Case 3 – Blatant Attempt by ‘Internationally Renowned’ Sleep Surgeon to Deceive Medical Insurers

 

The same sleep surgeon as in Case 1 and 2 was consulted by Mr P M, a 41 year old gentleman from the UK. Mr M complained that his wife was disturbed by his loud snoring for the past few years. He did not suffer morning tiredness, daytime sleepiness but his nose is often blocked as he was told to have a deviated nasal septum. He underwent a sleep study (results seen in Figure 1) which shows a Apnea-Hypopnea Index (AHI) of 3.4/hr (normal less than 5/hr), Respiratory Distress Index (RDI) of 13/hr (normal less than 5/hr) and lowest oxygen saturation (lsat) of 91% (normal is above 90%). He was told to have Obstructive Sleep Apnea (OSA) and recommended surgery. To obtain approval from his medical insurers for the planned procedures, Mr M requested a letter stating his current problems. From the letter (see Figure 2), it is obvious that this doctor has attempted to misrepresent Mr M’s medical condition. He states that;

1. Mr M’s tonsils are huge and suffer from Severe Tonsillitis and that a tonsillectomy is required. However, Mr M says his tonsils were removed when he was a child in the UK! Clinical examination by Dr Chee confirmed that Mr M does not have any tonsils at all.

2. Mr M suffers from ‘Severe Acute Sinusitis’. From the clinical photos of the endoscopy done by this doctor, there is no pus, polyps or any evidence of sinusitis. No CT scan of the sinuses was done to confirm the diagnosis. This is a routine investigation before any sinus surgery is considered. Nonetheless, this doctor recommended Endoscopic Sinus Surgery and Sinus Washout. Even if Mr M did suffer ‘Severe Acute Sinusitis’, the first line of treatment is medical therapy with antibiotics, nasal sprays, oral steroids etc, not surgery.

Lastly, Mr M does not suffer from significant OSA based on the AHI and lsat readings. At most, he suffers from upper airway resistance syndrome (UARS) which does not require major surgery.

Takeaway Point

Patients should always seek a second opinion when told to undergo major surgery for seemingly mild symptoms. This doctor blatantly states that this patient has huge tonsils when clearly there were none. The patient was also told to undergo surgery (endoscopic sinus surgery) for a condition he did not have (sinusitis).

Patients should beware of doctors who are willing to distort the true nature of their medical condition. If you can’t trust the doctor to do the right thing, you probably can’t trust their medical opinion either.

Dr Gerard Chee

MBBS (S'pore), FRCS (Edin), FRCS (Glasg) Fellow, Otology / Neurotology (Can)

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