David Kerr: Rise of the medical selfie

david_kerrAccording to Twitter, 2014 was the year of the selfie. The Oxford English dictionary defines a selfie as “a photograph that one has taken of oneself, typically one taken with a smartphone or webcam and shared via social media.” Selfies began only a few years ago, but have reached epidemic and global proportions—and a new industry has developed with the creation of selfie sticks to support the phenomenon.

According to Time magazine, the selfie is not a reflection of an increasingly narcissistic society, but “created with the idea of direct communication. In essence, it’s more a document of the present, while traditional photography largely relates to the past.” From a medical perspective, selfies offer the opportunity to return to traditional medical education.

As a medical student in Scotland the training bible was Macleod’s textbook of Clinical Examination, with the emphasis on inspection, palpation, percussion, and auscultation as the classic sequence for a “proper” clinical examination after a thorough and detailed elicitation of the patient’s verbal history. In those days, stories also abounded about famous professors taking students for rides on public transport to hone their clinical inspection skills by observing the great British public firsthand.

Nowadays with a selfie, there is an opportunity for modern diagnosticians to practice their trade through the plethora of diseases and disorders that could manifest on a selfie, especially given the quality of resolution and clarity of images. These range from benign and malignant skin conditions, congenital malformations, cranial nerve palsies, and a variety of other neurological, ophthalmological, or endocrine disorders—and even atrial fibrillation.

If a selfie video is added then disorders of speech, movement, and breathing could be detected with the appropriate software analyses, or, alternatively, retinal scanning technologies could allow everyone with diabetes to be self-screened in the comfort of their own home. The frequency of selfies, settings, number of friends in the image, and overall demeanor could also provide clinicians with insights into mood and personality disorders.

Selfies could either be voluntarily submitted or perhaps software could be created to scour the internet to provide a source of material. However, as with much of the discussion on mobile health, ideas such as the medical selfie raise important questions about data ownership, privacy, and responsibility on the part of clinicians.

Of course, this is not a new idea as many medical conditions can be found within paintings and other fine art, most notably xanthelsma affecting the Mona Lisa. Here in the US, at least 20 medical schools already offer “art intervention” workshops where paintings are used as surrogate patients, allowing would be doctors to improve their clinical observation skills. These also allow students to see the clinical manifestations of less common medical conditions, such as arsenic poisoning and the myriad late manifestations of syphilis, as depicted in Bronzino’s An Allegory with Venus and Cupid.

Apparently, millions of selfies are taken each day and, for obscure reasons, are more popular in Australia than anywhere else. A caveat to their use in medical education is that around a third are digitally altered, thus potentially reducing their value as a teaching aid.

Nevertheless, as the quality of digital cameras embedded within smartphones continues to improve, selfies are here to stay at least for the time being. One opportunity for public health and disease prevention would be to create software that could digitally alter selfies to highlight the impact of certain behaviors on an individual’s appearance, such as excessive sun exposure, smoking, drinking, and sleep deprivation. In today’s self-obsessed world, this might just have more impact than traditional “information only” public health campaigns and the target audience would be the biggest creators of selfies—young people.

David Kerr has worn many hats, sometimes at the same time—diabetologist; editor of Diabetes Digest; researcher; and founder of VoyageMD.com, a free service for travellers with diabetes, and Excarbs.com, which focuses on exercise and insulin. He is now director of research and innovation at the William Sansum Diabetes Center in Santa Barbara, California. You can follow him on Twitter (@GoDiabetesMD) and LinkedIn.

Competing interests: The author has no relevant competing interests to declare. 

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