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Taking pictures of clients: is it ever okay?

Case study about consent, confidentiality & use of photography

Wendy, an outreach nurse, is relieved to catch up with Jack, her last client of the day. She’s concerned about a series of ulcerated sores on his right arm.


Rolling up Jack's sleeve to examine the sores again, Wendy concludes that they haven’t improved, and are now possibly infected. Uncertain of their cause and appropriate treatment, she suggests to Jack that he have the nurse practitioner (NP) at the clinic take a look at them. Jack declines.

Wendy makes a decision 

Knowing she’ll be away for the next two weeks, Wendy‘s concerned about follow-up for Jack. It will be hard for another nurse to assess whether the sores have deteriorated or improved without having previously seen them. Wendy decides to take a picture of the sores with her personal phone and text it to the nurses caring for Jack in her absence. That way, they can compare the change in the sores over time.

Wendy explains that she’s going to take a picture for his record, and without waiting for a reply, takes a photo of the sores on Jack’s arm. Jack doesn't say anything. She gives Jack a reassuring smile and rolls down his sleeve. Afterwards, she makes a brief note in Jack’s record and sends the photo to her colleagues’ personal cell phones. Still looking for a diagnosis, she decides to also email the photo to the NP at the clinic.

Were Wendy’s action’s appropriate?
  • What do you think of Wendy's actions?
  • Was it appropriate for her to take a photo of Jack's arm?
  • Was it appropriate to send the photo to the NP even though Jack had declined Wendy's suggestion that he visit the NP?
  • How would you respond if Wendy asked you what you thought?

Despite Wendy's good intentions, her actions breached Jack's privacy. She neither explained why she was taking the photo, nor obtained his consent to take or share it with her colleagues and the NP. Jack's silence did not mean he consented to having the photo taken, or to it being shared.

Wendy needed to discuss why she wanted to take a picture of the wound and obtain Jack's consent to take and share the photo with her colleagues.  By not obtaining Jack's consent and using her personal cell phone, Wendy acted inappropriately. She infringed on his privacy by taking a photo of his arm and sharing it without his consent. She also breached her employer policy by using her personal phone to store and share client information.

What could Wendy have done differently?

While Wendy’s intention was to support continuity of care for Jack, she needed to follow the Professional Standards, Privacy and Confidentiality practice standard and legal processes. This includes:

  1. Following agency policies related to use of photography, personal devices, and texting or emailing client information.
  2. Following agency policies for client consent related to taking and sharing photos with other health care professionals.
  3. Obtaining Jack’s informed consent to photograph his arm and to share the photo with her colleagues and the clinic NP.
  4. Discussing the situation with her colleagues and manager to advocate for resources and policies related to the use of technology that could improve client care.

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