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

Health and Disability Commissioner
Mr D
Mr D also sought treatment from the Clinic for erectile dysfunction. He described Dr
E’s assessment as very superficial, and the documentary evidence supports this view.
Again, no clinical examination was performed, and no clinical observations recorded.
Both should have occurred given Mr D’s age (68). Dr Tiller noted that one of the
medications that Mr D was taking has an adverse effect of impotence, yet there
appears to have been no assessment by Dr E of this possible cause.
Dr E initially stated that he “could not now recall exactly what was said during his
discussion with [Mr D]”. However, Dr E later advised that “the use of [Mr D’s] Hytrin
was discussed and there was no temporal relationship with the use of Hytrin and his
erectile dysfunction”. There is no record of any such discussion, which Mr D does not
recall.
Dr E’s expert, Dr Wright, suggested that Mr D’s consultation is “what would be
expected from the average GP when a patient requests Viagra”. In his view it “is
simply not practical to alter medications for other conditions in an attempt to alleviate
erectile difficulty”.
In weighing the views of Drs Tiller and Wright, I am mindful of their different
backgrounds. Dr Tiller is an experienced general practitioner with over 28 years’
experience in a variety of settings. He is a Fellow of the Royal New Zealand College
of General Practitioners, which supported his appointment as clinical advisor to HDC.
Through his work with HDC, he is very familiar with the application of the New
Zealand Code of Rights in a practical setting. Dr Wright is also experienced, having
worked for seven years in the men’s health area prior to taking up his current
anaesthetics role. However, he is not familiar with the Code and the specific
requirements that arise in New Zealand practice.
As noted above, Right 6 of the Code requires a patient-centred approach to
consultations so that the patient receives appropriate information about his condition
and the factors that could be contributing to it. The possibility that impotence may be
caused by a patient’s current medications is obviously information that should be
disclosed by a health professional assessing a patient’s erectile dysfunction.
There is also conflict over whether Mr D was made aware of the potential cost of
treatment. I endorse the view of Dr Tiller that “where a doctor is aware that a
recommended course of treatment will be expensive, that some information in that
regard should be provided by the prescribing doctor”. Dr E stated that Mr D was
advised of the cost, yet there is no documentary evidence to support his view. In
contrast, Mr D stated that he was surprised to find out the cost when he was leaving,
and felt pressured to pay at the time. Given Mr D’s description of a consultation that
was “relatively quick”, and with no contrary documentary evidence, I find his account
credible.
18 December 2008 18
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.