"I didn't know you were such a good cook": Photos as a tool for primary care clinician-patient communication

To examine audio-recorded primary care interactions with patient-initiated photo sharing around food and diet choices.

Data were 13 audio recordings of primary care visits with English-, Chinese-, or Spanish-speaking patients 60+ with two or more chronic conditions. Patients and clinicians completed pre-intervention surveys and some training on photo-taking / photo-sharing discussion. Data were analyzed using discourse analysis.

Photo-based communication interactions lasted 3:34-28:37 min and averaged one-third of the visit. Clinicians and patients both initiated the photo-based talk and transition to other topics occurred smoothly. In eight of 13 interactions, the photo-based communication task was raised, but conversation did not occur at that moment. When discussed, the photos raised opportunities to talk about patient's decision-making which led to dietary suggestions including clinical nutrition suggestions and referrals to other specialty clinics.

Photo-based communication in primary care can be used to promote patient activation and facilitate collaborative decision making that accounts for the patients' lived experiences and lifeworld.

By setting the agenda early, clinicians or patients can designate the photo-sharing as a relevant part of the visit. Photos may be most relevant as part of the problem presentation, diagnosis, or treatment recommendation sections of the visit.