Medical Practitioner, Dr E New Zealand Men's Clinic - Health and ...

More documents

Recommendations

Info

Health and Disability Commissioner … • Keep clear, accurate, and contemporaneous patient records that report the relevant clinical findings, the decisions made, the information given to patients and any drugs or other treatment prescribed. Prescribing drugs or treatment 4. You may prescribe drugs or treatment … only when you: • have adequate knowledge of the patient’s health • are satisfied that the drugs or treatment are in the patient’s best interest. Usually this will require that you have a face-to-face consultation with the patient or discuss the patient’s treatment with another registered health practitioner who can verify the patient’s physical data and identity. …” Opinion — Introduction It is unusual for four similar complaints to be made over a short period, from unconnected complainants in widespread locations around the country (Whangarei, Auckland, Tauranga and Dunedin). Although for most of the men involved their primary complaint was the poor “value for money” they received from their consultations, the main issue of concern to me is the poor standard of assessment performed by Dr E. For the reasons set out below, I consider that Dr E failed to provide services of an appropriate standard and adequate information to his patients, in breach of the Code. I also consider that the New Zealand Men’s Clinic is vicariously liable for Dr E’s breaches of the Code. Opinion: Breach — Dr E Mr A Mr A (aged 65) sought treatment from the Clinic for erectile dysfunction. He has a significant medical history, which he described on the Clinic’s questionnaire, noting that he suffered from diabetes and high blood pressure. Mr A was also taking five medications that are standard for a patient with cardiovascular disease. However, Dr E performed no physical examination, and no clinical observations were recorded prior to the prescription of a prostaglandin injection. 18 December 2008 14 Names have been removed (except the NZ Men’s Clinic) to protect privacy. Identifying letters are assigned in alphabetical order and bear no relationship to the person’s actual name.
Opinion 08HDC02899, 08HDC05986, 08HDC07100, 08HDC09984 Dr E submitted that he did discuss Mr A’s diabetes and hypertension management with him, but failed to document this. I also note that no consent form was signed by Mr A, despite the Clinic’s own caveat on the form that the doctor must ensure that the consent form has been signed and understood. Dr Tiller advised: “In my view an integral component of the management of a diabetic patient requesting erectile treatment would be history of the diabetes, including current control of hyperglycaemia and hyperlipidaemia. Unless these areas of management are controlled well, any improvement in erectile function can be expected to be short lived because control of further vascular disease is required to optimise erectile function. [Dr E] made no attempt to obtain history of the current diabetic and cardiac status of [Mr A]. While the ongoing management of these conditions would remain the responsibility of the general practitioner an assessment of these matters was required in order to offer effective long term treatment. [Dr E] should also have examined the peripheral arteries in the groin and legs and examined for an abdominal bruit that might suggest arterial disease of the aorta. Such disease would affect the arterial supply to the penis. Vascular surgical advice may have been warranted.” Dr E’s expert, Dr Sean Wright stated that “whilst Dr Tiller’s opinion strictly speaking, is medically correct it overlooks the practicalities of this situation … It is not appropriate for a clinic such as this to manage a patient’s ongoing medical problems, these patients invariably are after a ‘quick fix solution’ that will enable an erection on demand.” Dr Wright did, however, agree with Dr Tiller that the history taking, physical examination and record keeping could have been more thorough. Dr Wright also noted that, while the choice of treatment may not have been affected and “Dr E may be able to arrive at the appropriate conclusion swiftly, it would be prudent to take time to outline to the patient why other measures etc are not appropriate”. I accept that patients attend men’s health clinics because they are seeking specific treatments and that recurrent themes will arise. However, a health professional who allows consultations and treatment plans to become routine runs the risk that important details of a patient’s medical history will be missed. In case 06HDC11343, I stated: “The Code confirms that the Commissioner as decision-maker is expected to form an independent opinion on the reasonableness of the care provided. While I accept that there can often be a legitimate range of responsible opinion and practice, I am also conscious of my responsibility, as an independent guardian of patients’ rights, to distinguish between mediocre and good practice.” I endorse Dr Tiller’s view that, for a patient with Mr A’s significant medical history, Dr E should have performed a more complete examination prior to offering treatment, 18 December 2008 15 Names have been removed (except the NZ Men’s Clinic) to protect privacy. Identifying letters are assigned in alphabetical order and bear no relationship to the person’s actual name.
Page 1: Medical Practitioner, Dr E New Zeal
Page 4 and 5: Health and Disability Commissioner
Page 44: Health and Disability Commissioner

Medical Practitioner, Dr E New Zealand Men's Clinic - Health and ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?