Posted on September 10th, 2009 by Kelley Luckstein
Go on rounds at Minnesota’s Mayo Clinic.
Dr. Mike Wilson's favorite way to calm his nerves is to play the piano. And on the eve of a new job at the Mayo Clinic in Rochester, Minn., Wilson found himself eager to play.
So tomorrow night is my first long call, that's where you get to stay all night at the hospital," Wilson, who was part of a group of incoming internists, told ABC News in a recent interview. "I've done it a couple of times in medical school. I guess the difference is that this is first time you are responsible for the decision you make, you write the orders and you have the final say."
Wilson was preparing for his new job at a time when the entire field of medicine is being rocked by a debate over the government's role in providing health care. And one of the primary exhibits in that debate is the hospital he was about to join.
"The Mayo Clinic in Rochester, Minn., is famous for some of the best quality and some of the lowest cost," Obama said in a June speech. "People are healthier coming out of there, they do great."
Over the next three years Wilson and other new internists will be steeped in what some people say is a radically different approach to doing medicine. A lot of experts are convinced that the Mayo model -- in which patient tests are minimized, doctor salaries are fixed, records are electronic and groups of doctors work together -- proves that health care reform isn't about who pays for care, but about how it is given.
At stake in the debate is the role of insurance companies, how much care will cost, doctors' incomes and, ultimately, the well-being of the patient.
Slyvia Jaramillo is with Wilson in the incoming class of Mayo internists.
"I think it's exciting," she said of the health care debate. "I think it's, that's what makes it an exciting time to be in, you know, in medicine."
Wilson said the debate still had a lot of life in it.
"I think we need to keep talking about it," he said. "And I think it's finally come to the point where we realize something has to be done about this health care system."
'The Answer Is in the History'
While Americans like to believe more means better, a Dartmouth University study found that with Mayo, fewer tests and procedures has meant better-quality care.
Dr. Farrell Lloyd guides new doctors through the Mayo method.
"Concentrate on the patients symptoms," Lloyd advises the new doctors. "There are lots and lots of tests we can order. You know how I always say simplify? Only order a test if a patient is having a problem. ... If you start ordering tests for the potential that something might happen, you start really getting in a difficult cycle."
The cost of a test at Mayo is comparable to a test anywhere else. But the Dartmouth study found that Mayo reduced overall costs by performing only tests doctors deemed absolutely necessary.
"If you are ordering the right tests instead of ordering the wrong tests until you get to the right tests," Lloyd said, "we actually may reduce our cost."
Wilson and Jaramillo took the lesson to heart.
"Every test in the book does not equal improved health," Wilson said. "I think I came to Mayo thinking we would order every single test, on every single patient, and we'd find out the answer."
"It's actually a sign of inexperience," Jaramillo put in. "And that's what our older consultants have told us. People who are just starting out, like us, we are more likely to order X-Ray, CT, MRI, blood work, all of these fancy genetic tests that we have available. And a lot of times the answer is in the history."
The Dartmouth study found that Mayo's Medicare spending was in the lower 15th percentile in terms of costs. Mayo spent 43 percent less than hospitals like the UCLA Medical Center and 37 percent less than Johns Hopkins. Yet Mayo consistently ranks among them as one of the best hospitals in the country.
Another crucial difference: Mayo doctors are salaried employees. In other words, they are not paid for how many tests they run, how many surgical procedures they do or how many patients they see.
"I'm not figuring out how do I work most efficiently to get the most out of reimbursement," said Mayo surgeon Dana Thompson. "I'm working most efficiently to figure what are the needs of the patient and delivering quality care."
Collaboration Between Specialists
Though there have been no studies to confirm it, experts suspect that doctors who are salaried are likely to spend more time with patients.
"This is when I like working at Mayo," said Mayo. I get to sit down and really give full, undivided attention and time without the pressure of a lot of other things. If I was at a private practice, this would be a very difficult thing to do just because there are many time constraints on the number of patients that you have to see in the given day for productivity."
Thompson also has the advantage of electronic records, which most hospitals in the country are still waiting for. With the click of a mouse, she has access to a patient's entire medical history.
Mayo also attributes its success to a team approach. Doctors with different specialties work closely together on a patient's case in a process they call "integrated coordinated care."
Dr. Todd Baron, a gastroenterologist specializing in endoscopes, and Dr. Mike Levi, an ultrasound specialist, allowed ABC News to film their collaboration on one case.
"You haven't seen this case right?" said Baron.
"Nope," said Levi.
"This is an 80-year-old woman who had pancreatitis six weeks ago."
Baron said cooperation between doctors improved patient care.
"It's always good to get another mind into this before doing these things," he said.
And even during a routine procedure, Baron has no qualms asking for help.
"Can you call Dr. Levi?" he asked a nurse at one point.
In less than a minute his colleague walks in, and soon a decision is made. A different machine is wheeled in, and the two doctors switch positions mid-procedure.
For all of Mayo's successes, the debate outside has been mostly fought over who pays for coverage. But what's harder to legislate is perhaps the crucial thing: how medicine is practiced in this country.
What did Jaramillo and Wilson think of the argument that disrupting the current health care pricing system -- and consequently making it less profitable to be a doctor -- could discourage qualified people from going into medicine?
"I actually think it's going to draw people that are interested in medicine, like Mike and myself," said Jaramillo. "Because it isn't going to be money that drives us. But we're here because we love medicine, and we want to improve health care."
"We are America, one of the greatest nations on the earth, and what can we do to improve our health care system?" he asked. "And I'm so encouraged that, and I fully believe, that we can come up with a system that is better. I want to contribute to that system in whatever way I can."
Wilson emerged from his first night on the job tired and happy.
"Last night was the first night in my entire life that I felt like I was a doctor," he said.
But for Wilson and those embroiled in the debate over how to change our nation's health care, tomorrow it will start all over again.
ABC Nightline with Robin Roberts 09/09/09
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