Leave photography to photographers

August 1, 2005

If I had wanted to be a professional photographer, I would have foregone the 10 mind-numbing years of medical school, internships and residency training, bought a camera and started clicking. As it was, I became a dermatologist, established a successful practice, bought a camera — 20 in fact — and started clicking.

It's not what you think. I limit my passion for photography to weekends and well-deserved vacations when I get together with other camera buffs and explore this challenging blend of science, art and luck.

Frustrated

I am not talking about documenting the occasional lesion or rash. I am talking about medical brethren and sisters who are embracing the total body photography movement, albeit a bit too intimately. Instead of engaging a professional service to produce the medical record, they are choosing to photograph patients themselves. It is my opinion that dermatologists who take it upon themselves to do total body photography or, worse yet, assign a member of their office staff to do it, are establishing a very poor and downright risky precedent.

What is it?

For those who may not be familiar with total body photography, it is the practice of documenting the entire visible surface of a patient's skin for use as a baseline medical record, much like a bone scan or mammogram. The record can consist of traditional photo prints or high-resolution digital images on CD-ROM.

Physicians and, in some cases, patients use this photographic "map" of the body as a baseline of comparison when checking the skin for changes that might suggest basal cell carcinoma or malignant melanoma.

The concept is sound; far too many dermatologists rely on memory, handwritten notes and crude sketches or Polaroid photos to track patients with large numbers of dysplastic nevi or have been identified to be at high risk of melanoma. These archaic methods do not take into account the dynamic nature of skin, the fact that half of all melanomas are new lesions, and, last but not least, the belief that we, as dermatologists, have the mental capacity to remember every nevi on every patient. In truth, total body photography is a powerful tool all dermatologists should use to accurately document and follow patients at high risk of melanoma.

So what are the options? Some academic medical centers are fortunate to have biomedical photographers on staff whose job it is to document patients. Commercial photographers are another option. However, those trained in biomedical photography are few and far between; few physicians are willing to take a chance on an unknown photographer when a patient's health and the physician's reputation is at stake.

Two options

Which leaves us with two emerging options. The first requires the physician to purchase a photographic system to house in the practice.

The second is a turnkey service, in which the physician writes a script for a CD-based digital record - MoleMapCD® is one example. The patient goes to an approved biomedical photographer, undergoes a standardized imaging session and two weeks later, the physician receives two formatted, ready-to-use digital maps of the patient's skin. The physician also can provide the patient with a copy to support compliance with all-important self-exams.

It is beyond me why any physician would choose the first option. Who has thousands of dollars to invest in photographic equipment that will be obsolete in a year or two, the space to house it and the time commitment to accurately document a patient's total skin surface? And, finally, who wants to open the door to the tremendous personal risk of shooting nude patients in his or her office?