Through a screen, darkly : how do patient-initiated camera phone images contribute to general practice consultations?

![CDATA[Aims & rationale/Objectives: Patients are spontaneously beginning to show photos and video recorded on mobile phones during GP consultations. Case reports describe how such images assist with diagnosis, but little is known about how camera phone images contribute to, or detract from, patient-centred care. This study aims to explore GP perceptions of patient-generated camera phone images. Methods: Semi-structured telephone interviews with nine GPs from three States with a variety of clinical interests. Interviews were recorded, transcribed and common themes identified inductively. Principal findings: GPs describe two categories of images - clinical and social. They cited examples of clinical images assisting with diagnosis, but also recognised that taking and sharing images via their phones empowered patients. Patients became part of the health care team, maintaining control over images that they use as a pictorial medical record to show different doctors. In addition, the act of sharing social images can improve rapport as it is done within a trusting relationship. The otherwise unspoken story behind the image enhances the GP's understanding of the patient and their illness. GPs have also experienced patients inappropriately using camera phones during the consultation, and expressed concerns about documenting images shown to them. Implications: GPs privileged to be shown camera phone images are given insight into spaces in patients' lives outside the consulting room. Images may hold unspoken meaning, and enhance doctor-patient relationships. Potential, but avoidable, harms were identified in this study.]]