Clinical images are photographs that serve as succinct and memorable lessons. Importantly, patient right to privacy dictates appropriate consent be obtained prior to publication. Significant disagreement exists surrounding what makes a photograph identifiable, and thus, when consent is required. Variability in consent requirements makes preparation, submission and successful publication more difficult for authors. We sought to characterize the consent process and requirements among top internal medicine journals that publish clinical images.
Methods:
We identified the top 10 internal medicine journals, by impact factor, that publish exam-based images. We analyzed Instructions to Authors, journal consent form (if available), and all supplemental materials sent by the journal editor(s) as response to email query asking about consent rules and policies for clinical image submissions. Study results were shared with each journal’s editor to ensure that results accurately reflect the respective journal’s policies.
Results:
Publicly available information was available from all journals and query response was received from 7/10 (70%), of journals. All require written patient consent for clinical image based manuscript submissions. However, only half (50%) explicitly state that patient consent is required even if the patient is not identifiable, and several indicated that consent is only required if the patient is identifiable. Half (50%) request or require use of their own consent form. Half (50%) require consent form with patient signature be submitted to be archived by the journal, while the other half request that control be maintained by the author in order to maximize patient anonymity. Only 4/10 (40%) explicitly state that the discounted practice of black-out bars to cover eyes is not an acceptable form of anonymization. Only 1/10 (10%) journals make explicit to the patient that declining participation will not impact care or the doctor-patient relationship. 2/10 (20%) require that the patient be given right to review the submitted material before proceeding with consent.
Conclusions:
Consent requirements of top journals that publish clinical images shows widespread, and non-rational, variability. This makes it more difficult to obtain appropriate patient consent and represents a barrier to authors. A universal consent process and form is needed.