Why You Should Take Your Own Clinical Photos

Guest post by by Øystein Horgmo, Medical Photographer

As a medical photographer I should probably tell you that you should leave all your photographic needs to me, but that would be denying the reality of both photography and medicine.

Dealing with superficial anatomy, dermatology is a medical speciality that is especially well suited for photographic documentation --- and most of it can be done by the doctor herself.

Some of the larger hospitals and universities may have a resident medical photographer, but for the private practitioner these services are not readily available, so it will be useful for any dermatologist to know how to take good clinical photos.



Transferring from film to files has made photography affordable for everyone. This does of course not make it easier to take a good photo, but when experimenting doesn't cost anything, the learning curve can be steeper.

Here are 5 tips if you want to start documenting your clinical practice with photos:

1. Get the right equipment (for you)
The sales for digital SLRs (single-lens reflex) have soared the last years, making these cameras (formerly only used by pros and enthusiasts) pop up everywhere. If you're going to invest some time and effort in learning how to take full advantage of it, an SLR is the best choice.

There is, however, no point in getting an expensive SLR if you're just going to use the supplied plastic lens and leave it in "auto." For most people it would be better to spend the money on a good compact camera. It's cheaper, easier to use and faster to operate. 

2. Know how it works
I know it can be boring, but it's worth the while to read the camera manual. Most compact cameras has several different settings that are useful in different circumstances. Try them out and see what they do to the resulting image.

Two examples:

• The "macro" setting will let you take photos of objects close to the lens (for example a skin rash or tumor).
• The "portrait" setting will make everything but the subject you've focused on blurry (by opening up the aperture), making the subject stand out.

It's also very useful to know how to turn off the automatic flash and how to force the camera to flash.
  
3. Know what you want
Knowing why you're taking a picture is all-important in getting a good result. There is a mantra in photography that says "get closer." What it means is you should include in the frame only what you want to show.

If you're taking a photo to document the shape and look of a skin lesion, don't include anything but the lesion. If you want to document the location of a lesion on a patient's cheek, include only the patient's face. Psoriasis on a patient's back? Don't include the head and the legs. And so on. Getting closer, and removing all distracting elements, greatly improves the pictures.

In most cases this will mean actually moving your camera closer to the subject. You can also use the optical zoom, but this will make your camera more sensitive to shaking. Be sure not to use the digital zoom, as this reduces the image quality. 

4. Get the lighting right
Photography is all about light. Fortunately most examination rooms have a handy light source available - the surgical light.

The surgical light is the light source of choice when shooting close-ups. As the built-in flash on compact cameras as off-axis, it will provide uneven lighting, and sharp shadows, when the camera is close to the subject. The surgical light can be placed at any angle to the subject and provide light while still being out of the way.

The difference in light intensity between a surgical light and the rest of the room is too large for the camera to handle (more about this issue here). So if you need to take a photo that includes more than can be illuminated by the surgical light, you should turn it off and just use the ambient light of the room, or a flash if needed. Or, you can bounce the surgical light off a white wall or ceiling to raise the light level of the room.     

5. Know your limits
You should take your own pictures, but you should also know your limits as a photographer. There are several instances when you should consider hiring a pro. The most important being:

• Medical research
• Education
• Publication
• Advertisement

A medical photographer knows how to depict the different parts of the human body, both for scientific purposes and illustration. A quick snapshot is sufficient for a doctor to review his own work, but it might not be suited for a larger audience or be of a quality required for a journal. The knowledge of different photographic techniques and conventions and when to use them is important when the photos have purposes beyond documentation.

Just as a Mohs surgeon improves her skill with the quantity of operations, a medical photographer has handled a lot of different photographic assignments and knows what to look for and where to find it. As the scalpel, the camera is just a tool --- and it is ultimately the skill of the person using it that determines the result.

Good luck!

[All photos by Øystein Horgmo (C) www.oncolex.com]