A medical specialist in gynaecology and obstetrics is facing allegations that he did not adequately consider a patient’s symptoms, including an inverted nipple, before she was elsewhere diagnosed with stage-two cancer eight months later.
Dr Jaroslaw Krzyzanowski, whose address was given as The Medicus Medical Centre, Dublin 7, is facing allegations of poor professional performance arising out of his treatment of patient Ioanna Stefanakou in 2020 and 2021.
He is also accused that he carried out a breast ultrasound when he did not have the requisite standard of skill or expertise to do so.
On Tuesday Ms Stefanakou told the Medical Council’s fitness-to-practise committee she became concerned about the nipple on her right breast in mid-2020 because it had become inverted.
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She researched a specialist doctor, selecting Dr Krzyzanowski based on his biographical details which cited his experience in dealing with women’s health, she said.
Ms Stefanakou said on her first visit on September 25th, 2020, she had a conversation with Dr Krzyzanowski about her hometown, Kalamata, in Greece, which he said he knew as it was famous for its olives.
She said she asked Dr Krzyzanowski to refer her for a mammogram. But she said the doctor refused, instead performing a physical exam and an ultrasound. “‘I see everything is normal’, he said to me,” she told the committee.
The patient said when she continued to express concern about why her nipple was inverted Dr Krzyzanowski became less cordial and said: “I told you, you are very young.”
“He changed his voice; he was not kind like before,” the patient said.
Ms Stefanakou said five or six months later she noticed a lump in her breast and returned to Dr Krzyzanowski in May 2021.
She said that on this occasion Dr Krzyzanowski referred her to the Mater Hospital for a mammogram. She also said he recognised her from her previous visit and again asked her about her family’s home place in Greece.
Dr Krzyzanowski told the inquiry he did not remember Ms Stefanakou.
He said records indicated that when he had first seen a lump on the patient’s breast in May 2021 he had referred her for a mammogram, which was the correct thing to do.
The inquiry heard that following the mammogram in the Mater Hospital the patient had been diagnosed with stage-two cancer in the breast and the lymph nodes.
Ms Stefanakou told the inquiry “I just want him [Dr Krzyzanowski] to be 10 times more careful with other people than he was with me.”
An expert witness, consultant surgeon Denis Evoy of the National BreastCheck scheme, said national guidelines indicated “a case of an inverted nipple was always a situation for further assessment”. He said a referral should result in “a triple assessment involving clinical examination, radiology and biopsy”.
A second expert, consultant radiologist Sylvia O’Keeffe, said “if someone has nipple retraction, then the first line of action would be a mammogram”.
Dr Krzyzanowski said that the time of the first consultation was September 2020, which was during the Covid pandemic, and he said there had been significant uncertainty about referrals from GPs to BreastCheck services at the time.
The hearing was adjourned to a date yet to be announced by the Medical Council committee when Dr Krzyzanowski is expected to continue his submissions.
