Committee: Discipline
Decision Date: 05 Feb 2018
Summary:
On February 5, 2018, the Discipline Committee found that Dr. Albert Poh Soon Choong committed an act of professional misconduct, in that he has failed to maintain the standard of practice of the profession, and in that he has engaged in conduct or an act or omission relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
Dr. Choong is a family physician who received his certificate of registration authorizing independent practice from the College of Physicians and Surgeons of Ontario on October 10, 1972. At the relevant time, Dr. Choong practised family medicine in Toronto.
Patient A
Patient A became Dr. Choong’s patient about 20 years ago. In June 2016, she attended Dr. Choong with complaints of pain in her rectum due to constipation and as a result of medication she was taking to relieve headache and muscle pain. Given Patient A’s presentation, Dr. Choong offered to conduct a digital rectal examination, which the patient accepted.
Patient A was in the examination room alone with Dr. Choong. He did not offer her a chaperone. Dr. Choong directed Patient A to take off her pants and undergarments and failed to provide the patient with any draping. He then asked Patient A to bend forward and lean over the examining table, raising her rectum towards him. Dr. Choong’s positioning did not allow for adequate visual examination and he inadvertently inserted his finger in the patient’s vagina in a manner the patient experienced as forceful. Patient A responded quickly stating “oh no not there”. Dr. Choong then released his finger and proceeded to insert it in her rectum to perform a digital rectal exam. Following the examination, Dr. Choong recorded in his chart that the left lateral wall of the anus was tender, but there was no induration and no blood. He found no clinical evidence of the abscess. Given Patient A’s presentation and finding, Dr. Choong believed she had an anal fissure and prescribed an analgesic cream.
An expert retained by the College concluded that a digital rectal exam was clinically indicated in the circumstances. However, the expert opined that Dr. Choong failed to maintain the standard of practice of the profession in this case, explaining that the standard of practice for a female digital rectal examination is for the patient to be in the lithotomy position (on her back with legs open as for a pelvic examination) or lying on her left side. According to the expert, one would proceed in the lithotomy position, if the patient was being evaluated for possible pelvic complaints and a rectal examination was also required. If only a rectal examination is indicated based on the complaint, the left side lying position is standard. Given that Patient A was complaining specifically of rectal pain and she was constipated, a side lying examination was indicated.
The expert further concluded that Dr. Choong’s digital rectal examination technique displayed a lack of judgment. Not only did he not employ the appropriate technique for female patients, he also failed to provide modesty draping, demonstrating a lack of judgment and a failure to maintain the standard of practice. The expert noted that the examination, which was “clumsily performed”, may have a lasting negative effect on the patient’s experience.
On January 30, 2018, Dr. Choong entered into an undertaking with the College, wherein he agreed to resign from the College effective immediately and to not apply or re-apply for registration to practise medicine in Ontario or in any other jurisdiction.
Disposition
On February 5, 2018, the Discipline Committee ordered that:
Dr. Choong attend before the panel to be reprimanded.
- Dr. Choong pay costs to the College in the amount of $5,500.00 within 30 days of the date this Order becomes final.