Single Organ Doctors (SODs) and the Medical Merry-Go Round!
SODs are single organ Doctors. They specialise in one area of medicine such as cardiology (heart Doctor), neurology (nervous system Doctor), respiratory (lung Doctor), renal (kidney Doctor), rheumatology (joint and bone Doctor), haematology (blood Doctor) and gastroenterology (liver and bowel Doctor).
Most frail older patients have multiple complex medical problems affecting their daily lives, not just one single organ problem.
Unfortunately many of the patients I see have been on what I call the “medical merry-go-round”, seeing multiple single organ Doctors including the heart Doctor, the kidney Doctor, the lung Doctor, the blood Doctor, the bone Doctor, the joint Doctor and the brain Doctor, but then are still not “sorted”.
The “compartmentalisation” and “single organ approach” to complex elderly patients costs a lot more money, sometimes 1000% mark-up for State and Federal Governments to pay for rather than the individual, much cheaper and more successful care of a single Geriatrician in dealing with these complex elderly patients.
The single organ (SOD) doctor approach does not work to produce the best health outcomes for complex frail older patients, nor is it cost effective.
No one is taking control of the “whole patient’s treatment”, just individual doctors ordering their own tests and adding in more and more medications just increasing the risk for polypharmacy (too many pills prescribed) and adverse drug reactions.
Is it reasonable for a Doctor specialising only in only one “organ“ for example to only look at that organ and nothing else? That organ happens to be connected to other body systems! There is a person behind the organ! So by saying to the patient “I only look at and deal with that organ” is that good medicine? No it is NOT!
SODs should not be allowed a “cop out” and avoid doing the “hard yards” by not sorting out the patient using the lame excuse that “this is not my area of expertise”!
One of the principles in Dr Lipski’s book is to get rid of all medical specialists (SODs)! They should all be practising general medicine!
Even my VMO (Visiting Medical Officer) Specialist SOD colleagues agree and tell me that the best care for the complex frail older patients is with a Geriatrician.
Yes Geriatricians are the last of the JEDI General Physicians- they are dying out and being replaced by the Empire’s SODs!
Let’s have the debate- do we really need an Endocrinologist to manage diabetes? a Rheumatologist to manage arthritis? a Haematologist to manage anaemia? a Respiratory Physician to manage asthma? a Cardiologist to manage heart failure? when a General Physician or Geriatrician can do it all plus look and the functional outcome of the patient?
Too much of hospital care now is driven by “tick-box” medicine whereby protocols are followed instead of looking at the big picture, lack of thinking about the patient holistically, and losing the skills of clinical excellence.
Young Doctors in hospitals are being taught this compartmentalised medicine to the point where medical teams now can’t manage basic general medical problems. For example, any kidney failure is referred straight to the kidney (Renal) Doctors, high serum calcium and high blood sugar are referred to Endocrine Doctors, heart failure straight to Cardiology Doctors, anaemia straight to Blood (Haematology) Doctors.
So we are training a future generation of young Doctors who will be de-skilled and incapable of managing complex older patients and their multiple medical problems!
For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.