The scene

A GP member called the MDU's advice line about a patient with whom he was due to have a remote consultation because of the coronavirus outbreak. The patient was a 14-month-old infant who had developed a worsening nappy rash and was not responding to usual skin care advice. The mother's partner had just been diagnosed with COVID-19 and the family was self-isolating. The GP attempted a video consultation, but this was abandoned after the child became fractious when being undressed to expose the rash.

The GP wondered whether it would be better to ask the mother to send a photograph of the rash to his NHS email account, which could then be transferred to the clinical records, followed by a telephone consultation.

MDU advice

The GP was advised to ensure he was familiar with the GMC guidance on making and using visual and audio recordings of patients. He was asked to consider carefully whether a remote consultation in this case was the best approach - though the doctor could of course take in to account the risks of a remote consultation versus the risk of transmission of coronavirus.

The adviser acknowledged that medical images routinely form part of the clinical record in some specialties. As with other parts of the record, these must be handled securely in accordance with data protection legislation.

The adviser emphasised that the image should only be used for the specific clinical purpose of diagnosis and treatment of the child's rash; GMC guidance requires that written consent must be obtained if such images are used for purposes other than direct clinical care, such as teaching or research. The GP was advised to explain to the child's mother why a photograph of the rash could be important in order to help establish the diagnosis, and to record the rationale in the clinical records.

There may be circumstances where the sending of an intimate photograph of a child and its receipt and storage by another person could constitute a criminal offence. However, the offences require the images to be indecent, and have the defence of 'legitimate reason'. The GP was advised that where the photograph was clinically important in helping to reach a diagnosis (in the context of a normal face-to-face consultation being very difficult to safely achieve), this appeared to be a legitimate reason to have sought it and have a copy in the records, and should mean the image ought not to be considered indecent.

The outcome

The GP subsequently spoke again to the child's mother, explaining that a photograph could be important to establish the diagnosis and also be valuable in assessing how the rash responded to treatment. The GP also made clear that if the rash suggested further tests were necessary, such as swabs, then arrangements may have to be made for the child to be seen. The mother was relieved that it would be possible for her child to be assessed in this way, as she had been worried that she might have to wait until self-isolation was over, with the rash getting worse daily.

The photograph was sent to the GP's secure NHS email account, uploaded to the child's clinical records, and deleted from the email account when this had been done. The photograph suggested a severe nappy rash that was secondarily infected with candida albicans. Appropriate treatment was arranged and delivered to the mother and the child's rash recovered over the next week.

Storing digital images in medical records

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