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

Health and Disability Commissioner
The pre-consultation forms were completed by [Mr D] and indicated that his
presentation was for difficulty ‘getting an erection’. The symptoms had been
present for 1–3 years. Regular medication included Hytrin and synflex.
[Mr D] was aged 68 years.
The ‘Physical examination sheet’ was left blank. This form indicated that for all
patients on oral medications the blood pressure ‘must be done’. There was no
recording of blood pressure or pulse. There was no examination of the peripheral
pulses or any other area of the cardiovascular system.
A test dose of prostaglandin injection was given with a recorded 30% response.
Prostaglandin injections for home use were prescribed and dispensed.
The ‘injectable treatments’ consent form signed by [Mr D] contained information
regarding potential side effects of this treatment.
Clinical advice
It is my view that for a man of the age of [Mr D] examination of the
cardiovascular system was required before recommending treatment for erectile
dysfunction with anticipated resumption of sexual activity to follow. The forms of
the clinic required the doctor to record the blood pressure. This was not done. No
examination of the peripheral pulses was undertaken to assess the state of the
arterial circulation. No enquiry was made regarding cholesterol levels. It is my
view that the omission of any physical examination was a mild to moderate
departure from accepted standards for a medical practitioner. I acknowledge
that [Mr D] was an apparently fit and healthy man for his age of 68 years. There
was also no discussion of the possibility that Hytrin treatment might be
contributing to the erectile dysfunction. Impotence is listed in MIMS/New Ethicals
as a recognised adverse side effect of Hytrin medication. Doctors should always
consider long term medication as a possible cause of side effects and adverse
symptoms, such as erectile dysfunction.
See above comment.
The treatment offered and prescribed was reasonable.
The standard that I have used in providing this advice is that of the New Zealand
Medical Council in their publication ‘Good medical practice’. The Council define
good clinical care as including, amongst other factors, ‘adequately assessing the
patient’s condition, taking account of the patient’s history and his or her views and
examining the patient as appropriate’. The Council also recommends ‘referring the
patient to another practitioner when this is in the patient’s best interests’. It is my
view that an adequate history was taken but no clinical examination was
documented although this was required given the age of [Mr D].
18 December 2008 34
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.