Patients & Their Pictures

What does a picture say about a patient? Well, it depends on the type of picture. A photograph and an MRI can tell you volumes about the patient’s past, present, and future. In this week’s BrainWaves episode, we bring you two perspectives on imaging in neurology:

On the one hand, neurologists frequently utilize MRI in the evaluation and management of neurologic disease. As an example, Dr. Salim Chahin discusses the importance of new T2 lesions in patients with demyelinating diseases like multiple sclerosis, whereby the accumulation of new lesions may prompt a change in immunomodulatory therapy. He also recounts some of his own personal experiences in sharing computed tomography and MRI results with patients and their families. This is an incredible difficulty for any healthcare provider, to discuss what inflammation, or bleeding, or a mass lesion, may mean when it affects the brain. How can a patient or family understand without the years of training it takes to become a physician? Words are often insufficient. And when your words finally fail, images may not. Sometimes, as they say, you have to see it to believe it.


Mother and child. Reprinted with permission from the Ali Mendelson collection. See

On the other hand, an MRI or CT scan does not provide a social history. Dr. Ali Mendelson is conducting a research project delving into the minds and opinions of healthcare providers using patient photographs. Her question is simple: Does seeing the patient in their natural state impact the care that’s provided? Using personal photographs provided by family members, strategically placed in hospital rooms, she hopes to determine whether physicians and nursing staff (unknowingly) alter the course of a patient’s care in response to these emotional stimuli. Maybe physically seeing that a patient is a fighter, a resister, and a breaker of boundaries, can tip the balance just enough to push the provider to go the extra mile. The patient may receive greater support, their body may be challenged with a stronger antibiotic, their spirits may be tested with ceaseless rehabilitation. On the other hand, perhaps visualizing that a patient desires nothing more than to be surrounded by his or her family, to laugh, and to engage with them, may suggest to the provider that a life of dependence, of machines, of re-hospitalizations, is not the desired outcome. The patient may receive greater comfort, be relieved of pills and PT, and blessed by more time spent with family.

Is a simple photograph enough to reroute a patient’s entire clinical course? My guess: it will. Photographs are powerful. They are fierce. And they speak to us in far greater detail than progress notes.

Check out this week’s podcast on patients and the pictures we take of them. It is a strong recommendation for anyone interested in medicine, palliative care, and of course, photography. See for more of Dr. Mendelson’s incredible work.


[Jim Siegler]

The content in this episode was approved and vetted by Salim Chahine.

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