Names have been removed to protect privacy. Identifying letters are assigned in alphabetical order and bear no relationship to the person’s actual name.
- This Office received a complaint from Ms A about the care provided by private otolaryngologist Dr B. Ms A has a history of allergic rhinitis and had had nose surgery for a deviated nasal septum over 25 years ago. On 16 July 2019 Ms A’s general practitioner (GP) referred Ms A to Dr B for treatment of a nasal lesion. Ms A is concerned that Dr B ‘overserviced’ her by performing surgery and tests that were not clinically indicated, and that he did not inform her adequately about the risks associated with the surgery. In addition, this report considers whether Dr B managed Ms A’s complaint appropriately.
- During an initial appointment on 29 August 2019, Dr B diagnosed a small viral papilloma inside Ms A’s left nostril, which he considered required surgical removal. Dr B documented that Ms A ‘also expressed a desire to have her general nasal airway improved’. Dr B conducted a nasoendoscopy and discussed additional surgery.
- Ms A considers that Dr B ‘convinced’ her to undergo additional surgery (to improve her breathing and reduce her allergies) when she did not raise any concern about this. In response to the provisional decision, Ms A told HDC that she did not express a desire to have her nasal airway improved and did not initiate this conversation. Ms A stated that after conducting a nasoendoscopy to look at the papilloma, Dr B stated that she had reduced airways, drew diagrams to illustrate this, and suggested that she undergo surgery. She considered that Dr B ‘upsold’ her from the original purpose of her visit, which was to have the papilloma removed.
- In contrast, Dr B stated that he considered a surgical approach as ‘there was a fixed mechanical obstruction and rhinosinusitis that was unlikely to improve with medications alone’. He noted that Ms A graded her nasal blockage as 3–4 out of 5 on a sinusitis symptoms questionnaire form on 29 August 2019. This is supported by the clinical records. In response to the provisional decision, Ms A stated that she filled out the questionnaire at Dr B’s request, and with Dr B’s suggestion that her breathing was compromised. There is conflicting information as to whether Ms A had chronic sinusitis. Dr B stated that a CBCT scan on 31 October 2019 showed ‘significant inflammation of the paranasal sinuses and the cause for the mechanical block’. Dr B provided HDC with a statement from a diagnostic radiologist who said that the CBCT scan showed ‘mild maxillary sinus disease’. In response to the provisional decision, Ms A felt that Dr B’s and the diagnostic radiologist’s findings were at odds with each other.
