WEAPONS OF MASS DISTRACTION: Personal Injury Photography Tips to Avoid Distracting Elements

Personal injury photography can often be comical in its acquisition. Check out the following examples of unusual personal injury photography....

 

All too often does an image of an injury detract from its primary purpose of providing an accurate depiction of severity to cause an unnecessary and sometimes comical portrayal of subject matter. 

In Personal Injury photography the subject being documented must capture the attention of the viewer by minimizing focus elsewhere and avoiding any comical aspects which may detract from its purpose. To achieve this one must control any distracting elements such as background, jewellery, clothing and client posture/expressions. The viewer is unlikely to want to see a clients book collection, floral sofa pattern, or pink new crocodile shoes and ‘I Love Jesus’ socks. Facial expressions and posture can also create a quite comical effect and detract from the importance of the image.


To avoid background distractions a clear, clean non reflective white, black, green or blue cloth should be used. (Other coloured backgrounds can reflect colour casts onto the subject and may often clash with skin tones)
All clothing and jewellery in the vicinity of the subject much be removed. This is important in portraying the location of the clinical subject in relation to an identifiable part of the body. A photograph of a scar on a clients thigh without the knee cap in shot (either covered by clothing or out of shot) may fail to portray prominence. 
All clothing and jewellery in the vicinity of the subject much be removed. This is important in portraying the location of the clinical subject in relation to an identifiable part of the body. A photograph of a scar on a clients thigh without the knee cap in shot (either covered by clothing or out of shot) may fail to portray prominence. 


Jewellery and clothing is one of the major contributors of distracting elements not only by distracting the viewer away from the subject but also in displaying an injury out of context.


Whilst avoiding distracting elements may not be the most important factor in accurate personal injury photography, it is largely overlooked in its ability to draw attention away from the subject in a sometimes comical way. This may also possibly lead to photographic evidence carrying less evidential weight in court. Clinical photographer's are trained to control distracting elements through the use of local and national standard operating procedures developed to ensure the subject being documented is the focus of attention at all times.


Disclaimer: To my knowledge the images used in this blog post were not taken by anyone in a professional capacity as part of a personal injury claim. Images used are to highlight similar true to life personal injury photography examples I regularly come across 

Image Sources:

http://www.everystockphoto.com/photo.php?imageId=867325&searchId=828de69a2994bdb482cecf9d10c7f5f2&npos=6

http://www.everystockphoto.com/photo.php?imageId=1095060&searchId=828de69a2994bdb482cecf9d10c7f5f2&npos=9

http://www.everystockphoto.com/photo.php?imageId=2661988&searchId=828de69a2994bdb482cecf9d10c7f5f2&npos=50

http://www.everystockphoto.com/photo.php?imageId=1160081&searchId=828de69a2994bdb482cecf9d10c7f5f2&npos=139

http://www.everystockphoto.com/photo.php?imageId=2713185&searchId=828de69a2994bdb482cecf9d10c7f5f2&npos=260

http://www.everystockphoto.com/photo.php?imageId=1172079&searchId=7ff983fb58f776769fdfdc8faa69662b&npos=134
http://www.everystockphoto.com/photo.php?imageId=9693515&searchId=828de69a2994bdb482cecf9d10c7f5f2&npos=1002

 

IS EVERY MEDICAL EXPERT A DAVID BAILEY IN DISGUISE?!

Medical experts are increasingly including (and quite often charging) for photographs as part of their medico-legal reports. This is not only possibly damaging for the claimant in respect of accuracy in quantum assessment, but it is also having increasing cost implications for the solicitor. 

I am a specialist clinical photographer and director of Clinical Photography UK who provide national personal injury photography reports by qualified experts. This has led me to critically analyse the current contributors in photography for Personal Injury and Clinical Negligence claims. 

I predict many reading this have commonly been on the receiving end of poorly taken photographs by a claimant, commercial photographer or medical expert. Whilst most poor quality images are provided by the claimant themselves, medical experts are generally untrained in clinical photography and lack knowledge of specialist photographic techniques.

As many cases rely heavily on the physical appearance of an injury for either valuation, liability, or both, is an expert the right choice? 

To provide an example in context:

A plastic surgeons report on a rhinoplasty may state the Claimant has an obvious inverted V deformity as a result of an unnecessary excision of dorsal cartilage from the septum. An inferior or superior view would provide a more accurate depiction of the V deformity but is often overlooked by a commercial photographer. Whilst the medical expert may include an inferior view as part of his report, without the use of a fixed focal zoom lens the photographs would be shot at varying distances causing subject distortion. This would extenuate the shape and contours of the nose, leading to inaccurate and inadmissible photographic evidence (Please see my law gazette article on perspective distortion HERE).

For a case that relies heavily on photographic evidence of injury such as a subtle cosmetic or serious injury claim; clear and accurate photographs by a clinical photographer are vital.

Looking to the future

Basic training can provide a medical expert with knowledge on exposure, composition, and camera settings. Assuming the expert stores the images according to the DPA and relevant governmental protocols, there is no issue with experts including photographs as part of their report for reference purposes only. These images should not be relied upon for valuation or liability. If photographs are required to document severity or subtle deformity, a clinical photographer should be instructed. . Clinical photography is a specialist subject and also a profession, with hundreds of clinical photographers based at hospital sites around the UK, who are highly skilled and trained in photographing physical deformity and injury. Clinical photographers work on standardised procedures and can provide highly accurate results at roughly the same cost of an expert or commercial photographer. Post Jackson this is undoubtedly a more justifiable solution to documenting injury. 

IMI IMAGE OF THE MONTH

Institute of Medical Illustrators

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IMAGE OF THE MONTH MARCH 2013

Pinguecula by Tim Zoltie

St James University Hospital Leeds

This Image was taken using a slit lamp camera with 40 degree cross light and Nikon D3x attachment. The vignetting was produced naturally with no after effects or manipulation. Image was not taken for a PI or Clin Neg case and is just documenting a clinical condition. It does however show the accuracy involved in photographing difficult subjects and the advantages a clinical photographer can offer when documenting lesions in difficult places. A slit lamp provides macro close ups almost similar to a microscope and can pick up changes on the cornea and external eye conditions difficult to see to the naked eye. 

To View the link:

http://www.imi.org.uk/document/image-of-the-month

'PHOTOGRAPHIC EVIDENCE' LAW GAZETTE ARTICLE

Thursday 13 December 2012 by Tim Zoltie

PHOTOGRAPHIC EVIDENCE

The term ‘conversational distance’ is often used in personal injury and clinical negligence claims to describe the measurability of the prominance of a scar or deformity. It is deemed suitable for this purpose, yet in medico-legal photography it has no meaning.

It is clear that ‘conversational distance’ is not a descriptive measurement, so why is the term used so often? The term provides a suitable description of an injury in its context. A claimant’s physical scarring may play a large role in the assessment of quantum, and a medico-legal report or a solicitor’s notes must provide details on how it appears. For example: ‘The claimant has a two-inch scar prominent at conversational distance on the left lateral of his right thigh.’

While conversational distance is worked out at an average distance of one metre, the need for accuracy is minimal. The statement is only aimed at pointing out the scar can be seen from a short distance away and as such is suitable for this purpose. As clinical photography is strictly about accuracy and measurements however, this term as currently applied in claims is too broad to provide any sense of standardisation, and this distance can not be identified or repeated. When an instruction states: ‘Please photograph the left lateral of our claimant’s right thigh from conversational distance,’ the question becomes is this the distance from which to photograph the subject? Or is it how much of the claimant’s body is in shot?

The key element of clinical photography is standardisation. It is key to providing the accurate portrayal of an any lesion or injury, using standard operating procedures to ensure all photographs are correctly scaled, colour balanced, and can be held in comparison to one another. A standard operating procedure in the case of clinical photography is developed through local and field specific protocols, involving specific distance measurements, flash and camera settings.

When photographing a lesion, a clinical photographer will photograph a ‘locator’ and a ‘close-up’. While a close-up is defined by the size and scale of the lesion, the locator is defined at a set subject distance. The principle behind a locator is to identify the location of the lesion and view it in context to the rest of the body, thus having a similar purpose in principle to ‘conversational distance’. The difference between them however, ‘conversational distance’, has no defining measurements, while in clinical photography a ‘locator’ has a set scaled subject distance which is measured by the use of a SLR’s fixed focal length lens.

Subject distance, lens choice and camera settings all play a major part in photographic reproduction and can have a large effect on how an injury is portrayed. Subject distance in this case can be altered by simply including more of the body in frame, thus reducing the size and impact of the scar. For example, a scar on a wrist photographed at ‘conversational distance’ would look very different if the full arm was in shot, or just the hand and wrist. The distance therefore would need to be clarified. Alternatively taking the photograph at conversational distance would vary greatly depending on what lens was used. The brief is therefore decided by the photographer who is effectively deciding on how much of the body to include in the frame.

In clinical photography this is worked out by set protocols and standard operating procedures which are broadly defined by a locator and a close-up. The locator being pre-defined areas of the body which are shot dependent on which area the lesion is located. While these protocols may vary slightly between clinical photography departments, the overall result is the same: a standardised repeatable result is achieved. If all medico-legal photography were shot in this manner, standardisation could be more easily achieved.

A different perspective

So, the photography of a claimant’s injuries for a personal injury or clinical negligence claim can vary greatly depending on the settings used to produce the final image. As each variable can substantially alter the final photograph, there is a high possibility that any photographic evidence submitted may be inaccurate or even misleading. Perspective distortion is one of these variables, and is also a prime example of how photographic images can be manipulated even before the images are captured in digital format.

The above two images were both shot on the same camera (Canon EOS 5D Mark II digital SLR), with the same lens (Canon 24-105mm f4 IS) at variable focal lengths. The left image was photographed at 35mm, and the right at 100mm. This is a prime example of perspective distortion. As you can imagine, in terms of expert witness evidence the difference between the two above images could be paramount. Say for example, the above image was taken to portray the physical features of the nose for a clinical negligence claim against a surgeon following a rhinoplasty operation.

The image on the left would suggest an extenuation of the nose and in context, appears substantially large in relation to the face. This is therefore quite misleading. To avoid this distortion, the photographer must increase the subject-to-camera distance, providing a more accurate result and avoiding distortion. This would then display the nose in its true context at the correct focal length.

Tim Zoltie is clinical photographer at Leeds Teaching Hospitals and proprietor of Clinical Photography UK