Medicine with a Heart

by Gar Alperovitz

"It's the BMW of medicine." That's how a good friend, a physician's wife, described the Mayo Clinic. She had taken the trek to the small midwestern town of Rochester, south of Minneapolis, when everything else had failed. None of the specialists in the nation's capital could find the source of the chronic digestive failure that was causing her to lose a pound a week.

Clinic physicians quickly diagnosed a rare stomach disorder (only 200-300 cases reported each year worldwide) and successfully performed an arcane form of surgery. It turned out that the clinic treats this problem more often than any other facility — a tale one hears regularly at the Mayo. It's little wonder that the clinic gets the touchy cases, as my own experience suggests.

I first encountered the Mayo years ago when my father was suffering from a brain tumor that other specialists had pronounced inoperable. When we arrived at the small Rochester airport, I called the chief of neurosurgery, as instructed. The doctor cheerily answered my call a minute or so after being paged. "Take your dad over to Saint Marys Hospital and I'll be in touch with the admitting people by the time you get there," he advised. I did and, startlingly, so did he, dropping by to see my father shortly thereafter. Jolted out of my learned cynicism about the medical profession, I nevertheless told myself that the doctor was probably an old-fashioned Midwestern guy, an exception that proves the rule.

But our ensuing experience with physicians, staff, and administrators was equally pleasant, and my father's "inoperable" tumor was successfully removed. Many other acquaintances report similar experiences that attest to an institutional pattern rather than an occasional exception. Human, efficient, competent, personable - the Mayo Clinic is everything one hopes modern medicine can be. And this from one of the world's leading medical centers, where Ronald Reagan and King Hussein of Jordan have recently been patients.

When I took my father for brain surgery, the clinic had recently devised new optical instrumentation that permitted far greater sensitivity and accuracy in microsurgery. During a recent visit of my own, a specialist was almost dumbfounded when I said that two physicians in Washington, D.C., had recommended surgery. "In the first place, surgery is not indicated in your case," he said. "In the second place, we hardly ever do surgery in situations even remotely similar to yours — and haven't for years. When we do have to intervene we use laser or microwave techniques." He conveyed the distinct impression, shaking his head and saying something about "antiquated" and "obsolete," that my other physicians were practicing medieval medicine.

I was told that this determination to keep abreast of the most advanced technology dates from the founding Mayo brothers, who earned reputations as skilled and innovative surgeons. The brothers also developed group consultative methods to a fine art, drawing upon specialized knowledge from cooperating practitioners at a time, in the 1890s, when the idea seemed to violate the ideal of the lone genius.

One of their associates, physician Henry Plummer, contributed the extraordinary attention to organizational detail still evident. The largest medical facility of its kind in the world, the clinic runs like clockwork. Everything is computerized and seemingly synchronized — when a specialist orders a routine blood test, the results seem to be on his or her desk (or an assistant's computer) within a few hours. Hundreds of subterranean pneumatic tubes quickly carry bulky records from the main building to other facilities and medical centers around town.

Although thousands of tests and records are processed each day, patients experience little of the waiting typical of medical visits. They usually fill out the basic informational forms before coming to Rochester. In my own case, I had been told to prepare for at least three days in Rochester. When I had been examined by my specialist, the chief of his division, he said: "Let's see if we can get you out of here and home today." And he did: after our initial consultation at 8:30 a.m. I marched through a battery of tests, and when I met with him at 4:30 p.m., he had assembled and digested the results of my workup. This careful scheduling also produces, I am sure, efficient use of expensive X-ray, MRI and other equipment.

Although the clinic conducts a great deal of research, R and D and teaching do not dominate as at university medical centers. The central mission is treatment of patients, and this priority is evident even in architectural details. For example, a patient appearing for an X-ray enters a small dressing room from a main corridor. He or she is able to lock the door from the inside and can therefore safely leave valuables — there is no need for the usual sign disclaiming responsibility for lost or stolen items, and none is evident. Another door leads directly to the X-ray room but has no handle; it can be opened from the other side only when the technician has completed work with the preceding patient. This design insures security, privacy and an effective patient flow.

The result is that while the clinic is not a profit-making institution, it seems to be more efficient than any profit-making medical establishment I know. And the Mayo does not appear especially expensive. The waiting rooms are filled with ordinary midwestern folks sitting next to matrons in Dior suits.

I'm sure a good deal of what works at the Mayo Clinic can be traced to team spirit: its employees clearly know they are practicing or supporting world-class medicine, and no one would tolerate doing less than the best. "The people who scrub the floors at night have as much pride in their work as the surgeons,"a physician who studied at the clinic recently told me, "and they are as important as any other factor." Of course, the staff is concentrated in one small, isolated Minnesota town where the clinic is the central focus. Still, there is clearly something special going on at the Mayo — something of importance far beyond the world of medicine.

A central question of our time is how to integrate advanced technology with large numbers of people in a caring and personal way. The Mayo Clinic clearly has a great deal to teach.

Used with permission from Technology Review, April 1993.