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

Health and Disability Commissioner
and a vascular surgery referral may have been warranted. In addition, although I
accept that there was discussion about the intended treatment, the consent forms were
not signed.
Dr E’s treatment of Mr A shows signs of having been superficial. Mr A’s description
of the consultation having been brief seems convincing, and is supported by the
limited documentation.
By providing a cursory assessment, Dr E failed to provide Mr A services with
reasonable care and skill, and breached Right 4(1) of the Code. By failing to document
his care in relation to Mr A, in particular the failure to ensure that consent forms were
signed, Dr E breached Right 4(2) of the Code.
Mr B
Mr B is a healthy young man (aged 21) who sought treatment for premature
ejaculation. It is clear that Dr E’s assessment of Mr B was superficial. Although a
physical examination may not have been necessary, given Mr B’s age and health
background, he should have been asked questions about his sexual functioning, and
should have received “psychosexual advice and education in addition to any
treatments on offer” (in the words of Dr Tiller).
Dr Wright notes that “while these psychosocial aspects would certainly have added to
the history, they would have had no bearing on the case management at all. They are
quite simply irrelevant in a case of premature ejaculation in a young healthy male with
no erectile difficulty.” However, Dr Wright’s opinion illustrates his lack of familiarity
with the patient-centred approach that is expected under New Zealand’s Code. Right 6
of the Code affirms a patient’s right to the information that a reasonable patient, in
that patient’s circumstances, would expect to receive about his condition (including
any contributing factors). As Dr E has pointed out, men attend the Clinic because they
do not always feel comfortable discussing sexual dysfunction with their GP. Good
information is all the more important in such “one-off” consultations, when a patient
may not return for further advice.
Dr E acknowledged that “psychosexual counselling forms a fundamental part of a
successful outcome” of a patient’s consultation. However, Mr B describes a rushed
consultation without “counselling” of any sort. In my view, Dr E’s assessment was
deficient.
I also note that Dr E prescribed an approved medicine for use in an unapproved
manner. Although this is permissible in some circumstances, a medical practitioner
should advise the patient that the proposed use is unapproved. Dr E did not do so in
Mr B’s case.
By providing a cursory assessment, Dr E failed to provide Mr B services with
reasonable care and skill, and breached Right 4(1) of the Code. By failing to advise
Mr B of the unapproved use of an approved drug, Dr E did not provide Mr B
18 December 2008 16
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.