Sexual Assault

10 Things: Photography

When training lawyers, as I was yesterday, one topic we always discuss is photography and the pros and cons of taking photographs. Particularly genital photographs. I have found both prosecutors and defense counsel have some very specific opinions about this, and I love to have that conversation. But in the course of yesterday’s conversation, I realized that I, too, have some pretty strong opinions on the subject I figured I would share. Now, I am keenly aware that many of my colleagues outside the US have forgone genital photography entirely, but since it’s still commonplace here, and because I review a lot of injury photos as part of my job consulting on cases,  I’d like to offer up a list of 10 Things I’d love clinicians to consider when using photography in practice. Mind you, these really are strictly my opinion, so take them for what they are–a jumping off point for further discussion on the topic.

1.) Learn how to use your equipment. If you are taking blurry, poorly framed photos, it’s time to log some hours getting better with the equipment. And program managers? Photography is one aspect of medical documentation. Just as you wouldn’t let your team members slide on a badly written record, nor should you excuse folks who can’t take a quality (read: clear) photo.

2.) With that in mind, worry less about having the nicest, shiniest, most expensive camera equipment, and worry more about having equipment everyone can learn to use. Five figure camera equipment does no one any good if your staff is too intimidated to use it. Find the intersection between providing high quality photos that can be magnified to a reasonable size for court purposes and a user-friendly set up, and start there. If your team is chock full of photography wizards (and you have no serious budget issues that threaten your sustainability), then go all out and spend 20K if that’s what you want to do. But for the love of all things holy, make sure everyone can use the stuff.

3.) Feel free to keep images of a patient’s face and images of a patient’s genitalia in separate shots. I never need to review a photograph again where I can see both the patient’s face and genitalia in the same image. There is little that screams “I don’t spend a lot of time considering patient privacy issues” as loudly as this practice.

4.) Do not take any patient photos with your personal iPhone or other cell phone camera. Ever. This came up at the photography symposium in April, and a prosecutor, a defense attorney, and a hospital lawyer all  made it clear that this was a very foolish idea. Which I listened to incredulously–not because I didn’t agree with them, but because I couldn’t believe we even had to address this.

5.) Make sure your photos match the written documentation. If the photo is a shot of a patient’s eye, but you note that that particular photo is a shot of the patient’s leg, you just look sloppy, and that’s unnecessary. It also makes it appear that your program’s quality assurance process is lacking. That’s a vulnerability you just don’t need on cross-examination.

6.) Let there be rhyme and reason to your photos. I’m always confused when there are pictures of some injuries, but not others. Likewise, I am perplexed when I see that photos of the bruise on the buttock were taken with and without scale, but the bruise on the deltoid was not. It looks disorganized and, well, sloppy.

7.) Have policies and procedures that guide your photography. Make sure they keep pace with any changes in equipment, and that they address storage and release, as well. Consider addressing the different patient populations you serve–if you take care of pediatric and adult sexual assault patients, does one general policy adequately reflect the needs of both groups, or do you need to break it down a bit?

8.) At a minimum, keep a copy of the photos as a part of the medical record, even if you also release a copy to law enforcement. This is medical documentation, not just evidence of a crime. You would never complete the written record and hand the whole thing over to another agency without also maintaining the original; the same should be true of the photos.

9.) Can we talk about the routine use of the long-range, naked shot? I know there are times where a long-range shot is both necessary and helpful, but that’s not every case, and it probably isn’t even most cases. And also, see #3.

10.) Among your team and with other trusted professionals, keep talking about the issue of photography, holding the patient at the center of the discussion. As a profession, we are evolving in our attitudes and practices, and this is one of those areas that’s going to continue to change shape as technology and philosophies evolve.