The Three “P”s of Mayo–Patient-centered, Physician-led and Collaborative Partnership

Last week I attended the Mayo Clinic’s Annual Social Media Summit in Rochester. What most impressed me had nothing to do with the conference. On Tuesday afternoon before the Summit began I toured Mayo Clinic. It was supposed to be for an hour but lasted more than two because our group, consisting of one doctor and nineteen PR professionals, was so interested in the information being fed to us. I don’t know why the publicity folks were so intrigued, but for me Mayo’s philosophy of “patient-centered, physician-led” care hearkened back to a time when the patient-physician relationship was inviolate. It was stimulating to realize that my instincts of how medicine is best-practiced are right on target.

My myopic opinion regarding the fragmentation of healthcare sees the destruction of the patient-physician relationship by multiple entities, who are primarily interested in a piece of the economic pie, as central to our healthcare mess. At Mayo, no project moves forward unless there is a physician who champions it and it is the physician’s responsibility to ensure that every project is dedicated to improving some aspect of patient care. Physicians are salaried so they spend the time necessary to care for patients and are not incentivized to increase the numbers of patients seen or do procedures to enhance the bottom line. 

Every person I met who worked for Mayo reiterated the importance of putting patient care and comfort first. It was incredibly refreshing. The Mayo logo emphasizes a patient-first policy as well. I’d seen the logo multiple times but somehow never thought about what the three shields represent. Our tour guide explained: Patient care, research and education. The educational aspect was obvious as we walked multiple floors of patient care areas. I noticed no TVs in patient waiting rooms but many had computer screens where patients could learn about their conditions. It is a refreshing and calming atmosphere without the cacophony of media noise. There is art everywhere. Waiting rooms are spacious and well-lit. Meditation rooms and educational spaces abound. 

Children’s waiting area

Mayo has always represented excellent healthcare in my mind. Patient reports that come to me after a visit there are extraordinary due to the extent of the integrative care the patient experiences from multiple medical disciplines coming together. I expected to be impressed. I did not realize I would also be reassured. Putting patients first is what I’ll continue to strive to do, despite insurance interference, governmental policies or EHR dysfunction.

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Patient Information Retention and the Internet

A patient with hypertension asked me about the nutritional value of sea salt versus table salt. He had heard advertisements suggesting that sea salt was less dangerous to hypertensive patients like him and wanted to know if that was accurate. I whipped out my iPhone and quickly looked it up on the website. Within seconds I could confidently tell him that there is little nutritional difference between the two types of salt–sea salt is processed differently using an evaporative process  whereas table salt is mined, processed and has additives to keep it from clumping. Table sauce usually has iodine added to it as well. As a consequence sea salt retains minerals that vary depending on its source and thus has distinctive taste. So the difference is a cooking distinction but there is no medical benefit to its use. Individuals with hypertension need to be careful of their salt intake regardless of the source. Patient (and I) were suitably impressed.

Thirty minutes later I diagnosed a patient with a rare problem called Complex Regional Pain Syndrome (more commonly called RSD for Reflex Sympathetic Dystrophy). She developed her symptoms immediately after a minor surgical procedure and they were classic for the diagnosis. I spent a long time discussing what this meant; the poor understanding of its cause, possible treatments, prognosis and other possible diagnoses. I suggested that she look up information on and to see me back in two weeks after beginning steroids and sending her for PT. In the past I would have had misgivings about patients seeking information on the internet. As better resources have appeared on the web I am thrilled to be able to give patients a trusted information site. They are relieved to have access to another source of information and one that their physician is comfortable with. This reassures them that the information will be accurate. 

Studies suggest that patients retain somewhere between 14-50% of what they are told by their providers (see references below). Giving patients an authoritative site that they either write down or take a picture of on the white board I use makes it easier for them to recall what I said and further research information later. On their followup appointment they can ask further clarification with complicated issues or if it’s something easy, they can email me with their question. Since 80% of internet users are searching for healthcare information I am happy to supply them with accurate sources.
     Kessels RPC (2003). Patients’ memory for medical information. J Roy Soc Med 96:219-222.
     Jansen, et al (2008). Does Age Really Matter? Recall of Information Presented to Newly Referred Patients With Cancer. J Clin Onc 
     J R Soc Med. 2003 May; 96(5): 219-222.
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