10/10/2018
From the diary of Dr. Sharmin Jahan, Assistant Professor, Dept. of Endocrinology......
Recently I had the opportunity to have an observer-ship training at Mayo clinic, Rochester, Minnesota under Prof. Willliam F. Young, Chair, division of Endocrinology and specialist in PGA (Pituitary, Adrenal and G***d). It was worthwhile going there and I would like to share few of my experiences. Mayo is a nonprofit academic medical center focused on integrated clinical practice, education, and research. It employs more than 4,500 physicians and scientists and 58,400 administrative and allied health staffs that is more than the local population. It was established in 1883 by William Worrall Mayo and his two son William James Mayo and Charles Horace Mayo popularly known as the Mayo brothers. They, along with few others introduced the idea of integrated patient care and group practice. Interestingly, 27 years before their death they turned it into a foundation and today no one named Mayo is found there. What a foresight they had that saved it from the greed of their descendants.
It is the center for ultimate patient care. Everything has been designed to give comfort to the patient and make his visit to Mayo clinic as soothing as possible. First time I went to the receptionist, I noticed an inspirational note that read how the staff there should behave with the patient before they meet the doctor and it was really touching. I wished our hospital staff were as well behaved as they were.
Mayo is not only a hospital. It is at the same time an art gallery, a museum, a place of entertainment and refreshment for the patients. Its amazing architectural design is maintained so neatly that is genuinely surprising.
It has been ranked the no 1 hospital in 2016-17 in USA and 16 specialties occupied the top position. Division of Endocrinology holds the well-deserved top rank for last 21 years. It is the pioneer in development of residency program that has gained worldwide acceptance.
Prof Young has an appointment of 6-7 patients per day coming from all over the world. He takes 1.5 hour for each patient, 30 min each for going through computerized record followed by elaborate discussion and counselling with the patient and after visit summary recorded by Dictaphone. He only sees the PGA cases, refuses to give opinion outside his domain, instantaneously refers such patient and explicitly declares that he does not know much outside his realm. He, like others has a relatively relaxed schedule and gets plenty of time for research and study. Because of central data base compilation of records, research becomes much easier. In 2015, more than 2,700 research protocols were reviewed by the Mayo Clinic Institutional review board and 11,000 ongoing human research studies were conducted. These research initiatives led to more than 7,300 research publications and review articles in peer-review journals. One interesting thing I have noticed is the color coding system that indicates the current status of the consultation room.
Once he took me for a walk to show around the place I was astonished to see that nobody coaxed or hoaxed him, at most gave a courtesy smile then went back to their work. While taking a lunch packet during a symposium he had to stand in the line just like others.
The food in the cafeteria are served as standard portion size with labeling of calorie on each. Everywhere seats are reserved for wheel chair bound patients. At various corners hand books written in easy language on different medical topics are available for the patient. There are different nurse educator each for DM, nutrition, steroid, osteoporosis and so on. In the Gonda lobby there is a piano that is played by the patient whenever he likes. Confidentiality of patient is of utmost importance and taking their picture or disclosing their files is absolutely prohibited without permission.
Interestingly most of the complicated endocrine cases are dealt with expertise within a small time frame. For example a pituitary tumor or a Conn’s patient at most needs to stay for 4-5 days from diagnosis to surgery and discharge. The hormonal assays are mostly done by tandem mass spectrometry having high level of accuracy and precision. So, dealing with endocrine case is quite straightforward without the need for much preparation.
Once I asked Prof. Young how an institution can be run in such a well manner for around 150 years? He replied that, it was controlled by a board of Governors and that there was absolutely no political influence from outside since beginning. Everything is done in the most fair way starting from recruitment of medical staff and admission of students. Everyone is liable to their action. So, there is no choice except to follow the rule strictly.
Lastly, I ponder what it is that makes Mayo the Mayo and what is our deficit. Mayo is not the achievement of a single bright star physician, rather it is a collective effort. The system they have developed has turned it into the no 1 hospital for last 2 decade or so. I realized, we have the full potential, but unfortunately we have a complete lack of system and to be frank: any respect for such system. Many a times we brag on our achievement and clap on our success. But the reality is, we are in the midst of nowhere and if we do not wake up immediately, then it might be too late.
