A senior doctor in Singapore was suspended for 12 months by the Singapore Medical Council (SMC) after his misdiagnosis resulted in his teenage patient losing a testicle.

After the teen consulted him over swelling and pain in his testicle, Yeo Khee Hong, who had been in practice for some 38 years, incorrectly diagnosed the 15-year-old with an infection.

The correct diagnosis was testicular torsion, which happens when the spermatic cord supplying blood to the testicle becomes twisted, cutting off blood supply.

After his condition worsened, the teen was rushed to hospital and had to have emergency surgery to remove his left testicle.

SMC estimated that Yeo's patient would have had a 90.4 to 97.2 per cent chance of salvaging the testicle if he had been diagnosed correctly.

Doctor did not make referral to confirm diagnosis

The patient consulted Yeo at his clinic on Mar. 22, 2019, according to an SMC disciplinary tribunal.

He was about 15 at the time.

The teen told Yeo that he felt pain in his left abdomen which had originated from his left testicle.

After examining him, Yeo diagnosed him with abdominal colic and prescribed medication for diarrhoea and intestinal cramps.

However, the patient returned to see Yeo five days later on Mar. 25 and told him that there was swelling and pain in his left testicle.

Finding that it was enlarged and tender, Yeo diagnosed him with orchitis and epididymitis, or inflammation caused by a bacterial infection.

He also ordered a full blood and urine test for the patient and prescribed him antibiotics.

Yeo, did not, however, refer him to a specialist or to the Accident & Emergency (A&E) department to confirm his diagnosis.

Patient needed surgery to have testicle removed

About a week later, on Apr. 1, 2019, the teen's father called Yeo to tell him that his son's condition had not improved, and the teen was in severe pain.

Upon Yeo's advice, the father brought the teen to hospital immediately.

The A&E department assessed the teen's condition, and confirmed the diagnosis of testicular torsion.

However, the condition had restricted blood flow to his left testicle by this point, making it no longer viable.

As such, he had to undergo surgery to have it removed.

In July 2020, the teen's father made a complaint to SMC alleging Yeo's negligence, after which SMC asked Yeo to provide an explanation.

In December 2020, Yeo wrote an apology letter to his patient and his family.

He later pleaded guilty to a charge of professional misconduct.

Failed to act as reasonable and competent doctor: SMC

SMC's investigation found that Yeo had "failed to act as a reasonable and competent doctor" and "was in breach of the applicable standard of care".

SMC's lawyers pointed out that the patient was "at risk of testicular torsion" given his age and the results of Yeo's examination.

They added that "a reasonable and competent doctor" would have considered the possibility of the diagnosis, and not ruled it out without a referral to an A&E of a hospital or a specialist such as a urologist or paediatric surgeon.

Contending that Yeo had acted negligently, SMC's lawyers said that he was "content" to treat the patient with antibiotics, perform laboratory investigations, and "to make the decision to refer only if the pain and swelling persisted in a few days and depending on the full blood count test results”.

They said the patient "suffered emotional and psychological distress" from the loss of his testicle.

The potential harm to the boy also includes fertility issues, SMC's lawyers added.

Had patient's best interests at heart: Doctor

In mitigation, Yeo said that he had been "candid and cooperative" with SMC's investigation and pleaded guilty as he was "extremely remorseful".

He said he was "deeply saddened" by the patient's plight and that it "will continue to weigh heavily on his mind".

Yeo contended that his misdiagnosis was a wrong judgment call, but one borne out of good intention as he did not want to cause undue alarm to the patient.

While accepting that there were lapses on his part, Yeo said that he had the patient’s well-being and best interests in mind and was trying his best to treat him.

Yeo also said he has learnt from the incident and corrected his medical practice.

Offence was one-off, out of character: SMC

Despite Yeo's seniority as a medical professional, the tribunal noted that this was an "isolated incident" and that Yeo "had a long unblemished track record and good professional standing".

"The present offence was one-off and out of character. In our view, he is unlikely to re-offend," the tribunal said.

By pleading guilty, Yeo had saved time and resources, and removed the need for the patient's family to be involved in the proceedings, the tribunal noted.

The tribunal also felt that Yeo had given them "reasons to believe he was genuinely remorseful".

"He had acknowledged the seriousness of the harm caused to the patient, apologised to the patient and his family, and taken steps to improve his medical practice to prevent the recurrence of the offence," the tribunal said.

Apart from the 12 months' suspension, Yeo will be formally censured and will have to submit a written undertaking to SMC that he will not undertake in the conduct or similar conduct in future.

He will also have to pay the costs and expenses of the proceedings including the costs incurred by SMC's lawyers.

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