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Medical system in the US-Mayo clinicZhi Hua RanDepartment of gastroenterologyRen Ji HospitalMedical system in the US-May1History of Mayo clinic Mayo Clinic evolved gradually from the frontier practice of Dr.William W.Mayo and his two sons-Dr.William J.Mayo and Charles H.Mayo.History of Mayo clinic Mayo Cl2Dr.Mayo and his two sons Dr.William W.MayoDr.Charles H.MayoDr.William J.MayoDr.Mayo and his two sons Dr.3History-Key Dates Dr.William W.Mayo emigrated from England to the US in 1846 Became a doctor in 1863 Appointed as a Civil War examining surgeon for the Union enrollment board,first Minnesota district Moved to Rochester in 1864History-Key Dates Dr.Wil4History-Key Dates His two sons began their medical training early,first by observing,and later by assisting their father on patient visit and with autopsiesWe came along in medicine like farm boys do on a farm-Dr.William J.MayoHistory-Key Dates His two5Dr.William J.Mayo The elder brother,graduated from University of Michigan Medical School in 1883Dr.William J.Mayo The elder6Dr.Charles H.Mayo The younger brother,graduated from Chicago Medical College of Northwest University in 1888Dr.Charles H.Mayo The young7History-Key Dates 1864-Dr.William Worrall Mayo moves to Rochester 1883 and 1888-Dr.Mayos two sons,William and Charles,join him in practice after they had finished medical school 1883-A tornado strikes Rochester.Mother Alfred Moes,founder of the Sister of St.Francis,proposes to build and staff a hospital if Dr.W.W.Mayo and sons will provide medical care.1889-Saint Marys Hospital opens with 27 beds 1892-First partner added to Mayo family practice.More physicians are involved to join,thus beginning the concept of medical teamwork.History-Key Dates 1864-8History-Key Dates 1905-Dr.Louis Wilson develops a rapid way to diagnose surgical specimens(quick-frozen tissue section stained with methylene blue),which allows Mayo surgeons to explore,diagnose,and repair all in one operation 1907-Patient registration number“1”given out.5000 patients register at“Mayo clinic”,as it has come to known 1914-Mayo isolates throxin,the principle active component of the thyroid gland.This is only second time that a pure hormone has been isolated 1915-Organization of the worlds first formal graduate training program for physicians,the Mayo School of Graduate Medical Education 1919-The Mayo turn over the assets of the Mayo clinic to the nonprofit Mayo Properties Association,the forerunner of Mayo FoundationHistory-Key Dates 1905-9History-Key Dates 1920-Mayo develops a system for grading cancer numerically,which is adopted worldwide and still used today 1925-Dr.William H.Goeckerman reports on the use of tar and ultraviolet light to successfully treat psoriasis.This is a therapeutic breakthrough that remains a highly effective treatment for psoriasis 1926-Mayo Clinic Proceedings begins publication 1930s-Mayo scientists pioneer methods for measuring motility of the esophagus and adapt them for clinical testing now used worldwide 1934-Edward C.Kendall,Ph.D,isolates cortisone,a hormone from the suprarenal cortex that will later be used to treat rhematoid arthritis with dramatic resultsHistory-Key Dates 1920-10History-Key Dates 1938-Dr.Frederick Moersch first reports median thenar neuritis(carpal tunnel syndrome)1939-William and Charles Mayo die within a few months of each other 1944-First therapeutic application of streptomycin to treat tuberculosis.1947-Discovery of Factor VII,a blood-clotting component 1950-Drs.Edward C.Kendall and Philip S.Hench are awarded the Nobel Prize for isolation and first clinical use of cortisone First human diagnostic cardic catherization 1955-Mayo is among the first to perform successful open heart surgery to repair congenital heart abnormalities after refining the Gibbon heart-lung bypass machineHistory-Key Dates 1938-11History-Key Dates 1965-Computer monitoring of patients introduced in Cardiac Care Unit at Saint Marys Hospital 1966-Dr.Leonard Kurland introduces the Rochester Epidemiology Project,a medical records-linkage system that has made Olmsted County one of few places in the world where the occurrence and natural history of disease can be accurately described.The project has generate more than 1,000 publication on long-term incidence,prevalence,and mortality rates for many diseases 1969-First FDA approved total hip replacement in the US 1972-Mayo Medical School opens 1973-Mayo introduces the first CT scanner in North AmericanHistory-Key Dates 1965-12History-Key Dates 1976-The North Central Cancer Treatment Group is created 1980-Mayo researchers are among the first to propose intensive insulin therapy to reduce the complication of diabetes 1986-Mayo Clinic Rochester,Saint Marys Hospital,and Rochester Methodist Hospital integrate 1986-Mayo expands outside Minnesota for the first time with the opening of Mayo clinic in Jacksonville,Fla 1987-Mayo Clinic opens in Scottsdale,Ariz.And St.Lukes hospital,Jacksonville,Fla Mayo Clinic Rochester goes smoke-free,of the first medical centers in the country to do so 1990-Mayo researchers help identify the source of illness affecting people taking health supplement L-tryptophanHistory-Key Dates 1976-13History-Key Dates 1992-Mayo begins to form a regional network of clinics and hospital 1994-Mayo study finds no link between breast implants and connective tissue disease 1995-Mayo opens it web site 1996-Mayo Eugenio Litta Childrens hospital opens,part of Saint Marys Hospital in Rochester 1998-Mayo Clinic Hospital opens in Phoenix,Ariz.2000-Mayo Clinic Transplant Center opens in Rochester providing a single setting where patient receive all of their transplant service from evaluation to follow-upHistory-Key Dates 1992-14The Beginning of Group Practice Pressed by the demands of their busy surgical practice and the exploding growth of medical knowledge,the Mayo brothers invited others to joint their practice:Augustus Stinchfield (1892)Christopher Graham (1895)Melvin Millet (1898)Henry Plummer (1901)added diagnostic skillLouis Wilson (1905)developed the labMaud Mellish (1907)developed editorial services Harry J.Harwick (1908,local banker)improved business proceduresThe Beginning of Group Practic15The Beginning of Group Practice The group was the beginning of a new way to practice medicineIt has become necessary to develop medicine as a cooperative science;the clinician,the specialist,and the laboratory workers uniting for the good of the patientIndividualism in medicine can no longer exist The Beginning of Group Practic16Group PracticeNo one is big enough to be independent of others-A quote by Dr.William W.Mayo Group PracticeNo one is big e17The Beginning of Group Practice Group practice was also a natural expression of the Mayo brothers personalities.As Harry Harwick,who worked alongside them for 31 years,wrote:The first and perhaps greatest lesson I learned from the Mayos was that of teamwork.For my brother and I was no mere convenient term of reference,but rather the expression of a basic,indivisible philosophy of life.The Beginning of Group Practic18Architect of the Mayo Practice Dr.William Mayo claimed that the best days work he ever did for the clinic was the day he hired Henry PlummerArchitect of the Mayo Practice19Dr.Henry Plummer He introduced the dossier medical records system that facilitated sharing of information All of a patients data,from both clinic visits and hospital stays,was entered into a single file,which traveled with the patient and was stored in a central repositoryDivided a diagnostic index to facilitate access to these records for researchDr.Henry Plummer He introduce20First building for an integrated medical practice-1914On the site Harold W.Siebens buildingRegistered patients:30,000First building for an integrat21Growth of Specialtes Orthopedics in 1912 Neurology in 1912 Thoracic surgery in 1915 Dermatology in 1916 Pediatrics in 1917 Neurologic surgery/proctology in 1919Growth of Specialtes Orthopedi22Integrating research and education with practice The Mayo school of Graduate Medical Education opened in 1915 with an endowment from the Mayo brothers Their program became one of the first in the world to train medical specialistsIntegrating research and educa23An integrated medical practiceMayo ClinicAn integrated medical practice24A gift to the peopleThe Mayo brothers contributed the bulk of their life saving to a private,non-for-profit,charitable organization-Mayo foundation in 1919A gift to the peopleThe Mayo b25A gift to the people“We want the money to go back to the people,from whom it came,and we think we can best give it back to them through medical education”Said Dr.William J.MayoA gift to the people“We want t26A gift to the people From this point on the Mayos,their partners and all future Mayo Clinic physicians would receive a salary and would not profit personally from the proceeds of the practice All proceeds beyond operating expenses were contributed to education,research and patients care They established a board of governors and a committee system to provide effective oversight of many aspects of Mayo life,thereby reinforcing the cooperative spirit of the foundersA gift to the people From this27The present More than six million people have been treated at Mayo Clinic since its frontier founding It encompasses three clinics and four hospitals in three states,employing more than 40,000 physicians,scientists,nurses and allied health workers Through growth and change,Mayo Clinic remains committed to its guiding principle“The best interest of the patient is the only interest to be considered”The present More than six mill28Location of Mayo Clinic Rochester,Minnesota Jacksonville,Florida Scottsdale,ArizonaLocation of Mayo Clinic Roches29Rochester,Minnesota 1500 doctors and scientists Mayo Clinic Saint Marys Hospital Rochester Methodist Hospital Rochester,Minnesota 1500 doct30Rochester,MinnesotaGonda buildingRochester,MinnesotaGonda buil31Rochester,MinnesotaGonda buildingRochester,MinnesotaGonda buil32Rochester,MinnesotaGonda buildingRochester,MinnesotaGonda buil33Rochester,MinnesotaRochester Methodist HospitalRochester,MinnesotaRochester 34Rochester,MinnesotaPlummer building Rochester,MinnesotaPlummer bu35Plummer building Kahler HotelSiebens-PlummerPlummer building Kahler HotelS36Rochester Methodist Hospital Licensed beds available 794 Admissions 18,412 Average length of stay(days)4.5 Operating rooms 41 Surgical cases 18,159Rochester Methodist Hospital L37Rochester,MinnesotaSaint Marys HospitalRochester,MinnesotaSaint Mary38Saint Marys Hospital Licensed beds available 1,157 Admissions 42,328 Average length of stay(days)5.6 Operating rooms 58 Surgical cases 29,849Saint Marys Hospital Licensed 39Rochester,Minnesota-2004 Statistics Mayo Clinic Unique patients 321,900 Outpatients visits 1.42 million Personnel Staff physicians and scientists 1,509 Residents Fellows 1,414 Temporary professionals Allied health staff(clinic and hospital)21,077 Total Staff 24,000 Rochester,Minnesota-2004 40Rochester,Minnesota-2004 Statistics 80%of the patients-outpatients 20%-hospitalized 80%of Mayo Clinic patients:from Minnesota,Iowa,Wisconsin Rochester,Minnesota-2004 41A typical day at Mayo ClinicNew(outpatients)arriving 266Admissions to the hospital 238Surgical procedures 204Lab tests 33,653Radiology procedures 4,064CT scans 563Chest X-rays 726MRIs 219Electrocardiograms 670Units of blood and blood components used 3262004 StatisticsA typical day at Mayo ClinicNe42Medical ResearchBiomedical research at Mayo Clinic includes strong programs in basic and clinic researchMost Mayo medical staff participate in some research activityResearch Funding Sources(in millions)Mayo funds$121 Extramural funds$251 National Institutes of Health Other federal sources Commercial sources Total$372Medical ResearchBiomedical res43Medical Education Mayo School of Graduate Medical Education trained 17,000 alumni since 1915 Clinical residents and fellows 1,390 Mayo Graduate School has granted 459 graduate degrees in seven specialties since 1917 Predoctoral students 150 Mayo Medical School has trained and graduated 1,000 students since 1972Medical Education Mayo School 44Jacksonville,FloridaMayo ClinicSt.Lukes HospitalJacksonville,FloridaMayo Clin45Jacksonville,Florida 325 doctors and scientists 253 Residents,fellows and temporary professionals Opened in 1986 Delivering health care services in 50 medical/surgical specialties cancer treatment organ transplantation heart surgery neurosciences 91,000 patients were diagnosed/treated in 2004 13,000 patients underwent surgeryJacksonville,Florida 325 doct46Scottsdale,Arizona Mayo Clinic ArizonaMayo Clinic HospitalScottsdale,Arizona Mayo Clini47Arizona Opened in 1987 Services in 65 specialty and surgical disciplines,including programs in cancer treatment and organ transplantation.Mayo Clinic is a premier academic medical center in the Southwest.Staff physicians/scientists 344 Residents,fellows and temporary professions 101 Served 100,000 patientsArizona Opened in 198748System in Mayo Clinic Clinic Bulletin Weekly announced;From Monday to Saturday As early as at 7 AM;Noon time(12:301:30);6 PM Medical grand rounds(every Wednesday)H.Lee-New Technologies in criminal investigation GI grand rounds(every Thursday)System in Mayo Clinic Clinic B49System in Mayo Clinic Well-organized and advanced system shuttle bus-every 5 min page-telephone everywhere Computer connected-included all patients information Humanity System in Mayo Clinic Well-org50System in Mayo Clinic Residency 3 y Resident in chief:the forth year General Internal Medicine 2 mo (outside Rochester)Community Internal Medicine 2 mo(Rochester)Urgent Care 1 mo(outpatient w/o appointment)Primary Care Clinic 1 mo(outpatient w/appointment)Pulmonary 1 mo(inpatient)Oncology 1 mo(inpatient)Cardiology 2 mo(inpatient)MICU 1 moSystem in Mayo Clinic Residenc51Resident training Morbidity&Mortality(every Monday noon time)Journal club Friday 7:308:30 Morning report(teaching):8:00-8:30 8:30 11:30:work round Lectures:ground rounds morbidity and mortality Resident training Morbidity&52GI fellow training Pick mentor 1st year Weekly core lectures Journal club Statistics Endoscopy 2rd year:research 3rd:clinic practiceGI fellow training Pick mentor53Questions about Mayo Clinic Why do patients come to Mayo?Help with the diagnosis and treatment of a difficult medical problem-the main reason Because of its expertise,reputation for thoroughness and its team practice,which lets people get all the opinions,tests and treatments they need in one place,in a coordinated wayQuestions about Mayo Clinic Wh54Questions about Mayo Clinic How much time will a medical evaluation require?six working days Does Mayo specialize in certain areas?Mayo specialized in virtually everything Mayos strength is its comprehensiveness,its ability to provide“one-stop shopping”for the diagnosis and treatment of virtually any medical problem 100 medical/surgical specialtiesQuestions about Mayo Clinic Ho55Questions about Mayo Clinic Do the Mayo still own Mayo Clinic?Mayo foundation was established in 1919.All Mayo staff members are paid a salary and there is no profit-sharing Are there any Mayos still working at Mayo Clinic?The last family member on the medical staff was Charles W.Mayo(son of Dr.Charles H.Mayo),who retired in 1963.Robert Walters,a great-grandson of Dr.William J.Mayo is an administrator at Mayo Clinic Jacksonville.Questions about Mayo Clinic Do56President and CEO of Mayo ClinicDenis Cortese,M.DPresident and CEO of Mayo Clin57Best Hospital 2005#1:Johns Hopkins Hospital,Baltimore 32 points in 16 specialties#2:Mayo Clinic,Rochester,Minn.28 points in 14 specialties#3:Massachusetts General Hospital,Boston 24 points in 13 specialties#4:Cleveland Clinic 23 points in 12 specialties#5:UCLA Medical Center,Los Angeles 22 points in 14 specialtiesBest Hospital 2005#1:Johns H58Best Hospital 2005-Mayo Clinic#1 Digestive disorders U.S.News Score:100 Reputation:65.6%#1 Hormonal disorders U.S.News Score:100 Reputation:67.2%#1 Neurology and neurosurgery U.S.News Score:100 Reputation:52.5%#1 Orthopedics U.S.News Score:100 Reputation:58.2%#2:4 specialties;#3:2 specialtiesBest Hospital 2005-Mayo Clin59Mayo Brothers Mayo Brothers 60
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