Thursday, June 4, 2009

Mayo Clinic and The New Yorker.

Atul Gawande has written a great piece in the New Yorker about the costs of healthcare in this country. For his comparison, he has chosen McAllen, Texas, and of course, the Mayo Clinic in Rochester, MN. My home, and place of employment. The article is


It is a well written piece, and Dr Gawande seems to have an excellent grasp of the facts. I, in fact, chuckled at one point in the article when he describes being a visiting surgeon at Mayo, and being astonished at the preoperative care of one patient. I felt similarly after coming here from Cleveland Clinic, and although CCF is an outstanding instituion, practicing at Mayo is different. I also felt that the conversation with physicians in McAllen was a particularly insightful part of this piece as well. I also agree with him in principle on some of the problems inherent in many of the high cost areas within this country. He is also quite correct when he states that local influence, and/or "culture" is absolutely imperative as a means of cost controls. However, I disagree with his conclusion or assertion that Mayo as a model, is losing ground to more expensive models. I think the current administration's focus, particularly Orszag's, as well as an emphasis on the "Medical Home", Pay for Performance initiatives, and the rising emphasis on Evidence Based Medicine, and quality metrics shows quite the opposite. In fact, in the near future, judging from some of the grumbling amongst the physician community, the "Mayo Model" may become the ideal, a visionary example of excellence in the medical community, not only in the treatment of disease, for which we have achieved considerable recognition, but in the DELIVERY of care.

Make no mistake, there will be resistance, likely considerable resistance, and while there is certainly already some, judging from my conversations with physicians and providers around the country, it will likely increase substantially. The truth may become difficult to hear above the noise, and dogmatic expressions from both side will dominate any real discussion. But, and this is a huge but, IF we can see with clarity, work with purpose, and focus our efforts, real reform may be possible. As I have said on here previously, our problems are many, and many have not even been clearly delineatd yet, however, this should not deter us from striving for true and lasting change. Our patients, and their families deserve nothing less.

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