Medical information tattoos raise health-care questions

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Tattoos aren't just body art to some of Heather Myles's clients – they're also a matter of life and death.

Ms. Myles, a tattoo artist and owner of Inksmith Tattoos in Guelph, Ont., has inked a handful of clients, including two the past year, with warnings about their medical conditions. One teenager with a serious kidney condition had repeatedly lost his MedicAlert bracelet, so his parents brought him to Ms. Myles to have his health information permanently inked on his skin, in case of emergency. Another client had a MedicAlert symbol and her medication information tattooed on her wrist, after losing her bracelet while travelling abroad.

"As soon as she came back [to Canada] she got it tattooed so she never has to worry about it again," Ms. Myles says.

Now that tattoos are more a part of the mainstream, a small – but apparently growing – number of individuals with allergies, diabetes and other health issues are favouring medical tattoos over MedicAlert bracelets and necklaces, according to a report published Monday in the Canadian Medical Association Journal. The trend raises a number of concerns about the absence of guidelines on medical tattoos and their potential for confusing health workers, the journal says.

Robert Ridge, president and chief executive of the Canadian MedicAlert Foundation, says the primary worry is that emergency responders have been trained for decades to look for official medical bracelets or necklaces, not body ink.

"They're not trained to look for tattoos, and there's a good chance they could be missed in an emergency situation," Mr. Ridge says. He adds that tattoos can also become less legible over time.

Moreover, Brian Cole, director of provincial operations at St. John Ambulance in Ontario, says a major benefit of MedicAlert-type jewellery and pocket cards is that they can be updated to reflect a patient's changing health status. If, for instance, an individual with Type 2 diabetes was able to manage his condition to the point of no longer requiring medication, his MedicAlert information could be updated, whereas a tattoo would be permanent. Conversely, as people age, they may suffer additional health problems, Mr. Cole says.

"At what point do you have this whole host of multiple medical conditions somehow identified [with tattoos]" he asks.

According to the CMAJ, medical tattoos can vary wildly. Some are located on upper backs and shoulders while others are inked on wrists, forearms and chests. Some are plain and done in black ink, but others are elaborate, featuring butterflies, hearts or skulls and fancy fonts. On an individual who has multiple tattoos, a medical tattoo can be hard to spot.

The journal also points out emergency responders may be confused about a tattoo's significance. The letters "D.N.R." tattooed across someone's chest, for instance, could be the initials of a name or instructions not to resuscitate. (It notes that emergency personnel are not obligated to follow instructions indicated on tattoos.)

To address some of these concerns, Ms. Myles says she advises her clients to use their medical tattoos as back-ups, not replacements for medical jewellery. "I definitely recommend to people to still wear a bracelet," she says.

She also recommends they avoid embellishments and get medical tattoos wherever they would normally wear medical jewellery.

"Don't do anything fancy with it to change the design because then it won't be recognizable to medical staff that it's actually a serious tattoo," she says.

In the meantime, Saleh Aldasouqi, an associate professor of medicine at Michigan State University, says medical researchers should pay more attention to medical tattoos.

"This thing has to be standardized," Dr. Aldasouqi told CMAJ. "We have to at least teach and educate emergency personnel so they become more aware."