Practips_Sep03_DD.idd VOL 49: SEPTEMBER • SEPTEMBRE 2003  Canadian Family Physician • Le Médecin de famille canadien 1091 clinical challenge  défi clinique Practice Tips Real-time digital photography Adjunct to medical consultation Sody Naimer, MD Dr Naimer is a Lecturer in the Department of Family Medicine, Division of Community Health, at Ben-Gurion University of the Negev in Beer-Sheva, Israel. clinical challenge  défi clinique In general, photography is useful for documentation, follow up, defen- sive medicine, peer and specialist consultation, and patient education. Although it fulfils many of these needs, standard photography has several drawbacks.1-5 Mounting costs of good-quality fi lm and of developing colour prints are a serious consid- eration. Delays in receiving images, inability to alter resulting pictures, and restricted storage space are a few limitations of standard photography. I used standard photography in the past mainly to document rare fi ndings, and I shared my prints with colleagues for teaching or consulta- tion purposes. The expense of each picture led me to think twice about whether obtaining a photograph was justifi ed in each case. Digital photography has recently evolved into a ver y useful tool that greatly assists physicians in several ways. Instant production of vir tual images and our ability to take a snapshot whenever desired has broadened its use. The cost is virtually negligible, and producing a photo takes almost no time. Verbally describing many clinical conditions (eg, gynecologic diseases; anal fi ndings; lesions on any part of the dorsal surface of the body, such as the back, glutei, upper thighs, or ears; and even deep oral lesions) to patients will not always suf fice. No other technique seems to demonstrate to patients the disease or ongoing processes in these areas as well (Figure 1). As time allows, you can display images by downloading them onto your com- puter screen or view them directly from the back of the camera. Other benefi ts of digital photography are the abil- ity to share images via electronic mail, to duplicate images as many times as you like, to crop and adjust images received, to alter contrast in repro- duction, to project images for lectures or staf f meetings, to enlarge to accentuate details, to select only We encourage readers to share some of their practice experience: the neat little tricks that solve diffi cult clinical situations. Canadian Family Physician pays $50 to authors upon publication of their Practice Tips. Tips can be sent by mail to Dr Tony Reid, Scientifi c Editor, Canadian Family Physician, 2630 Skymark Ave, Mississauga, ON L4W 5A4; by fax (905) 629-0893; or by e-mail tony@cfpc.ca. Figure 1. Interdigital tinea pedis revealed using real-time digital photography 1092 Canadian Family Physician • Le Médecin de famille canadien  VOL 49: SEPTEMBER • SEPTEMBRE 2003 the best of a series of photographs of moving subjects or subjects pho- tographed when conditions were less than ideal, to have simple and rapid access to a large librar y of images without need for storage space, and obviously to use as a means of patient education in the office. I do not have to think twice about shooting a picture with an uncoop- erative child or worr y about poor illumination because, at worst, low- quality images can be deleted by pressing a button. Changing medical problems can be documented during progression until complete evolution. Objective comparisons of images can help you judge the outcome of inter- ventions, for instance, for acne, pig- mented lesions, or scars. I am personally fully satisfied with the digital photography that we have been using in our practice for the past 2 years. I strongly recommend incorporating real-time digital pho- tography into clinical practice. References 1. Sasson M, Schiff T, Stiller MJ. Photography without film: low-cost digital cameras come of age in dermatology. Int J Dermatol 1994;33(2):113-5. 2. Kokoska MS, Currens JW, Hollenbeak CS, Thomas JR, Stack BC Jr. Digital vs 35-mm photography. To convert or not to convert? Arch Facial Plast Surg 1999;1(4):276-81. 3. Spring KR. Scientific imaging with digital cameras. Biotechniques 2000;29(1):70-2,74,76. 4. Hollenbeak CS, Kokoska M, Stack BC Jr. Cost consider- ations of converting to digital photography. Arch Facial Plast Surg 2000;2(2):122-3. 5. Wall S, Kazahaya K, Becker SS, Becker DG. Thirty-five millimeter versus digital photography: comparison of photographic quality and clinical evaluation. Facial Plast Surg 1999;15(2):101-9. ... clinical challenge  défi clinique