Medical ethics

Breach of privacy: Medical journal retracts a paper for a photo used without patient's permission

From taking photos without their patients' knowledge to publishing photos without their consent, Indian doctors are failing ethical guidelines.

Last month, the Indian Journal of Plastic Surgery retracted an article after patient informed the editor of the journal that it contained and photograph of her, the use of which she had not consented to.

The article titled Surgical reconstruction or prosthetic rehabilitation following orbital exenteration: The clinician’s dilemma was about a woman who underwent a prosthetic graft in her eye socket. The eye had been removed surgically after a cancerous growth. The patient’s photograph had a cropped image of her face, mostly only showing her eyes. The article had been published in March 2014.

The retraction notice said that the photograph was taken without the patient’s permission. The notice further added, “In regards of the privacy of the patient and on grounds of infringement of obtaining patient consent the article in concern is being retracted. The patient image will also be removed from the online version of the article.”

The editor of the journal Dr Mukund Jagannathan said in an email interview that the patient had sent an him an email asking that the photograph be removed. She had “recognised” her photograph on the website of the journal. “I don’t know what misgivings she had, but she requested that the photos be taken off the net,” he said. “It was a cropped photo of only part of the face.”

Jagannathan said that since there was no value of the article without photos, the entire article was retracted.

The article’s main author Dr Himanshi Aggarwal from King George’s Medical University in Lucknow is yet to answer the email queries from

Repeated offence

With increased access to medical journals online, such instances of breach of consent have been reported often. The lack of consent infringes of the privacy of the patient, who is often taken by surprise to see his or her image online.

Retraction Watch, a website that tracks retractions in scientific papers, has recorded several papers that were retracted on grounds of confidentiality all over the world.

For a 2013 article elaborating in the Journal of Trauma Management & Outcomes about brain surgery procedures at the Cleveland Clinic in Ohio, a surgeon failed to take consent from her patients before publishing case descriptions and CT scans, citing as reason that all identifying details had been removed. The article was retracted from the journal.

Sometimes, even after consent is taken, the patient or the patient’s guardians may not understand the extent to which the article is accessible to the public.

A 2012 paper in the Indian Journal of Dermatology, Venereology and Leprology had to be retracted after the parents of a 14-year-old Argentinian suffering with Dellman syndrome, a genetic brain disorder, revoked their consent. The author of paper said that the parents of this boy had not initially understood that the open access article could be browsed by the general public.

Retractions of articles are not easy to trace. The article on the eye surgery had been retracted in June, but Retraction Watch traced it only in November. By creating a repository of retracted articles, the blog attempts to promote transparency and integrity in science and scientific publishing.

“Unless journals inform such sites themselves, it is very difficult to trace a retraction,” said Amar Jesani, consulting editor with the Indian Journal of Medical Ethics. “There are tens of thousands of journals published (all over the world).”

While the prosthetic eye surgery article has been pulled down online, physical copies of the 2014 edition of the journal will remain with those who already have them.

Specific consent

Medical bodies around the world have laid out ethical standards to avoid these breaches of patient privacy. As per guidelines issued by American College of Medical Genetics and Genomics, before taking photographs of patients, the patient will have to provide consent for all uses that will be made of the image, including medical records, medical teaching, medical publication – open access or ones with a paywall.

The British Medical Journal’s guidelines mention an exception for images such as X-rays, ultrasound images, or images of indistinct parts of body that do not reveal the patient’s identity and say that these can be used without consent. However, any image that identifies the patient needs written consent.

The International Committee of Medical Journal Editors also specifies that nonessential identifying details should be omitted and informed consent should be obtained if there is any doubt that anonymity can be maintained. They also clearly state that masking eye region in photographs is inadequate protection of anonymity.

Many doctors in India usually take a “general consent” from the patient seeking permission to use the photos for medical purposes. “General consent is with reference to using these photos for medical purposes but if used in a journal etc, specific consent needs to be taken,” said Jagannathan.

However, in India, even medical photographs are often taken without a patient’s consent and then posted on social media.

However, even the way the prosthetic eye article was written providing details of the patient’s age, background, history of the disease that could help identify her. These should only be published with a specific consent of the patient, said Jesani.

“The interaction between a doctor and a patient is supposed to be confidential, unless there is a danger to larger society,” said Jesani. †

We welcome your comments at
Sponsored Content BY 

The perpetual millennial quest for self-expression just got another boost

Making adulting in the new millennium easier, one step at a time.

Having come of age in the Age of the Internet, millennials had a rocky start to self-expression. Indeed, the internet allowed us to personalise things in unprecedented fashion and we really rose to the occasion. The learning curve to a straightforward email address was a long one, routed through cringeworthy e-mail ids like You know you had one - making a personalised e-mail id was a rite of passage for millennials after all.

Declaring yourself to be cool, a star, a princess or a hunk boy was a given (for how else would the world know?!). Those with eclectic tastes (read: juvenile groupies) would flaunt their artistic preferences with an elitist flair. You could take for granted that and would listen to Bollywood music or read Archie comics only in private. The emo kids, meanwhile, had to learn the hard way that employers probably don’t trust candidates with e-mail ids such as

Created using Imgflip
Created using Imgflip

And with chat rooms, early millennials had found a way to communicate, with...interesting results. The oldest crop of millennials (30+ year olds) learnt to deal with the realities of adolescent life hunched behind anonymous accounts, spewing their teenage hormone-laden angst, passion and idealism to other anonymous accounts. Skater_chick could hide her ineptitude for skating behind a convincing username and a skateboard-peddling red-haired avatar, and you could declare your fantasies of world domination, armed with the assurance that no one would take you seriously.

With the rise of blogging, millennial individualism found a way to express itself to millions of people across the world. The verbosity of ‘intellectual’ millennials even shone through in their blog URLs and names. GirlWhoTravels could now opine on her adventures on the road to those who actually cared about such things. The blogger behind could choose to totally ignore petunias and no one would question why. It’s a tradition still being staunchly upheld on Tumblr. You’re not really a Tumblr(er?) if you haven’t been inspired to test your creative limits while crafting your blog URL. Fantasy literature and anime fandoms to pop-culture fanatics and pizza lovers- it’s where people of all leanings go to let their alter ego thrive.

Created using Imgflip
Created using Imgflip

Then of course social media became the new front of self-expression on the Internet. Back when social media was too much of a millennial thing for anyone to meddle with, avatars and usernames were a window into your personality and fantasies. Suddenly, it was cool to post emo quotes of Meredith Grey on Facebook and update the world on the picturesque breakfast you had (or not). Twitter upped the pressure by limiting expression to 140 characters (now 280-have you heard?) and the brevity translated to the Twitter handles as well. The trend of sarcasm-and-wit-laden handles is still alive well and has only gotten more sophisticated with time. The blogging platform Medium makes the best of Twitter intellect in longform. It’s here that even businesses have cool account names!

Self-expression on the Internet and the millennials’ love for the personalised and customised has indeed seen an interesting trajectory. Most millennial adolescents of yore though are now grownups, navigating an adulting crisis of mammoth proportions. How to wake up in time for classes, how to keep the boss happy, how to keep from going broke every month, how to deal with the new F-word – Finances! Don’t judge, finances can be stressful at the beginning of a career. Forget investments, loans and debts, even matters of simple money transactions are riddled with scary terms like beneficiaries, NEFT, IMPS, RTGS and more. Then there’s the quadruple checking to make sure you input the correct card, IFSC or account number. If this wasn’t stressful enough, there’s the long wait while the cheque is cleared or the fund transfer is credited. Doesn’t it make you wish there was a simpler way to deal with it all? If life could just be like…

Created using Imgflip
Created using Imgflip

Lo and behold, millennial prayers have been heard! Airtel Payments Bank, India’s first, has now integrated UPI on its digital platform, making banking over the phone easier than ever. Airtel Payments Bank UPI, or Unified Payment Interface, allows you to transfer funds and shop and pay bills instantly to anyone any time without the hassles of inputting any bank details – all through a unique Virtual Payment Address. In true millennial fashion, you can even create your own personalised UPI ID or Virtual Payment Address (VPA) with your name or number- like rhea@airtel or 9990011122@airtel. It’s the smartest, easiest and coolest way to pay, frankly, because you’re going to be the first person to actually make instant, costless payments, rather than claiming to do that and making people wait for hours.

To make life even simpler, with the My Airtel app, you can make digital payments both online and offline (using the Scan and Pay feature that uses a UPI QR code). Imagine, no more running to the ATM at the last minute when you accidentally opt for COD or don’t have exact change to pay for a cab or coffee! Opening an account takes less than three minutes and remembering your VPA requires you to literally remember your own name. Get started with a more customised banking experience here.

This article was produced by the Scroll marketing team on behalf of Airtel Payments Bank and not by the Scroll editorial team.