Diagnosis by Photograph? It's NOT Worth A Thousand Words
It is rare that a medical condition can be diagnosed solely by a photograph. Without the corresponding medical history and other detailed information about the person, a picture is not worth those proverbial "thousand words". The medical magazines must plenty of photographs to test the diagnostic acumen of clinicians, but these are often accompanied by a long medical explanation, and have at least two or three diagnostic considerations (clinical possibilities).
I love my new digital camera. I had always prided myself as being a good medical photographer using my collection of 35mm lens, but my digital one trumps them all. Lighting is always a consideration when doing medical photography. The best medical pictures use a circular flash the surrounds the lens; eliminating much of the shadows that accompany a flash located above the lens. The light has to be perfect to get a perfect picture. I have been taking medical photographs for over three decades but I would never expect another clinician to be able to consult on a case with me, based solely on a photograph.
Clinicians who practice in very remote areas, often use high-resolution photographs or videos for medical consultation. The military has been experimenting with this for years. Live feeds can be sent across the world to specialists for consultative advice. There are even cases where doctors have remotely operated on patients by telemetry and robotics. Who really knows where this technology will end, but don't expect to find this equipment in your local computer store.
On the WebMD Ear, Nose, and Throat message board, I am getting an increasing number of links to photographs that the posters would like me to view. This is not really helpful. In most cases, the photographs are of poor quality (sorry, but we clinicians are picky), and do not reveal the three dimensional view that we really need. A photograph is not even close to seeing the actual picture. I know that people are just trying to be helpful and thorough, but photographs are not really helpful.
Making a diagnosis is much more than visual. For instance, when I look in the throat at some inflamed tonsils, I don't just take a quick glance; I examine the throat. I look around that tonsil from all sides, I smell the breath (mostly inadvertently), I look at the surrounding tissue above and below that tonsil; I look at the teeth and gums, the sides of the mouth, and I feel the neck carefully for suspicious lymph nodes or lumps. I can look for rashes, feel the skin for fever, and listen to the heart for murmurs that may accompany strep throats. If the person is a smoker, I take that exam up another notch, adding cancer to my diagnostic considerations. I can perform certain diagnostic studies, like a rapid strep, culture, blood count, or mono test. And, I can see and talk to the patient. The medical history is the probably the most important part of any medical encounter.
When someone posts a brief posting and even a picture on WebMD hoping to get both a diagnosis and a treatment plan, it is not happen. A diagnosis is not made this way. Not only are WebMD health experts prohibited from diagnosing someone; how in the world are we going to treat them? Yes, we give suggestions/advice; many times pointing the person in the right direction. We can make suggestions on what they can do to help symptoms, such as pain. However, this is not a true, medical encounter and should never be viewed as such.
Everyone is taking digital photos now. I sutured a child the other day in the clinic, and the mother clicked away on her cell phone. Sometimes, a teen patient will take pictures of me doing a surgical procedure on them. Some medical providers absolutely forbid this practice; I really don't care. However, I would hate for those photographs and videos to appear on You Tube or shared on medical web sites from someone seeking a "second opinion".
"Look at this mole. Do you think it is cancer? Should it be biopsied or removed?"
In recent months, I had one person attempt to post dozens of pictures, including microscopic slides of something he removed from a part of his body, asking for my opinion. People request to send x-rays and MRIs, and well as complete medical records. A few years ago, I looked at a few of those photos, but not anymore. Sometimes, that is way too much information, if you know what I mean.
I run the ENT board. I really feel sorry for someone addressing questions about hemorrhoids or sexually-transmitted diseases. Can you imagine those pictures being posted? Don't get me wrong; photographs can be helpful in some cases, but usually not in the context of providing an educational service on WebMD member boards.
On the Boards, I do miss not looking at the face asking the question. Is she crying? Is she young or old? Is she a she? During a medical encounter, I watch the eyes more than any other part of the body. The eyes are truly the window to the medical soul, and reveal so much about a person. No offense to the visually impaired who have adjusted to a life without seeing those eyes. In my clinic, I will try not to converse with anyone wearing sunglasses (unless they are blind or prescription ones). I want to see those eyes, those reactive emotions, even if they have a sore toe.
The Internet is progressing rapidly, but it will always have its limitations. With advanced telemetry, it will be possible to monitor and even accurately diagnose patients from remote areas, and perhaps, even perform certain endoscopic surgeries. This will never be like having a live, breathing, talking, complaining, crying, moving patient in the room with you. The art and practice of medicine requires that you reach out and hold a hand, or even give a hug to a grieving patient. A robotic arm is not going to do that. A two-dimensional picture, often out of focus and frozen in time, will never be a substitute for seeing something "first-hand".
Want to see how easy it is? What would be your diagnosis for these three pictures? These are some EASY ones. If you do well, I will post give you some more difficult ones. Post your guesses and I will post the answers in about a week.
Related Topics:
Photo credit: Rod Moser, PA
I love my new digital camera. I had always prided myself as being a good medical photographer using my collection of 35mm lens, but my digital one trumps them all. Lighting is always a consideration when doing medical photography. The best medical pictures use a circular flash the surrounds the lens; eliminating much of the shadows that accompany a flash located above the lens. The light has to be perfect to get a perfect picture. I have been taking medical photographs for over three decades but I would never expect another clinician to be able to consult on a case with me, based solely on a photograph.
Clinicians who practice in very remote areas, often use high-resolution photographs or videos for medical consultation. The military has been experimenting with this for years. Live feeds can be sent across the world to specialists for consultative advice. There are even cases where doctors have remotely operated on patients by telemetry and robotics. Who really knows where this technology will end, but don't expect to find this equipment in your local computer store.
On the WebMD Ear, Nose, and Throat message board, I am getting an increasing number of links to photographs that the posters would like me to view. This is not really helpful. In most cases, the photographs are of poor quality (sorry, but we clinicians are picky), and do not reveal the three dimensional view that we really need. A photograph is not even close to seeing the actual picture. I know that people are just trying to be helpful and thorough, but photographs are not really helpful.
Making a diagnosis is much more than visual. For instance, when I look in the throat at some inflamed tonsils, I don't just take a quick glance; I examine the throat. I look around that tonsil from all sides, I smell the breath (mostly inadvertently), I look at the surrounding tissue above and below that tonsil; I look at the teeth and gums, the sides of the mouth, and I feel the neck carefully for suspicious lymph nodes or lumps. I can look for rashes, feel the skin for fever, and listen to the heart for murmurs that may accompany strep throats. If the person is a smoker, I take that exam up another notch, adding cancer to my diagnostic considerations. I can perform certain diagnostic studies, like a rapid strep, culture, blood count, or mono test. And, I can see and talk to the patient. The medical history is the probably the most important part of any medical encounter.
When someone posts a brief posting and even a picture on WebMD hoping to get both a diagnosis and a treatment plan, it is not happen. A diagnosis is not made this way. Not only are WebMD health experts prohibited from diagnosing someone; how in the world are we going to treat them? Yes, we give suggestions/advice; many times pointing the person in the right direction. We can make suggestions on what they can do to help symptoms, such as pain. However, this is not a true, medical encounter and should never be viewed as such.
Everyone is taking digital photos now. I sutured a child the other day in the clinic, and the mother clicked away on her cell phone. Sometimes, a teen patient will take pictures of me doing a surgical procedure on them. Some medical providers absolutely forbid this practice; I really don't care. However, I would hate for those photographs and videos to appear on You Tube or shared on medical web sites from someone seeking a "second opinion".
"Look at this mole. Do you think it is cancer? Should it be biopsied or removed?"
In recent months, I had one person attempt to post dozens of pictures, including microscopic slides of something he removed from a part of his body, asking for my opinion. People request to send x-rays and MRIs, and well as complete medical records. A few years ago, I looked at a few of those photos, but not anymore. Sometimes, that is way too much information, if you know what I mean.
I run the ENT board. I really feel sorry for someone addressing questions about hemorrhoids or sexually-transmitted diseases. Can you imagine those pictures being posted? Don't get me wrong; photographs can be helpful in some cases, but usually not in the context of providing an educational service on WebMD member boards.
On the Boards, I do miss not looking at the face asking the question. Is she crying? Is she young or old? Is she a she? During a medical encounter, I watch the eyes more than any other part of the body. The eyes are truly the window to the medical soul, and reveal so much about a person. No offense to the visually impaired who have adjusted to a life without seeing those eyes. In my clinic, I will try not to converse with anyone wearing sunglasses (unless they are blind or prescription ones). I want to see those eyes, those reactive emotions, even if they have a sore toe.
The Internet is progressing rapidly, but it will always have its limitations. With advanced telemetry, it will be possible to monitor and even accurately diagnose patients from remote areas, and perhaps, even perform certain endoscopic surgeries. This will never be like having a live, breathing, talking, complaining, crying, moving patient in the room with you. The art and practice of medicine requires that you reach out and hold a hand, or even give a hug to a grieving patient. A robotic arm is not going to do that. A two-dimensional picture, often out of focus and frozen in time, will never be a substitute for seeing something "first-hand".
Want to see how easy it is? What would be your diagnosis for these three pictures? These are some EASY ones. If you do well, I will post give you some more difficult ones. Post your guesses and I will post the answers in about a week.
Picture A: What is this rash on my son's legs?
Picture B: My daughter has a fever, rash, and sore throat. What is it? Is it serious?
Picture C: What is this skin lesion on my son's upper arm?
Related Topics:
- WebMD Video: Tips For Finding The Right Physician
- WebMD Video: Physician Assistants - Filling a Void in Healthcare
Photo credit: Rod Moser, PA
16 Comments:
Picture C looks like a reaction to a fake tatoo!
Yep, picture C looks like a tattoo of a shark or whale.
I agree. Picture C looks like a tattoo of a shark. The kid probably really got one and wanted it to be removed which can leave something looking like that picture. I've seen videos on how tattoos are removed and that's looks like a healing process of the skin. I think he maybe not telling his parents something. I think someone might be overreacting over the thing.
PICTURE C:
Good job! Yes, that is a skin reaction to a temporary henna tattoo...of a shark. It looks more accurate upside-down.
It took several weeks for the shark to finally fade....
Hint for Picture A: It itches...a LOT.
Hint for Picture B: Also had a high fever and bad sore throat.
Number 1 looks like poison ivy, but then I remembered that you live in California, so I'm going to guess it's poison oak (I don't think you have poison ivy out there, do you?).
I wouldn't have recognized it except that my son, now 20, was always getting into poison ivy as a small kid. I remember his worst bout. A tree had been knocked down in a storm and the trunk was covered in poison ivy. Wearing nothing but a small pair of cotton shorts, he had climbed all over the fallen tree. He got it all over his body, but it was especially bad on his inner thighs. He was miserable! I wanted the pediatrician to see him. The nurse said no, I couldn't bring him in because there was a chicken pox outbreak and they didn't want chicken pox in the office. I begged, please I know poison ivy when I see it, but this is really bad, I really want the doc to take a look. After a couple of days they finally relented and let me bring him in to a side entrance after hours. My smugness at being judged correct - it was a very severe case of poison ivy - didn't last long. The doc pointed out a small patch of something a bit different. Yes, my boy had poison ivy AND chicken pox were just starting to come out too! He was a mess for days! My husband stayed home and gave him oatmeal baths several times a day.
Yes, Picture A is POISON OAK, and yes, we don't have poison ivy in California (at least in my area, or I would get it!). Excellent job!
If doctors would LISTEN to patients a bit more often, their diagnostic jobs would be a bit easier.
I would guess that picture B is strep throat/scarlet fever. The rash looks a little like roseola (maybe too bright, though), but since the rash is there while the fever is present and a sore throat isn't part of roseola, I'd guess the strep.
Good guess...are you the same "anonymous"?
Yes, that is scarlet fever. Great job seeing that I did not say anything about that "strawberry tongue" sticking out.
Do you need a job?
No, the scarlet fever one is the only one I answered. I "cheated", however. I knew that a rash can sometimes come with strep, though, but I looked up the symptoms on the web and came up with scarlet fever. I didn't know that scarlet fever was from strep, however, so I learned something new.
~Donna
And I'm the one who guessed poison oak. I'm living in the west now and know that we don't have poison ivy (or lightening bugs) which is why I guessed poison oak.
I'm a big fan of your blog. I grew up in Western PA and can relate to many of the things you write about. Thanks for sharing your thoughts with us.
Kate
Donna...you didn't cheat on the scarlet fever photo. Have you ever asked your doctor a question, only to have him excuse himself for a moment and leave the room? When he returns, did you find it odd that he has some new-found knowledge? The bottom line? He went and looked it up...just like you. There is nothing wrong with doing a little personal research.
Kate...thank you for your kind comments. Since we are both from Western PA, we share a lot more than just lightening bugs and poison oak. We share the some Pennsylvania culture.
Love you both!
I wonder who got the shark?
If the person was from Pennsylvania, they would have probably guessed "trout" or "bass".
Just kidding.....
1ST ONE LOOKS LIKE PSORIASIS,2ND ONE COULD BE CHICKEN POX,3RD ONE IS AN ALLERGIC REACTION
I agree with your considerations on sending images over the internet without any notice on the quality. Please have a look at www.woundontology.com where color calibration and ontology should deal with several of these problems
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