.
Thank you.
15
I like to call doctors "Health Care Providers" to their faces. The reaction is priceless.
13
Yes, our hospital administration likes to do that too.
2
@Mark why? What Joy do u get out of telling a fellowship trained physician with up to 12 years of post undergraduate training that they and a medical assistant are "health care.probiders". Does it make your interactions better.
3
@mrf I believe Mark is using irony.
1
I'm sure your patients' experience is much more tolerable with your caring about who they are, and how valuable for the medical professionals who train with you to learn the importance of this. In moments of high stress I used to sometimes close my eyes and call up a visual image of my late husband's similarly caring oncologist, hear in my mind his steady warm voice explaining things to us, and regain calm. He kept us both relatively sane through impossible times.
28
You truly seem kind & caring
which goes a long way especially
for people who are in “cancer-world”.
It is touching that you observe the
photos of your patients & remember
them & see them as humans
who love sunshine and their dogs.
All best to you, Dr. S!
13
Frankly, I'd prefer to be treated by a physician who knows who i am without a photo reminder. I get that this is the new normal, with doctors carrying impossible patient loads.
Still, no photos, please.
How sad that the medical profession needs patient photos to remind them that they are caring for real human beings, and that we lead lives outside of our appointments and treatments - and to be sure they are treating the correct patient.
19
It’s also for two other reasons
1)Many patients have the same name (e.g Maria Rodriguez)
2) To reduce fraud from someone using someone else’s insurance card.
28
You might have one oncologist, but they have many patients. I want the doctor to be sure which patient I am.
13
I still remember the shock of seeing my photo years after I had completed treatment. Sitting alone in the exam room, I had idly opened my medical file. The photo had been taken in the throes of chemotherapy and I'd forgotten how sick I looked and was. I welled up with such tenderness and compassion for that terrified young mother staring back at me and I wished I could reach back and hold her close.
64
an excellent portrait of a human side of medicine. ah, thank you, Doc Sekeres.
37
If Dr. Sekeres typifies the sort of doctor projected by the articles he writes for the NYT, then I can see why the Cleveland Clinic has such a stellar reputation for its physical and emotional quality of care. Such physicians are in my experience, not common.
Dr. Sekeres' snaphots of medical practice are fascinating and touching.
52
With a recent diagnosis of breast cancer , I was asked by my radiation oncologist if they could take my photo at the front desk as they took it.
I have no idea how this helps anyone. They also took pictures of my breast that I resent and did not consent to.
Today they confused me with another patient as I readied for someone else’s dose of radiation. After 4 weeks of daily radiation nobodyF knows who I am or recognised me. I think think the author is unusual. The array of medical
specialists I’ve been forced to see thanks to cancer, all demonstrate they don’t care who I really am, and have never asked and there is no time for anything but the most rushed and false pleasantries between two people one of whom hates loathes and detests the other for what they represent and the power they yield. I would like my photo deleted. There is a power imbalance and I did not consent freely or without duress.
The article just made me feel sad and pathetic.
55
@Moon Ray Tell your oncologist you would like your photograph deleted. You might also mention you could use the name of a good counselor to help with the way you are feeling now. You are undoubtedly not the only one upset after 4 weeks of daily radiation and a breast cancer diagnosis. I hope both the radiation and counseling help.
24
@MoonRay - It sounds like you have some feedback your physician and his/her staff may need to hear. It seems like I get some sort of survey on “how did we do” everywhere I go lately. Whether you specifically get asked about your experience with them or not, you, or a friend or family member, have the opportunity, and the right, to give polite and specific feedback on how you were treated at a very vulnerable time, once you feel up to it. And if you want to.
20
@Moon Ray When I entered the radiology treatment room the photo appeared on the screen for the technician, and presumably me, to ensure they had the correct patient. This was in addition to calling me by name, and asking for Name, Birth Date, and reason for treatment.
7
Thank you for this commentary. I too work with an EHR with photos of my patients. In retrospect the software engineers may have (un)intentionally inserted a bit of humanity into these programs ... A reminder of why many of us went into medicine. To care for people and improve their lives.
31