Remote Consulting, Remote Images and Consent

Increasingly, GPs are taking photographs of patients’ skin lesions and rashes during the consultation, often using their mobile phones.  This may be to monitor a lesion or condition; or discuss it with GP colleagues, particularly those carrying out the minor surgery for the practice; or share with Dermatology colleagues to assess referral requirements.  The images are also useful for teaching purposes, and occasionally when giving presentations.  The LMC recommends that all GPs taking visual images of any patients, follow the GMC guidance, “Making and using visual and audio recordings of patients”.

With the advent of remote consultations brings video recordings into this scenario as well. As a general rule, remote intimate examinations should not be video and audio recorded and patients discouraged from sending images of intimate parts of their body.  There is a detailed chapter in the RCGP/NHSE  document that looks at this topic. Considerations around consent, both implied and explicit, mental capacity, chaperones all need to be considered and documented. Updated to this, new guidance published in July 2020, is specific to the  key principles for intimate clinical assessments undertaken remotely . It is aimed at clinicians who are consulting remotely with patients through a digital channel (e.g. online, email, text, video-link) across healthcare settings in England.

Key issues of confidentiality and consent apply, and additional guidance is available from the DoH Reference Guide to consent for examination or treatment (2nd edition, 2009).

As with all consent, GPs are advised to provide adequate explanation to their patient of the purpose and benefit of taking the photograph, taking account of capacity, and to ensure that there is no pressure placed on the patient to give their permission.  Appropriate secure arrangements should be made for storage of the image. These details, along with a written statement of verbal consent, should be entered in the patient’s medical record.  If the photograph is subsequently used or shared for a different purpose to that consented by the patient, the patient must be contacted to update the consent accordingly.

When the photograph is used for secondary purposes, (such as teaching), although not a legal requirement, it is good practice to obtain written consent by asking the patient to sign a form, and keep this with the photograph.  Please click here for a sample consent form.

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