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10 Tips for Better Patient Care and Better Business

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10 Tips for Better Patient Care and Better Business The Dermatologist’s Guide to Effective Clinical Photography 10 Tips for Better Patient Care and Better Business Photography has become essential to the practice of dermatology and aesthetic surgery. It provides a mechanism to improve patient care, enrich your documentation, aid in patient education/consultation, and allow you to set realistic expectations for your patients through the use of “before and after” images for cosmetic procedures. Despite the power of great photography, most medical practitioners find it difficult to capture high quality images. Consis- tent lighting, as well as camera and subject placement is critical to taking the quality photos that can showcase your skills and expand your practice. We have compiled ten invaluable tips to help you and your office achieve the best photographic results possible. Put a mark on the floor where the photog- of the distal cheek. This will help your pre- and Stand your ground. ▪ 1 rapher should stand. Try to keep the camera post-treatment images maintain consistency for successful comparisons. Many photographers stand too close to their over this line to maintain the distance. subjects, which may create distortion in the Photographing extreme close-ups Perspective is also important in non-clinical image. Additionally, at a short distance, the For extreme close-ups, special equipment is situations. The effects of laser and cosmetic bright flash from most cameras will overex- often required. The macro mode on a point- treatments can be effectively documented pose or “wash out” the center of the picture. It’s and-shoot camera, or a macro lens on a digital with consistent patient positioning. To reliably much better to maintain a reasonable distance single lens reflex (DSLR) camera, will enable duplicate patient positioning: from the subject—typically around four feet or the proper focus when you are photographing Place or note small marks every 3-4 inches more—and use the camera’s zoom feature to at a distance of less than six inches. ▪ on the wall opposite where the patient will isolate the subject of the picture. Set your camera or lens to macro. On many be standing to have their picture taken. Maintain consistent distances ▪ cameras, this is denoted by a small flower The marks should generally range in height When taking before and after pictures, it is icon. from just under five feet to just over six feet very important to maintain consistent dis- Use a tripod. This is essential for taking ex- to accommodate all patients. tances from the subject. There are some easy ▪ treme close-ups with the macro mode. Label the marks on the wall with colors, let- techniques to help with this. Take some test photos to gain a better un- ▪ ters or numbers to correspond with patient Keep your camera on a tripod to keep your ▪ derstanding of the lighting requirements. height. ▪ camera steady. Make sure your patients are photographed Put marks on the floor where the tripod legs ▪ with their shoes off to remove height varia- ▪ stand, as well as marks on the floor where Maintain perspective. tions based on high heels or thick soles. the subject should stand—about two feet 2 It’s important to take all of your photographs Have your patients stand with their toes on from the wall to minimize hard shadows on from a consistent angle, or perspective. This ▪ the spot you’ve marked on the floor. Ask the wall. ensures that you can make useful comparisons them to point their nose to the spot that If a tripod isn’t a viable solution because of between images taken at different times. corresponds to approximately four inches space restrictions, try one of the following below their height. For example, if a 5’10” Establish standard positions techniques: tall woman is standing to be photographed, Establishing a regular set of positions for pho- she should point her nose at the spot at or Attach a piece of string to your camera the tographing each part of the body will make it about 5’6” high on the wall. ▪ length of the distance between the cam- much easier to track the progress of a treat- era and the subject. The string then acts as ment. For example, facial photos should be Note that asking the patient to look at the a convenient measuring device to ensure taken with the patient’s Frankfort horizontal spot does not achieve the same result; con- that the subject will stand the same dis- plane (i.e., the imaginary line from the external sistency in positioning over multiple pho- tance from the camera each time. (To avoid auditory canal to the infraorbital rim) parallel tographs comes from the patient pointing contamination, be careful not to touch the to the ground. For oblique facial views, you their nose at the spot. The color of the dot string to the subject.) should align the tip of the nose with the edge can be noted in her chart. Page 1 Positioning almost frozen. “Too warm” will occur if the red rendering the image useless for its intended There are five commonly used angles for most and yellow tones of the picture are increased, purpose. Alternatively, an overly bright expo- medical photographs: frontal, oblique (45˚ causing the patient to look flushed. sure might minimize wrinkles and other skin left and right), and lateral (90˚ left and right.) features that may need to be highlighted in On some cameras, you can combat this type For each of these, position the same height the photograph. of distortion by adjusting the white balance. markers on the opposite walls. Have the sub- When possible, keep this set to “auto” or “flash” The key to proper lighting is to provide enough ject turn and point their nose to the spot that for closer images. On some point-and-shoot light to illuminate the subject, but to diffuse corresponds with their height. In this manner, cameras and all DSLR cameras, the white bal- the light or provide it from an indirect angle. you can maintain consistent positioning over ance can be manually set. This will remove the harsh shadows without multiple visits. overexposing and washing out all the shad- Consistent settings Camera Height ows in the image. In any case, it’s critical to set up the room with The height of the camera is important. An im- the same type light for each photograph and The two specific factors to consider in light- age taken from below someone’s chin will look keep the setting consistent on the camera. ing a photograph are angle and intensity, very different than one taken from six inches and there are multiple ways to manage their above them. Know the height on the tripod Close the blinds in each room during photog- effects on a picture. Many of the methods are that corresponds to the mark on the wall raphy. Use your flash or hot lights as the pri- camera- and/or light-dependent; a general and the height of the patient. Extend every- mary light source. Each of the light sources— understanding of the factors involved can go thing and make marks on the extension tube fluorescent, exam light, flash, and hot lights— a long way toward understanding the proper corresponding to the proper height. Finally, are different colors of light. If you change the setup. make multiple marks on the floor where the light you use between photographic sessions tripod belongs to enable you to position the of the same patient, their skin will appear to Angle tripod and quickly take the photographs of all be a different color in each session. Light traveling straight from the camera and angles. Be sure to add all of these settings to reflecting from a subject tends to flatten the Clinical images can also be detrimentally in- the patient’s photographic record, so they are features. Conversely, light coming from an fluenced by background, clothing, jewelry, readily reproducible for each visit. extreme angle will drastically increase shad- makeup, and hairstyles. owing. Navigation of these extremes can be Use a plain grey or dark-colored poster fairly simple—provide ample light at moderate Let there be light. ▪ board or wall as a backdrop for all of your angles. 3 photos. Your best results will be obtained by using Consistency in color is also important for good two light sources to illuminate the object from photography. While the color of your photo- For darker-skinned patients, blue or grey ▪ will provide enough contrast. both sides. This will remove the harsh shadows graphs can be influenced by a number of fac- and light “fall-off” often seen on one side of an tors—the paint color on the walls, colors worn Advise your patients to remove any acces- image due to the light coming from the other by a patient, the number of office windows, ▪ sory that may appear distracting or cause side of the subject. and the fluorescent lights on the ceiling—the distortion in any pre- or post-treatment Whether you are using one or multiple light single most important factor in achieving con- photos. sistent color is to provide the exact same light sources, you should diffuse the light or bounce each time you take a photograph. Have your patients wear a collarless gown it off the walls to illuminate the entire room ▪ to maintain neutral and accurate skin tone and create a softer effect. Diffusion is accom- While our eyes automatically adjust from light in your images. plished using the on-flash diffuser, a third-par- source to light source and balance out the col- ty diffuser such as a Lumiquest flash diffuser, or differences, cameras have a more difficult This will ensure a consistent look for accurate or a “soft box” to scatter the light, enabling it time doing this.
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