Remote consultations

Images and videos

When is it appropriate to use photographs and video consultations as part of patient care?

During a remote consultation you should consider using photographs and video consultations if it helps assess or diagnose a patient, and supports clinical decision making. 

However, it won’t always be possible or appropriate to assess a patient’s condition remotely. In these cases, you should consider if a face to face consultation to examine the patient is necessary, or signpost to other services where appropriate. Our remote consultations flowchart can help you with these decisions. 

How do I protect patients when images are needed to support clinical decision making?

You can protect patients by only asking for images if this is needed to support clinical decision making, and by using secure arrangements for storing and transferring them. You must seek informed consent (paragraphs 5, 10, 12-13, 16-20, 30 and 59, Decision making and consent) and be clear about the reason why a photograph or video consultation is needed, and how it will be kept secure (paragraph 13, Making and using visual and audio recordings of patients). 

It is important to be aware that photographs and recordings made as part of the patient’s care will form part of their medical record. The UK health departments publish guidance on how long health records should be kept and how they should be disposed of. You should follow this guidance whether or not you work in the NHS. 

If you have concerns about the security of patient information, you should speak to your employer. Every UK health organisation should have a Caldicott Guardian (sometimes known as a Personal Data Guardian in Northern Ireland) who is responsible for protecting patient information and making sure it is used properly.

Intimate examinations

What should I consider when deciding whether to carry out an intimate examination remotely?

An intimate examination carried out remotely may support clinical decision-making. However, you should carefully consider whether this is clinically necessary to provide a diagnosis, and whether it is more appropriate to examine the patient in person if this is possible. If you and the patient decide to proceed remotely, you should still offer a chaperone wherever possible.

You should also consider whether there are alternative ways to diagnose the patient’s condition. These could include showing the patient images of the condition or symptom they suspect they are experiencing, or asking patients to describe rashes, or lumps. 

• When carrying out remote intimate examinations via video, it is important to consider:
• whether you can see well enough to assess the patient
• that patients may find it more embarrassing to present themselves to a camera/screen for examination than to a physical examination 
• that patients may have concerns about the security of the line, that the video might have been recorded or might otherwise be stored somewhere allowing access in the future.

Our guidance,  Intimate examinations and chaperones,  provides further information about issues to consider when carrying out intimate examinations.

What should I consider when dealing with images of intimate areas specifically?

You should be particularly cautious when requesting and storing images of patients’ intimate areas. 

What you consider to be intimate may not reflect the patient’s view. Patients may find it embarrassing or distressing to share images of their body. They may need additional reassurance about how their images will be kept secure before providing consent for storage and processing.

You should also consider relevant laws regarding intimate images of adults, as well as safeguarding issues for vulnerable adults. 

Children & young people

What do I need to consider when consulting remotely with children and young people?

As in any consultation, face to face or remote, you must continue to safeguard and protect the health and wellbeing of children and young people. This includes treating them as individuals, respecting their views, as well as considering their physical and emotional welfare.

Communication

In paragraphs 14–21 of our 0–18 years: guidance for all doctors we say you should:

• find out what children, young people and their parents want and need to know 
• talk directly to children and young people who are able to take part in discussions about their care
• explain things using language or other forms of communication they can understand.

So that you can provide good care, it’s also important to consider the preferences of the child or young person. For example, would they prefer the consultation to be text-based, phone or video. You should check if they want anyone else with them, and that they’re clear on their right to confidentiality. 

Consent

As a general principle, obtaining consent before any procedure, involves providing your patient with information in a way that they can understand, so they can make an informed decision about whether or not to go ahead. 

You must decide whether a young person is able to consent to investigations or treatment. You should assess this on an individual basis. 

In paragraphs 22–26  of our 0–18 years guidance for all doctors, we say that at the age of 16 it can typically be presumed that a young person has capacity to make most decisions about their treatment and care. And we also stress that it is important to remember that consent is about the patient’s maturity and capacity to understand and make decisions rather than their number of years. 

If it’s clear that the child or young person isn’t able to give their consent, you should seek consent from a parent or guardian. But remember, even if a child or young person isn’t mature enough to make decisions for themselves, their views and preferences are still important and should be considered.

Safeguarding

You should always keep in mind your responsibility for safeguarding children and consider how this will work in a remote setting. 

What do I need to consider when dealing with intimate images of children and young people?

If you have considered all options and you believe that intimate images of a child are needed to support clinical decision-making, you should follow your local information governance policies and seek advice from your medical defence organisation.  

In Making and using audio and visual recordings of patients, we say children or young people under 16 who have the capacity and understanding to give consent for a recording may do so, but you should encourage them to involve their parents in the decision making. Where a child or young person is not able to understand the nature, purpose and possible consequences of the recording, you must get consent from a person with parental responsibility to make the recording (paragraph 21). 

You should be aware of and follow relevant laws regarding intimate images of children and young people. You should also remember your responsibility to safeguard children at all times (paragraphs 8–11, 0–18 years guidance for all doctors).