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Clinical Image Consent Requirements: Variability among Top Ten Medical Journals


The consent process for publication of clinical images in medical journals varies widely. The extent of this variation is not known. It is also not known whether journals follow their own stated best practices or the guidance of the International Committee of Medical Journal Editors (ICMJE). We assessed consent requirements in a sample of 10 top impact factor general medicine journals that publish clinical images, examining variability in consent requirements for clinical image publication and congruence of requirements with the recommendations of the ICMJE. Clinical image consent requirements varied widely from journal to journal. None of the studied journals, even amongst n = 4 ICMJE members or n = 8 journals who self-report adherence to ICMJE guidelines, comply with all of the recommendations of the ICMJE. Half of studied journals require a journal-specific consent form. Among top medical journals there is significant heterogeneity in consent requirements for clinical images. Variability of consent requirements is neither practical nor rational; inconsistent requirements create uncertainty for authors, present impediments to dissemination of scholarship, and undermine a shared professional understanding of how best to protect patient privacy. We propose adopting a standardized consent form and process for publication of identifiable images in medical journals, with uniform elements and explicit definitions.

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Fig. 1


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The authors would like to especially thank and acknowledge Susan Hurwitz for editorial assistance.

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Correspondence to Juan N. Lessing.

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Portions of this material were presented in poster form at the Society of General Internal Medicine Mountain West regional meeting and the Society of Hospital Medicine annual meeting, both in 2017.

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This study did not have human subjects and therefore did not require IRB approval.

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Dr. Mark is a paid consultant to KenSci. Inc., and the founder and CEO of Sound Life Sciences, Inc. The authors declare that they have no conflict of interest.

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Lessing, J.N., Mark, N.M., Wynia, M.K. et al. Clinical Image Consent Requirements: Variability among Top Ten Medical Journals. J Acad Ethics 17, 423–427 (2019).

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  • Informed consent
  • Consent requirements
  • Clinical image
  • Variability
  • International Committee of Medical Journal Editors (ICMJE)