Panel hearing summary 2013.0171

Decision of the Medical Board of Australia

Performance and Professional Standards panel

Jurisdiction: Western Australia
Date of Hearing: 10 September 2013
Date of Decision: 10 September 2013

Classification of Notification:

Clinical Care - Inadequate or inappropriate treatment

The matter involved the alleged unsatisfactory professional performance of a general practitioner in his treatment of the patient on 8 July 2008 (first consultation) and 22 July 2008 (second consultation).

Allegations

The Medical Board of Australia alleged that the practitioner behaved in a way that constituted unsatisfactory professional performance under s.191(1)(b)(i) of the National Law, in that he:

1. failed to examine the patient at the first consultation to assess the clinical signs associated with her presenting problem. 
2. formulated an inadequate management plan for the patient which failed to address her presenting problem and was based on inadequate clinical reasoning. 
3. prescribed the patient a number of supplements that were unnecessary and/or inappropriate given her presenting condition, specifically:
   1. Lipotropene with Methionine x 90 caps 
   2. Sodium Ascorbate Powder 150g 
   3. Kefir Turkish Yogurt x 5 sachets 
   4. Paracea Forte Bioceuticles x 60 caps 
   5. Dr Fu Ease Up Formula x 60 tabs and 
   6. Dr Fu Long Dan Xie Gan Tang 200 pills, alternatively, Dr Fu Long Dan Xie Gan Wan 200 pills.
4. failed to conduct and/or refer the patient for appropriate testing, specifically:
   1. vulval and vaginal swabs for microscopy and culture, including swabs of any lesions found 
   2. urinalysis and 
   3. liver function tests in relation to the suspected liver problems.

Finding

The panel found that the practitioner had behaved in a way that constituted unsatisfactory professional performance under s.191(1)(b)(i) of the National Law in that he:

1. failed to examine the patient at the first consultation to assess the clinical signs associated with her presenting problem; and
2. failed to conduct and/or refer the patient for appropriate testing, specifically:
   1. vulval and vaginal swabs for microscopy and culture, including swabs of any lesions found
   2. urinalysis and
   3. liver function tests in relation to the suspected liver problems.

(allegations 1 & 4 were found proven)

Determination

The panel believed that the practitioner was managing a patient with a chronic condition and that it would have been reasonable for him to have allocated a longer consultation. The panel was aware that the patient had seen several specialists and was looking at alternative medicine to manage her condition.

The panel also considered that the practitioner was going to see the patient in several consultations to deal with her chronic conditions. The second consultation, at which the patient was clearly upset by being made to wait for a long period of time, led to the breakdown in the therapeutic relationship. This prevented further consultations from taking place. Nevertheless, the panel found that the practitioner should have examined the patient at the first consultation. It would not have been crucial to perform a vaginal examination at the first consultation but it would have been necessary to perform other clinical examinations.

The practitioner stated that he does practise conventional medicine as a General Practitioner but most of his practice is towards alternative medicine.

The practitioner agreed to allocate and plan reasonable time for patients with chronic conditions and to perform clinical examinations when required.

The panel cautioned the practitioner.