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Letter to the Editor
Medico-legal recommendations for the safe use of medical photography in orthopaedic surgery and traumatology
Recomendaciones médico-legales para el uso seguro de la fotografía médica en cirugía ortopédica y traumatología
C. Martin-Fumadóa,
Corresponding author
carles.martin@comb.cat

Corresponding author.
, E.L. Gómez-Duránb,c,d, J. de Casoe,f, J. Arimany-Mansoa,b,g
a Cátedra de Responsabilidad Profesional Médica y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
b Área de Praxis, Servicio de Responsabilidad Profesional, Colegio de Médicos de Barcelona, Consejo de Colegios de Médicos de Catalunya, Barcelona, Spain
c Facultad de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
d Clínica Galatea, Fundación Galatea, Barcelona, Spain
e Sección de Urgencias, Servicio de Cirugía Ortopédica y Traumatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
f Departamento de Cirugía, Universitat Autònoma de Barcelona, Barcelona, Spain
g Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of medical photography &#40;MP&#41; for diagnostic purposes&#44; medical-healthcare follow-up&#44; teaching or the transfer of knowledge is currently essential in medical practice&#46; Indeed it may be stated that MP has universally become an integral part of daily clinical practice&#44; particularly in specialties termed as &#8220;visual&#8221;&#44; such as dermatology&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> plastic and repair surgery or orthopaedic surgery and traumatology &#40;OST&#41;&#46; There have even been proposals for the standardisation of MP in OST for scientific publication purposes&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Today&#39;s use of photography for medical purposes has also increased enormously due to the mass market and universal use of instant messaging platforms for smart phones&#46; Thus&#44; a recent survey demonstrated the generalised use of WhatsApp&#174; for medical healthcare purposes among OST specialists who considered it as a useful tool in taking therapeutic decisions&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> often making use of photographs or imaging tests through this application&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Thanks to the ever-increasing demands we believe it is essential for professionals to receive some basic recommendations for the safe use of MP&#44; taking into account the legal&#44; medico-legal and deontological framework to be applied&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">With regard to MP&#44; we must first distinguish the actual management of it and this should be the same as any other document generated in the care process&#44; and should therefore compulsorily be included in the medical record&#46; In healthcare centres&#44; the MP filing&#44; preservation&#44; maintenance and safety of access is the centre&#39;s responsibility&#44; whilst in the case of healthcare professionals who act independently they themselves are responsible for the management and custody of the documentation involved&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Secondly&#44; with regard to the actual use of MP&#44; we can differentiate between 2 different layers of legal protection which should be assessed&#58; on the one hand&#44; the fundamental right to protection to the actual image &#40;regulated by Organic law 1&#47;1982&#41; must be adhered to and on the other&#44; personal data protection &#40;regulated by the European Union 2016&#47;679 General Regulation on protection of Data and its adaptation to the said regulation according to Organic Act 3&#47;2018&#41; must also be adhered to&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">With regard to personal data protection it is important to underline that there have recently been legal modifications that strongly condition the way in which the professional may act&#44; establishing demands which govern the cases of&#58; &#40;a&#41; obtaining or taking photographs and their incorporation into the patient&#39;s medical record&#44; and &#40;b&#41; the possible exposure of the photography for teaching purposes or for scientific publication&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the taking of or obtaining of photographs&#44; few legal doubts have arisen regarding the photograph being treated as one more element&#44; like any other complementary proof of a medical-healthcare procedure&#44; included in the patient&#39;s medical record&#46; However&#44; although it is not legally necessary&#44; to guarantee absolute transparency of the medical activity&#44; it is advisable to offer information about the purpose of the photograph&#44; and about aspects relating to data protection and the incorporation of that photograph in the patient&#39;s medical record&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Furthermore&#44; regarding exposure for teaching purposes or for scientific publication of a photograph which result from the professional activity of an OST specialist&#44; we have to also distinguish 2 cases of different legal treatment&#46; The first concerns the situation in which the photograph cannot identify the patient &#40;not even from the additional information provided when the photograph is exposed&#41;&#44; and the second refers to the situation in which the patient may be identified from exposure&#46; When the photograph does not allow for identification of the person&#44; no type of authorisation is required&#46; However&#44; when the patient may be identified&#44; directly or indirectly from additional information&#44; we must be given express authorisation for that exposure&#44; and this must be as specific as possible &#40;indicating the specific photograph to which authorisation refers and its authorised purpose whether this be&#44; for example&#44; for university teaching or continuous training&#44; scientific publication&#44; etc&#46; purposes&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally&#44; when the legally regulated concept of identification is unclear and in cases when the professional doubts whether the photograph allows the patient to be identified or not&#44; we would recommend obtaining the corresponding authorisation from the patient&#44; when posterior exposure of the photograph is planned&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Level of evidence</span><p id="par0050" class="elsevierStylePara elsevierViewall">Level of evidence V&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Martin-Fumad&#243; C&#44; G&#243;mez-Dur&#225;n EL&#44; de Caso J&#44; Arimany-Manso J&#46; Recomendaciones m&#233;dico-legales para el uso seguro de la fotograf&#237;a m&#233;dica en cirug&#237;a ortop&#233;dica y traumatolog&#237;a&#46; Rev Esp Cir Ortop Traumatol&#46; 2021&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.recot.2020.06.015">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;recot&#46;2020&#46;06&#46;015</span></p>"
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                          "etal" => false
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                            3 => "J&#46;M&#46; Mascar&#243;-Ballester"
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Article information
ISSN: 19888856
Original language: English
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