JMIR Publications

ABSTRACT

Background:

Medical case reports published in academic journals often contain images, including patient photographs. Photographs from published case reports have previously been found in online image search results such as Google Image Search. This means that patient photographs circulate beyond the original journal website and can be freely accessed online. While this raises ethical and legal concerns, no systematic study has documented how often this occurs.

Objective:

The aim of this cross-sectional study was to provide systematic evidence that patient photographs from case reports published in medical journals appear in Google Image Search results.

Methods:

A structured search of PubMed was conducted to identify all indexed medical case reports published within a one-year period between July 1, 2017, and June 30, 2018. The search produced 23,589 results. Based on the original study, it was anticipated that approximately 37% of the case reports with photographs would include at least one image found online. Using a confidence level (CI) of 95% and a 4% margin of error, a sample size of 585 was required. The main outcome measure was whether at least one photograph from each case report was found on Google Images, when using a structured search. Chi-square tests, simple logistic regressions, and generalized estimating equations were conducted.

Results:

From a random sample of 585 case reports indexed in PubMed, 186 contained patient photographs, for a total of 598 distinct images. Results demonstrated that at least one photograph from 76.3% of the case reports (142/186) was found on Google Images. At least one photograph from 76.3% of the case reports (142/186) was found on Google Images. 18.3% of photographs included eye, face, and/or full body photographs, including 10.9% that could potentially identify the patient. The odds of finding an image from the case report online were higher if the full-text article was available on ResearchGate (OR 9.16, 95% CI 2.71 to 31.02), PubMed Central (OR 7.90, 95% CI 2.33 to 26.77), or Google Scholar (OR 6.07, 95% CI 2.77 to 13.29) than if full-text was available solely through an open access journal (OR 5.33, 95% CI 2.31 to 12.28), but all factors contributed to an increased risk of locating patient images online.

Conclusions:

A high proportion of medical photographs from case reports was found on Google Images, raising ethical concerns with policy and practice implications. Journal publishers and corporations such as Google are best positioned to develop an effective remedy. Until then, it is crucial that patients are adequately informed about the potential risks and benefits of providing consent for clinicians to publish their images in medical journals.