Surgeon Accused of 'Upselling' Unwanted Surgery Leading to Nostril Collapse

A woman has accused a surgeon of 'overservicing' her by convincing her to undergo unnecessary additional surgery, resulting in the collapse of her nostril and leaving her feeling 'extremely humiliated.'

The patient, who approached the Health and Disability Commissioner (HDC), alleges that the surgeon failed to provide sufficient information about the risks of the procedure, and that the pre-surgery tests were not well-informed. According to an HDC decision released today, the woman met with an otolaryngologist in August 2019, who diagnosed a benign tumour inside her left nostril and recommended its removal.

The surgeon claimed that the woman had expressed a desire to improve her nasal airway and that they had discussed additional surgery. However, the patient maintains that the surgeon 'convinced' her to undergo the surgery, despite her not wanting to improve her nasal airway and not initiating the conversation about it. She described the additional procedures as an 'upsell' that followed the original purpose of her visit, which was to have the tumour removed.

The surgeon performed the additional surgery in June 2020, which included procedures to address sinus issues, improve airflow, drainage, and ventilation. Within two days of the surgery, the woman raised concerns with the surgeon, informing him that her left nostril collapsed when she inhaled deeply. The surgeon advised her to continue rinsing it and to add a steroid spray to the rinse.

After three weeks, she visited the surgeon again and was told that 'the nose has settled down beautifully.' However, there was no record in the clinical notes of her raising concerns about the collapsing nostril during this visit. At a third post-operative appointment, she again outlined her concerns. The surgeon became defensive, agreeing that the nostril was collapsing but stating that 'this was still a good outcome.'

The surgeon's consultation notes document the woman's complaint for the first time at this point, noting near full healing and suggesting that the tumour could not be ruled out. However, he felt the analysis was overly cautious and that the nasal passage was entirely normal. He discussed possible interventions to correct the collapse, including surgery, but the patient felt that the surgeon's response was dismissive.

The woman described a heated disagreement with the surgeon, who then informed her that he no longer wished to treat her and asked her to leave. She said she was 'castigated' by the receptionist for her apparent rudeness and left the clinic. She emailed the clinic with a complaint on the same day, but claims she did not receive a response from the doctor or the clinic.

The surgeon defended his actions, stating that the woman's explanation of the final appointment was 'wholly unacceptable' and that 'something certainly didn't feel right about the way (she) engaged and what was being explained to her.' He claimed that the collapse was caused by forced breathing and that normal breathing post-surgery may take up to 12 months. He described the woman as 'overly dramatic' and said she became upset when video images showed that the nasal cavity was not out of place. He stated that she was not interested in viewing the video footage or developing a treatment plan moving forward, and that he knew she could be 'very unpleasant and aggressive,' leading him to 'terminate the consultation' to avoid an argument.

The surgeon also informed the commissioner that he had written a 'full report' to her GP on the same day and advised her to seek the guidance of another ear, nose, and throat surgeon.

Deputy Health and Disability Commissioner Vanessa Caldwell found that the doctor breached part of the Code of Health and Disability Services Consumers' Rights by failing to provide the woman with a written acknowledgment of her complaint within five working days and missing an opportunity to resolve the issue. She criticized the surgeon for ending the doctor-patient relationship 'to avoid an argument' and stated that this was not a sufficient reason to do so, nor was the woman making a complaint about him.

Caldwell emphasized that consumers are entitled to ask further questions about the outcome of surgery and to make complaints under the Code. She noted that even if the relationship was deemed 'irretrievable,' as the doctor submitted, it should have been managed in a professional manner.

While Caldwell was unable to make a finding about the doctor's diagnosis due to a difference in clinical opinion, she acknowledged that the woman 'trusted' his judgment as an 'expert.' She stated that this illustrates an imbalance of power within the doctor-patient relationship, where consumers may feel unable to challenge a doctor's recommendation or make decisions based on trust rather than an informed choice based on knowledge about their health status and alternative treatment options.

Caldwell noted that the doctor had taken the matter 'very seriously' and made changes to his practice, including participating in a consent development forum, data collection processes, formalized complaint procedures, a review of doctor-patient relationship guidelines, and an increase in staff, including a plastic surgeon who specializes in nasal surgery.

The doctor was instructed to apologize to the patient and undertake an audit of compliance with the complaints procedure.