As the saying goes: A picture may be worth a thousand words. In health care, it may spare a thousand words used to explain by telephone what “the incision seems more open,” “more red than I expected,” or “concerned that the wound is not healing right” means.
However, a photograph is not a diagnosis. Sending one is not, by itself, a treatment plan.
More than twenty years ago, after my fifth spinal surgery, I learned the difference. The incision was on my back, beyond my field of vision. As the Steri-Strips loosened, the wound edges began to separate. My wife was not trained to assess a surgical wound, but she could photograph it so I could see what was happening. Even as a physician, I could not monitor what I could not see.
The photographs made the change visible to me, and I sought clinical evaluation. An infectious disease physician examined the wound directly, recognized that the separation extended beyond a superficial opening, and obtained a culture. Bacterial growth was confirmed. I was rehospitalized, treated with intravenous antibiotics, and eventually discharged with a PICC line through which I self-administered antibiotics for two months.
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I cannot reconstruct every earlier step. What I remember clearly is this: The photograph made the change visible to me. The examination established its clinical significance.
Observability is part of the treatment plan
“Watch the incision” sounds straightforward. But it assumes the patient can see the incision, knows what normal healing should look like, can recognize meaningful change, and has a practical way to reach someone when it occurs.
Those assumptions often fail. Wound location, pain, limited mobility, visual impairment, or body habitus may make observation difficult. A willing family member may help but have no basis for deciding whether what they see is expected.
In one wound-clinic study, 86 percent of patients had wounds that were difficult to see, and only 20 percent monitored their wounds themselves. Patients described loss of autonomy when they could not see the wound. Most believed photographs would help them track healing, and more than half believed photographs would increase their participation in care. The study was conducted in a wound clinic rather than a postoperative cohort, but the practical lesson applies broadly: Monitoring is not feasible merely because the patient has been told to do it.
Observability belongs inside treatment planning, alongside cost, transportation, cognition, caregiving, and treatment burden. A basic question is easily missed: Can the patient see what they are being asked to watch?
A family member can help make change visible. They should not be expected to determine its clinical significance.
The photograph is not the intervention
Much of the literature asks whether wound photographs improve diagnosis, reduce visits, or support remote monitoring. The more useful clinical question is what must surround the image before it becomes part of care.
One vascular-surgery program trained patients or caregivers before discharge to submit a daily wound photograph and symptom report for two weeks. A designated team reviewed submissions daily and contacted patients when findings were concerning. The image did not function alone. Its value came from the clinical loop built around it.
A randomized trial of 492 patients after emergency abdominal surgery found that smartphone wound follow-up did not significantly shorten the overall time to diagnosis of surgical-site infection. It did increase the likelihood of diagnosis within the first seven postoperative days, reduce community-care attendance, and improve patients’ experience of obtaining advice.
Workflow matters as much as technology. In a pediatric ambulatory-surgery study, 166 families reported sending a postoperative wound image, but a corresponding image was found in the electronic record in only 121 cases. Clinical management changed in 20 percent of encounters. An image may affect treatment and still become detached from the record, the responsible clinician, or the continuing clinical story.
The photograph is clinical information. The treatment plan determines what is being watched, who interprets it, when they respond, and what happens next.
A photograph can also falsely reassure
Images may not show warmth, tenderness, odor, drainage volume, wound depth, pain out of proportion to visible findings, or systemic illness. Lighting, focus, distance, skin tone, camera quality, and angle also affect interpretation.
In a study of 523 surgeons reviewing clinical vignettes, adding wound photographs increased specificity and confidence but reduced sensitivity for detecting surgical-site infection. Surgeons were also more likely to recommend too low a level of care when photographs were included.
A clear image can create an impression of clinical completeness that it does not deserve. In my case, the photograph helped me recognize change; direct examination identified its depth and associated concern. The photograph should contribute to the assessment, not conclude it.
What a usable image pathway requires
For patient-generated photographs to become actual care rather than another stream of unprocessed information, six elements should be explicit:
- First, define what is being monitored: “Watch the wound” is less useful than explaining the expected course and which visible changes should prompt contact.
- Second, determine whether the patient can observe the area: If not, the plan may require help from another person, a nursing check, an earlier visit, or another method.
- Third, provide a secure way to send the image: Patients should know whether photographs can be uploaded through the portal or another approved platform rather than relying on personal email or unprotected text messages.
- Fourth, pair the image with context: Include what changed, when it changed, and whether there is increasing pain, drainage, fever, chills, weakness, or another concern. The picture and the patient’s account are complementary.
- Fifth, identify who will review the image and within what time frame: A photograph uploaded Friday evening but not reviewed until Monday remains governed by administrative time while the wound changes on biological time. Patients need an expected response window and another route when waiting is not appropriate.
- Finally, explain when a photograph is not enough: Some findings require direct examination. Some symptoms require urgent evaluation regardless of what the image appears to show. A portal should never obstruct timely care.
Recent expert recommendations similarly place telemedicine within a personalized wound-care pathway, complementary to face-to-face care rather than a replacement for it.
Visibility is not responsibility
Smartphone cameras can reduce verbal ambiguity, establish a visual timeline, support triage, and sometimes prevent unnecessary travel. But not every patient has a smartphone, portal fluency, adequate vision or dexterity, or someone available to help. A digital route cannot become the only route back into care. Nor should responsibility shift simply because the patient can take a picture.
The patient’s responsibility may be to notice, document, and report change. The clinical team’s responsibility is to interpret that change, place it in context, and make clear what should happen next.
In Care-Full Medicine, I describe Follow-Through as the deliberate return to the clinical sequence when the original treatment plan no longer fits. A photograph can initiate that return, but it must reach someone, be interpreted, and lead to a decision about whether remote guidance is sufficient or direct examination is needed.
A picture may be worth a thousand words. In health care, it becomes part of actual care only when someone can say:
We have seen the change. Here is what it may mean. Here is what happens next.
Alan P. Feren is a retired surgeon, independent physician, health care consultant, and patient advocate with more than 50 years of experience in clinical practice, system leadership, and health care innovation. Formerly in academic and community surgical practice, he has worked across the evolving landscape of managed care and clinical governance.
In the 1990s, Dr. Feren co-authored clinical guidelines that evolved into what is now MCG Health, now used by more than 80 percent of U.S. health plans and over 3,100 hospitals. He has advised health technology startups, helped shape managed care policy, and served as a clinical content developer for health care technology platforms.
His work centers on restoring shared understanding between clinicians and patients in an era defined by speed, fragmentation, and technological mediation. Drawing on both professional experience and his own journey as a complex patient, he writes about transparency, accountability, and the disciplined methods that make medical care trustworthy. He is a contributor to KevinMD and a podcast guest. More information is available at mypersonaladvocate.net and on LinkedIn.
