Checkup

Vital Signs: The importance of being integrated

Dr. George Bartley

Dear Reader:

"For your liver, press 1. For your spleen, press 2. For your pancreas, press 3. If you are unsure which organ is causing your symptoms, please stay on the line and an operator will be with you momentarily." Although this scenario may sound far-fetched, I worry that many patients, especially those who lack a "goto" primary care physician to oversee their medical care, can end up confused and frustrated by health care's á la carte offerings. We're inundated with ads and testimonials about new drugs, treatments, and miracle cures, and are swamped with news stories reporting the latest research findings. But the road to good health is not clearly marked and there are plenty of "operators" providing dubious directions.

Our goal at Mayo Clinic is to provide the best care to every patient every day through integrated clinical practice, education, and research. Integration is the key, but the concept is often taken for granted. When I see patients, I rely on a cadre of highly trained colleagues who represent nearly every specialty in adult medicine and who believe that we are more effective working together than working alone. Perhaps equally importantly, we all use a centralized electronic medical record that allows every team member access to the same information. For instance, if a lung specialist prescribes certain antibiotics for a patient with pneumonia, the ophthalmologist knows to watch for side effects that may show up in the eye. Conversely, if the ophthalmologist starts a particular type of eye drop to treat glaucoma, the pulmonologist understands that the drug occasionally may have harmful effects on breathing and heart rate. Such information can fall through the cracks in the absence of a coordinating physician or an integrated medical record.

Patients, too, may underestimate how challenging it is to provide outstanding, integrated care. One useful comparison is to think of a medical center as a restaurant that never closes and has little control over how many and when its customers come to its doors. This restaurant desires to provide virtually every dish in the world's thickest cookbook, prepared by a topnotch culinary team in a kitchen stocked with just about every gadget and spice imaginable. And it wishes to provide the meals in an aesthetically pleasing, restful environment. Unfortunately, for much of its business, the restaurant is paid less for the meals than it costs to provide them at the quality its customers deserve and expect. Little wonder that many medical practices don't even attempt to provide integrated care, which is extremely expensive, but rather choose to concentrate on a limited number of services that can be provided efficiently and profitably. Although such specialization may be beneficial to the providers, it often transfers the responsibility of oversight and coordination to patients or their families.

Finally, as we strive to heal the sick, we simultaneously wish to advance the science through medical education and research. Such complementary activities not only benefit patients today, they are absolutely necessary to ensure that medicine continues to progress rather than stagnate or decline. Our ultimate goal is to meet the needs of our patients. Thank you for honoring us with your trust.

Sincerely,

George B. Bartley, M.D.
Chair, Board of Governors