discipline summaries in 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 . The Discipline Committee also found that Dr . Wojcicki is incompetent . After receiving information from an anonymous source and from a physician , the College began a Section 75 ( 1 )( a ) investigation into Dr . Wojcicki ’ s practice . Dr . X , an independent expert , provided an opinion on Dr . Wojcicki ’ s internal medicine practice and complementary and alternative medicine ( CAM ) practice based on his care of 25 patients . Dr . X concluded that Dr . Wojcicki ’ s care did not meet the standard of practice of the profession in all of the 25 charts reviewed . In 24 of these charts , Dr . X also found that Dr . Wojcicki ’ s care reflected a lack of knowledge , skill and judgment and that his clinical practice is likely to expose many of his patients to a risk of harm or injury . The details of Dr . X ’ s concerns include :
• Dr . Wojcicki ’ s documentation practices do not meet the standard of practice of the profession . For example , he does not appear to use a Cumulative Patient Profile or similar instrument to document patient ’ s previous and current medical problems and treatment ;
• Dr . Wojcicki makes a diagnosis without explaining his reasoning in the same chart note [ which ] is particularly problematic in light of the unconventional diagnoses ( e . g ., adult hormone deficiency syndrome ) that [ he ] reaches ;
• In many instances , Dr . Wojcicki makes a treatment recommendation without indicating clearly why he has chosen a particular course of action ;
• In many instances , Dr . Wojcicki recommends that patients with atherosclerosis undergo chelation and “ plaque therapy ” which consists of intravenous administration of phospholipids and other agents . This treatment is not considered standard and … if offered should be done so in the context of an approved research study or under the auspices of the CPSO ’ s Complementary / Alternative Medicine policy ;
• In several instances , not only with regard to plaque therapy and intravenous chelation , but also in regard to bioidentical hormone replacement therapy … Dr . Wojcicki ’ s practice does not adhere to CPSO ’ s
Complementary / Alternative Medicine policy ;
• Dr . Wojcicki recommends that patients with testosterone levels below the reference range be treated with testosterone creams , even in older adults ( e . g ., patients over the age of 65 ) who do not have symptoms and signs strongly suggestive of testosterone deficiency , and even in those with a history of prostate disease ;
• Dr . Wojcicki recommends that patients with “ adult hormone deficiency syndrome ” or simply “ hormone deficiency ” be treated with growth hormone [ and ] in some cases this diagnosis is reached even when IGF-1 is within the reference range … the standard of practice is such that the diagnosis would generally be made or confirmed by an endocrinologist [ and ] treatment should also generally occur under the supervision of an endocrinologist ;
• In many instances , Dr . Wojcicki appears to have ordered tests that are not indicated given the clinical circumstances – e . g ., C-peptide levels , FSH and LH levels in women who are obviously post-menopausal , estradiol and progesterone in men , co-enzyme Q10 , Vitamin A , mercury , various tumour markers , etc . … the ordering of these tests reflects a lack of knowledge and judgment and is inconsistent with the standard of practice ;
• In one instance , Dr . Wojcicki treated a patient with a history of estrogen receptor positive breast cancer with estrogen . Such treatment is contra-indicated and … should only be offered in extremely unusual circumstances with the approval of a patient ’ s oncologist ;
• Dr . Wojcicki treated post-menopausal women with estrogen . Because of the increased risk of cardiovascular disease , the standard of practice is that estrogen should only be used to treat severe menopausal symptoms , for a short period of time , and only after discussion of benefits and risks ;
• In at least one instance , he treated a patient with newly diagnosed metastatic breast cancer with unconventional treatments without documenting a discussion regarding chemotherapy and without referring her to a medical oncologist ; and
Full decisions are available online at www . cpso . on . ca . Select Doctor Search and enter the doctor ’ s name .
Issue 4 , 2016 Dialogue 75