At 60 years old and with almost 30 years of private practice under his belt, Dr. G understood what sort of physician he was. Better put, he understood what sort of physician he was not. He was not the sort who wanted to coddle patients, or become friends with them, or look at their family pictures.
Dr. G, who took great pride in his unblemished record as a urologist and the fact that he was highly sought after, had enough introspection about himself to understand that he preferred surgery because he really did not want the sort of interaction with patients that general practitioners were required to provide. He liked getting referrals, knowing what the problem was, fixing it, and sending the patient back to his primary care physician or urologist for the “hand-holding” part.
Dr. G's colleagues knew him as brusque, but extremely competent. He had little tolerance for long conversations with patients, but as a urologic surgeon he was one of the best. For this reason, he was never short on referrals, and had plenty of work.
Adult circumcision
One referral was Mr. P, a 44-year old doorman who was referred to Dr. G by another urologist. The referring physician noted that the patient was suffering from phimosis, and the physician believed that surgery—specifically circumcision—was in order. A look at the patient's chart also indicated that Mr. P was a smoker and had type 2 diabetes. A physical examination revealed an inability for the foreskin to be retracted behind the glans penis. After the examination, Dr. G agreed with the referring doctor that a circumcision was necessary, and informed the patient.
“My wife and I…” began Mr. P, sheepishly, “we haven't been able to be intimate for a long time. This will fix that, right?”
“This will fix the problem with your foreskin,” the physician said. “You should be able to return to normal sexual relations.”
The surgery was scheduled, and took place several weeks later. It was uneventful, and Dr. G did not give it or the patient much more thought until more than a year later, when he was served with papers informing him that he was being sued for malpractice.
A legal matter
He immediately called a defense attorney and they went over the allegations together. The attorney informed the physician that the patient was claiming that the circumcision had been performed faultily, and that as a result, the patient was now impotent and unable to have relations with his wife.
“That's ridiculous,” Dr. G fumed. “There was nothing wrong with that surgery. That patient has uncontrolled diabetes. That's the cause of his impotence!”
“That may be true,” the attorney replied, “but undoubtedly the patient has found a physician who will testify as an expert witness that there was something negligent about the surgery. A jury, especially male jurors, may be sympathetic to the relatively young patient who cannot have sex with his wife.”
Dr. G told the attorney that he intended to do whatever was necessary to protect his reputation, and he would go to trial if that's what it came to. And indeed, that is what happened.
At trial, as predicted, the plaintiff's attorney introduced an expert urologist and an expert neurologist. The urologist testified that it was his belief that the surgery had been performed negligently and was not within the acceptable standard of care. The neurologist testified to the decreased function and sensation of the plaintiff's penis. The plaintiff and his wife both testified as to how the impotence had negatively affected their marriage, and how the physician had told them that they would be able to have sex after the surgery.
Although he still firmly believed he had done nothing wrong, Dr. G saw the men in the jury squirming and began feeling concerned. His concern abated when his attorney stood up and began his cross examination. The attorney was able to get each expert witness to admit that uncontrolled diabetes can and does cause impotence, and that there was no clear evidence that the surgery had been performed negligently, aside from the patient's complaints of continued impotence. The attorney also cross examined the plaintiff and was able to get him to admit that he did not take his diabetes medications as prescribed, check his blood glucose, monitor his weight or stop smoking, as he should to control his diabetes.
The defense then introduced its own experts – a neurologist who said that the plaintiff's symptoms were related to out-of-control diabetes and an expert urologist who testified that Dr. G had not deviated from the accepted standard of care. The jury deliberated for less than an hour and returned with a verdict in favor of Dr. G.