Special Report: The Mayo Clinic, Rochester, Minnesota

Courtesy Mayo Clinic

The oldest and largest private medical practice in the world continues to be the gold standard in health care.

You wouldn’t believe how many people try to smuggle monkeys onto airplanes. Which leads to monkey bites. Which leads to panicky calls from passengers to the Mayo Clinic Preferred Response team, a service of the legendary medical institution that gives subscribers in remote locations immediate access to expert health-care advice anytime, anywhere, from a yacht in the Caribbean to a safari in Zambia.

“I have a whole raft of beast-bites-man-trying-to-impress-woman stories,” says David W. Claypool, M.D., medical director of Mayo Clinic Medical Transportation. “One man demonstrated to his girlfriend his ability to kiss an iguana, and the iguana bit him. He worried: Will I get rabies?”

Certainly most people turn to the Mayo Clinic with more prosaic, albeit serious and often critical, health issues. It’s the oldest and largest private medical practice in the world. More than 500,000 patients are treated every year, at the mother ship in Rochester, Minnesota, or the satellites in Arizona and Florida. Some have been referred by their own physicians at home, and some just show up at the door moaning, “Help—migraines.” And they moan in many languages. “We’ve had Spanish interpreters since the 1920s because of wealthy people coming up from Mexico, Cuba and South America,” says Matthew D. Dacy, director of Heritage Hall, the clinic’s museum, and the de facto historian. “Now probably a hundred countries send their patients to us. Our concierge service has interpreters, dieticians, clergy—whatever they may need.”

Mayo has been an iconic (and ironic) name in health care for more than a century—a place surrounded by cornfields but considered the gold standard or the last-chance saloon by royalty (both actual and media-ordained). It’s where Lou Gehrig was diagnosed with the disease that now bears his name, where King Hussein of Jordan underwent a bone-marrow transplant to fight lymphatic cancer, where the Dalai Lama had a recent checkup and was pronounced in excellent health (except for a slight irritation in his eyes).

The why and how of Mayo’s reputation is based in its three-shield logo: clinical care, research and education (with a nod to one-stop shopping). “Any patient comes in the door with two burning questions,” says Stephen J. Russell, M.D., Ph.D., dean for Discovery and Experimental Research. “One is: What is it and how did I get it? And the other is: What can you do for me? If we can’t answer those questions, we’re doing the research about the environmental factors, the genetic factors and how the disease works. And if we can’t do much to alter the natural history of the disease, we have research going on to address that, too.”

Rochester was just a stagecoach stop when William Worrall Mayo, M.D., arrived in 1863 as an examining surgeon for the Union army in the Civil War. He stayed because his wife said, “We’re not moving again,” and 20 years later, when a tornado destroyed much of the city, he cared for the wounded and helped raise donations to build a hospital staffed by nuns. (St. Mary’s is still in service as one of the two facilities used for Mayo patients who require hospitalization; there’s a VIP floor of wood-paneled suites with a Cordon Bleu–trained chef, safes for jewelry and spa robes.) Dr. Mayo’s two sons inherited the practice at the dawn of medical specialization, building a constellation of partners skilled in pediatrics, orthopedics, obstetrics and other fields beyond their ken. One of the partners was a physician with the heart of a systems engineer who created what is still the infrastructure of Mayo Clinic: the unified medical record. In the early 20th century, patient information traveled via pneumatic tubes; today the results of a lab test can be on multiple computer screens an hour later.

Marjorie Merriweather Post chartered a train from California to bring her father, the Grape-Nuts king, to Mayo for an appendectomy. And shortly after Charles Lindbergh completed his historic flight to Paris, the Mayo brothers funded an airport, realizing that any modern clinic should be accessible by plane. The old train depot is now a Mexican restaurant.

One wall of the Mayo Building lobby is inscribed with the names of $10 million donors, mostly grateful former patients—names that include Hilton, Guggenheim and the president of the United Arab Emirates. But Mayo has been not-for-profit since 1919, when the founder’s sons signed a deed of gift, ensuring the longevity of the place by giving it away. They put themselves and everyone else on salary, and today all 2,000-plus staff doctors are salaried, removing any incentive to order additional tests or second opinions unless they’re in the best interest of the patient. There have been many honors and firsts. Mayo had the first blood bank in the country, the first CT scanner in North America, and two Mayo doctors won the Nobel Prize for discovering cortisone.

“If you have something that’s been tough to diagnose or tough to treat, there’s probably somebody at Mayo Clinic who’s the world’s expert in that,” says cardiologist Sharonne N. Hayes, M.D. “But even if you don’t have a complex disease or illness, there’s a reason to come here because of the importance of your time. Often we can do in three or four days what would normally take three or four weeks elsewhere, because we’re all under one roof.”

Speed and skill are the reasons Yousif B. Ghafari has been doing an annual “executive checkup” at Mayo for ten years, ever since he turned 50 and his friends in the Young Presidents’ Organization deemed it essential. “It’s for people like me who are pushy,” teases Ghafari, an international architect from Dearborn, Michigan, and former U.S. ambassador to Slovenia. “I go in for an appointment and see lots of people in the waiting room, but within minutes my name is called.” His schedule over 48 hours is dictated by head-to-toe, age-appropriate testing and any current concerns—EKG, liver enzymes, blood sugar, thyroid function, cholesterol and triglycerides, mole check, plus this year a podiatrist for toenail discoloration and the ophthalmologist for changes in night vision.

“Mayo is Mayo for two reasons: people and technology,” says Gianrico Farrugia, M.D., director of the Center for Individualized Medicine. “We specialize in merging technology with individualized care.”

The mandate for the next decade is about using someone’s own DNA to generate new tissue and help cure diseases. “Ten years ago the first human genome was sequenced, and then there was a sort of radio silence,” Dr. Farrugia explains. “There was an expectation that medicine would suddenly change, but it did not.” Last year Mayo decided that genomic medicine should be incorporated into patient care, and there are current clinical trials about the genes associated with breast and colon cancer. “It’s now relatively easy to get the information,” says Dr. Farrugia. “What’s really hard is how to make that information useful to the patient. One genome is a huge amount of data—the equivalent of 42 million Twitter messages. Our strength is how we interpret the data. We have an electronic medical record that goes back to the beginning of Mayo, and we have every surgical specimen that has ever happened here. Putting those things together, we are in the optimum position to drive the next generation of patient care.”

The biggest Post-It note consumption at Mayo is surely at the Center for Innovation. It’s the country’s first group of embedded designers in a medical facility, a techy in-house industrial-design studio that looks as if it were modeled after the offices of Google or Facebook and whose goal is nothing less than transforming the experience of health care. A sign at the entrance reads: “Think Big, Start Small, Move Fast.” (And someone has tacked on: “Breathe Deep.”) All those Post-Its filling the walls are incubating ideas, perhaps exam rooms redesigned from the patient’s point of view or a “smart mirror” that could ask if you took your medication and coordinate with devices that record changes in weight or blood pressure or glucose or hand grip strength.

Everyone at Mayo seems to have drunk the Kool-Aid, including the electrician who frets about the most convenient placing of outlets and the cleaning woman who declares that she saves lives (if she’s keeping the room free from infection, she’s right). “We’re not known as the heart place or the cancer place or the knee place,” says Dacy. “We do all those things, but we’re known for comprehensive care, and people work together in this collegial way. The customer service philosophy is powerful. We have a dress and decorum committee—you won’t see unshaven doctors in scruffy scrubs like on the TV shows, and the reason is to respect patients.” Monkey bites and all.

For more information, go to mayoclinic.org.

In and Around the Mayo Clinic Rochester

There’s no Ritz-Carlton in Rochester, Minnesota—no Four Seasons or Mandarin Oriental or Peninsula, either—and the city’s idea of an Italian restaurant is the Olive Garden. This is the dirty little secret behind any visit to the Mayo Clinic: You’ll get world-class medical care, but it’s the badlands for eating or sleeping. Saudi princes and celebrities have stayed at a hotel-within-a-hotel called the International Hotel, on the top two floors of the Kahler Grand Hotel (from $400; 20 Second Ave. SW; 507-280-6200; internationalhotelmn.com), built in 1921 by a friend of the clinic’s founder. The suites are traditional (read: old-fashioned) but graceful, with kitchens available for those who bring personal chefs—and a speed-dial button to Mayo.

When asked about where to eat, one Mayo physician advised, “My house,” and shared the name of a well-stocked market three miles away. Zzest Market & Cafe ($ 1190 16th St. SW; 507-424-0080; zzestmarket.com) is also a terrific little eatery. In the downtown area is a sophisticated tapas bar called Söntés (4 Third St. SW; 507-292-1628; sontes.com).

Three airlines fly to Rochester: American Eagle (through Chicago), Delta (through Detroit or Minneapolis/St. Paul) and Allegiant (through Phoenix).

$ Establishment accepts no charge/credit cards or accepts cards other than the American Express Card.

Facts

Mayo Clinic patients who got massages after heart surgery experienced a major decrease in pain, anxiety and muscle tension.

New studies are exploring herbs to combat the fatigue of chemotherapy and other remedies once deemed too “woo-woo.”

More than 100 acres of the Mayo Clinic campus are physically connected via climate-controlled pedestrian subways and skyways.

Mayo’s old train depot was the Western White House during the Munich crisis that led to World War II, when F.D.R. lived in a private railroad car while his son James had surgery for a gastric ulcer.