For the record, the Soapbox family is not crazy about going to the US for medical care, but our eldest daughter (let’s call her “Missy”) has some serious health issues (I blame it on Mr Soapbox’s gene pool) and her GP refused to book the necessary appointments with specialists because—get this—“there were too many cooks in the kitchen”!
So we followed in the footsteps of Mr Soapbox and our younger daughter “Mini” and set out for the Mayo Clinic in Rochester, Minnesota.
We got off to a less than auspicious start. I kicked over Missy’s hot chocolate in the airport lounge, our plane was late and they lost our luggage. Luckily Ms Soapbox and Missy are easy going souls and rolled with it. OK, Missy rolled with it, Ms Soapbox fretted until the bags showed up at midnight.
After an initial hiccup (Missy’s “intake” doctor was on vacation and appointments that should have been pre-booked were not) her cardiologist sorted out her appointments overnight. These ranged from baseline tests to assessments with a number of specialists.
Some specialists were able to see Missy within a couple of days, but others, specializing in more complex cases, were booked 3 weeks out. Not good.
That’s when we became “checkers”.
The “checker” system
Thousands of patients flow through Mayo each day. Most have appointments scheduled outside of the “anticipated” window of five to eight business days. This wreaks havoc with hotel reservations, return flights and life in general and would be a colossal problem but for the fact that the minute they get their appointment schedules everybody starts shifting them around.
The Mayo booking process allows a patient to “check in” with a doctor hours or even days in advance of their scheduled appointment and hang around in the waiting room in the hope that the doctor can squeeze them in. Sounds goofy but it works.
In Missy’s case this meant foregoing breakfast (twice) on the chance the doctor could see her—he did.
Too many cooks?
Missy’s cardiologist was stunned by our GP’s belief that involving specialists would result in “too many cooks in the kitchen”. The Mayo model is based on the collaborative efforts of a number of specialists working as a team to deliver the best results for the patient.
His comment: “There’s no such thing as too many cooks in the kitchen”. The real challenge is to ensure that all of the “cooks” are communicating effectively. That’s where Mayo Apps come in.
All of the Mayo doctors work off the same page (literally) and have done so for decades.
About 100 years ago Dr Henry Plummer, one of the original partners, created the “unit record”—a single file that records everything related to a patient’s care—physician notes, lab reports, surgical dictations, correspondence, appointment schedules, X-rays, ultrasounds, CT and MRI scans, echocardiograms — you name it, it’s all in the unit record.
In 2005 the unit record went electronic. Not only is the record instantly accessible to all of the doctors who record their findings immediately after each appointment, it’s instantly accessible to the patient who’s downloaded the Mayo app to her iPhone or iPad. A sign of trust given the US is one of the most litigious nations in the world.
The Mayo app is secure as human nature will allow…you guessed it, the waiting room is abuzz with conversations like this: Wife: It looks like you’re leaking protein. Husband: I’m leaking what???
What Alberta can learn from Mayo
Harvard economist, Jeffrey Sachs says “Good health requires seamless connections among the family doctor, specialists, hospitals, diagnostic units and others. Instead we have a horrendous maze of separate organizations, insurers, and providers, each on its own accounts and information systems. The result is waste, fraud, and abuse of hundreds of billions of dollars each year.”*
Mr Sachs was talking about US but the “horrendous maze” is springing up in Alberta as well, particularly since the government agreed to underpin private concierge clinics and diagnostic clinics with a publicly funded safety net.
It doesn’t have to be this way. We can develop a healthcare system powered by collaboration and “seamless connections” by learning from those who do it best.
The Mayo’s motto is “The needs of the patient come first”. This is expressed in its priorities which include Allow time for questions. Anticipate the patient’s needs and Go the extra mile.
The Alberta Medical Association also has a motto—Advocating for Patients First—but fails to take it to heart. The “one ailment per visit” rule allows doctors to pad their incomes at the expense of their patients. GPs abandon their patients once they’re put on the wait list where they may languish untreated for years.
Trust me, a patient knows when her doctor is merely giving lip service to “patients first” or going the extra mile. It’s time for the AMA to step up.
Electronic Medical Records
Alberta Health Services has been working on a province-wide Electronic Health Record (EHR) system since 1999. By 2010 roughly 2,600 physicians or 50% of the “eligible community physicians” were using the system.**Very little progress has been made since then.
Missy spent days schlepping from MRI clinic to X ray clinic to specialists’ offices gathering up her medical records because her GP was not electronically connected to anything.
The Mayo Clinic converted 6.2 million patient files (some dating back to 1907) to electronic records in 2005. It continues to update its files by 350,000 patients a year (the system now contains 8 million electronic patient files). Surely Alberta Health Services can finish the job it started in 1999 and convert the records of 3.9 million Albertans to an electronic system accessible to all including the patient.
What the Soapbox family learned from Mayo
We learned something we already knew but couldn’t access in Alberta:
- Medicine is a personal service. It begins with listening to the patient and creating a relationship based on trust.
- Human health is a complex thing. Specialists see what they are trained to see; when they collaborate their collective efforts are far superior to their individual contributions.
- This is the 21st century. It’s easier to collaborate electronically.
And on a personal note, after living together in a hotel room for eleven days, Ms Soapbox and Missy learned that they don’t need much personal space as long as there’s something half decent on TV.
*“How Not to Make America Great” by Jeffrey D Sachs, Esquire April 2013, p 86
** Government of Alberta Backgrounder dated May 14, 2011