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

Opinion 08HDC02899, 08HDC05986, 08HDC07100, 08HDC09984
Appendix 3
Expert advice from Dr Stuart Tiller: Mr B
“Thank you for the request that I provide clinical advice in relation to specific
questions posed regarding the care provided by [Dr E] to [Mr B] at the New
Zealand Men’s Clinic.
I have given earlier advice on 10 th April 2008 in relation to this complaint.
Advice requested.
• General advice on the standard of care provided.
• Specific advice on the standard of the clinical assessment/examination
performed.
• Specific advice on the clinical treatment prescribed and/or dispensed.
• Whether any professional standards apply, and whether these standards were
complied with.
• Any other comment.
Clinical advice
It is my view that the pre-consultation questionnaire completed by [Mr B]
canvassed necessary clinical history. However, as previously advised, [Mr B] did
not supply information in relation to any ‘other currently taken medications’ or
‘allergies to medication’. It is my view that [Dr E] should have completed these
entries when reviewing the history with [Mr B] during the consultation. It is also
my view in relation to a young man complaining of ‘coming too soon’ and
difficulty with ‘maintaining an erection’ that further elaboration of these
complaints was required. Were these primary problems dating from the
commencement of sexual activity? Or were the problems secondary, after previous
satisfactory sexual experience? Was [Mr B] within a stable relationship where
discussion of sexual matters could take place? Was [Mr B] aware of ‘performance
anxiety’? There should have been some discussion regarding the need for adequate
sexual preparation prior to intercourse. In the absence of such detailed questioning
to establish the underlying cause of the perceived sexual inadequacy, any
treatment provided would be symptomatic only, and would not necessarily deal
with the underlying cause/causes of the sexual difficulties. Although I previously
advised that I thought the departure from standards of care were mild, upon
reflection I would now consider that the care and advice offered by [Dr E], in
the context of a specialist men’s clinic dealing with issues of sexual
performance and satisfaction, to have been a moderate departure from
accepted standards. It was important for a young man of the age of [Mr B], to
receive psychosexual advice and education in addition to any treatments on offer.
18 December 2008 27
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.