Showing skin: When medical photos get provocative

Picture, if you will, a magazine cover photo of a (presumably) unconscious and mostly nude female patient, one leg raised and the other sprawled sideways, being positioned for surgery by three men in scrubs.

Outpatient Surgery magazine published a photo exactly like this on its cover last month to accompany a story about safe surgical positioning, igniting a barrage of criticism from readers who felt the image was degrading, distasteful, insulting and offensive. (Click here to judge for yourself.)

What were the editors thinking? Nothing, apparently, if we’re to believe editor-in-chief Dan O’Connor, who pennedmea culpa of sorts this month, claiming the blowback “caught us by surprise.”

His rationale: “Anyone who’s been around surgery knows that patients are very frequently left much more exposed than the patient on our cover was.”

Really? Really?

Illustrations for medical articles and public health messages tend to be a sensitive subject. Remember the firestorm over Georgia’s Strong 4 Life childhood obesity campaign? Or the FDA’s failed attempt to add graphic photos to cigarette packages? Or the Minnesota Department of Health’s colonoscopy campaign featuring huge billboards of a backside with pants at half-mast? What one person sees as blunt, refreshing honesty can look to someone else like crass overkill.

Titillation as a sales tactic is nothing new either. But it’s arguably a whole different ethical proposition when this strategy is used to depict the care of patients who are vulnerable, forced to compromise their dignity and control and, in the case of surgery, unconscious and unaware of what’s being done to them.

For the record, the magazine cover photo didn’t strike me as “pornographic,” as one critic accused. But I’d call it deliberately provocative, perhaps even exploitive.

Why the choice of a female patient? Did the three people in scrubs all have to be men? Why her entire anatomy below the waist and not, say, an arm or shoulder? Why an obviously young and slender woman instead of a middle-aged man? And what was up with the double entendre in the tagline’s promise of “maximum exposure” to patient safety tips?

The article itself tackled a serious and important subject. Patients who are sedated, especially for lengthy surgeries, can be at significant risk of developing pressure ulcers that are painful, debilitating and costly to treat. Safe, proper positioning during surgery is one of the keys to avoiding this complication.

But never mind the fact that the patient demographic at greatest risk of pressure ulcers is older adults. Sex sells, so we get a cover photo of a shapely upraised leg instead of one that’s bony and arthritic. In the same manner we get images of mammography featuring one attractive semi-nude young woman after another, even though breast cancer is most prevalent in middle-aged and older women. With all that skin on display, the underlying message can become cheapened and sometimes ultimately lost.

I suppose you could argue that even when medical imagery is tarted up with firm young flesh, it at least has the benefit of depicting something real. After all, not everyone was unhappy with the surgery magazine’s choice of cover photo; one (female) surgical nurse told the editor she thought the patient “was covered appropriately.”

It begs the question, however: Appropriate according to whose definition – the patient or the OR staff?

Tellingly, no one spoke up to say the photo was inaccurate.

To give him his due, Mr. O’Connor recognizes that health care practices long regarded as standard may leave patients feeling exposed and compromised. He writes: “Well, here’s a thought. If we think patients would be uncomfortable with how we treat them when they are anesthetized, then is there something wrong with how we’re treating patients?”

Well, here’s a thought for you, Mr. O’Connor. Why don’t you ask patients themselves? I bet they’d have something to say.

But enough of my opinion. What do readers think?

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