By Peter Accetta, MD
Because dermatology is a visual specialty, we as dermatologists deal with visible problems, including rashes and lesions, whose progress and treatment can be tracked with our own eyes. In dermatological care, therefore, a picture can be worth more than a thousand words. In some cases, it can help save a life. But how many of us are using digital photography in our practices? As an amateur photographer and a dermatologist who makes regular use of digital photography, I conducted some research to find out.
As detailed in this Journal of the American Academy of Dermatology (JAAD) letter to the editor, I surveyed 1,000 randomly selected, board-certified, practicing U.S. dermatologists from the American Academy of Dermatology’s (AAD) membership database. Respondents could choose to answer the questionnaire and return it in the addressed, stamped envelope provided, or respond online. A total of 377 physicians responded.
They were asked whether they obtain digital photographs of patients in their offices or clinics, and how they used these images. The most common indication for obtaining a digital image was to document a lesion. Also notable was that:
- Forty-four percent of clinicians used digital images to confirm biopsy sites before excision.
- Eighteen percent of respondents did not use digital imaging, even though 91 percent reported owning a digital camera for personal use.
- The most commonly reported reason for not using digital imaging photography was that it is too time consuming.
- Twenty eight percent of the non-photographers said that they had no need for it, whereas 18 percent cited prohibitive cost and 21percent reported complexity as a deterrent to use.
Dermatologists in this study widely agreed that the use of photography could improve patient care, but 18 percent of respondents admitted that they do not regularly use photography.
As I noted above, those who do not use photography said it is because it is too complex and expensive. This once may have been true; those of us who remember film photography can recall what it was like to need a camera with a macro lens and specialized flash. Such equipment could be rather expensive. It also took practice and skill to get the right shot, and you would not know whether the exposure was good until the developed photograph arrived a week or more later. Then you would have to label the photos and file them in the corresponding patient records.
Many of today’s cell phones have simple, easy-to-use cameras with resolutions that were available only in professional equipment just a few short years ago.
Digital photography has made the entire process more convenient. Although you can still spend a lot of time and money purchasing and configuring a complex digital photography system, most of us already own cameras that are powerful enough to do the trick.
Many of today’s cell phones have simple, easy-to-use cameras with resolutions that were available only in professional equipment just a few short years ago. If you’re using a computer and own a digital camera or camera phone, take advantage of the equipment you already own and add digital photography to your practice.
During the past 10 years I have used an extraordinarily simple system that requires no specialized equipment and no added software. We prepare a sticker with the patient’s name and date and apply it directly to the patient’s skin, making sure to include one or more anatomical landmarks.
Then, with an ordinary digital camera, I take photos to assess patients’ responses to therapy, to track lesions, or to document biopsy locations.
On my computer, I create a folder for each day and all the photographs I take that day are put into the folder. I also place a note in the patient record to indicate that a photograph was taken. No further notation is necessary.
Even for a busy day, such a folder will contain fewer than 50 photographs. When I need to reference a photo, I merely do quick visual scan of the folder contents. It generally takes less than a minute to locate the desired image.
Of course, there are more advanced systems available, with searchable databases in which photographs can be indexed by patient name, account number, or other identifier, and tagged with additional information. Such systems can be costly and complicated, and more importantly, someone has to take the time to enter all that additional information. Mine is a much more practical and simple system that can work on any computer, whether it’s a Mac or PC.
I hope that the system I have described will help to convince those who are reluctant that using digital photography in your practice doesn't need to be costly or complicated. Develop a system that works for you and that will allow you to take advantage of this simple technology to improve patient care and tracking of your patients’ conditions over time.
Peter Accetta, MD, is a fellow of both the American Academy of Dermatology and the American Society for Dermatologic Surgery. A graduate of Fordham University and the UB school of Medicine, he serves there now as a voluntary clinical associate professor of dermatology.
NOTE: When using a photo system, be sure that your practice's photo storage system is designed to mitigate risks to patient privacy and is HIPAA compliant.
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