The literature provided by the Mayo Clinic emphasized the importance of patient participation. Three of Shawn’s doctors dismissed his questions with condescending remarks. They provided little or no insight into the diagnostic tests they had ordered and spent no time discussing the results. There is absolutely no excuse for how he was treated by these so-called doctors. The internist coordinating Shawn’s care and the neurologist gave no indication that they had read his records as they made numerous comments amply demonstrating their ignorance of his history. Only one physician, the pulmonary specialist in the allergy clinic, treated Shawn with respect, answered his questions, and took an interest in his case. Twenty five percent is a failing score no matter what the game, but in patient care is a disgrace. It indicates that Mayo Clinic’s reputation for patient orientation and care is vastly overrated.
The internist responsible for coordinating Shawn’s care was one of the most inept clinicians I have ever seen. He never took the time to digest all the medical records Shawn brought with him. He did not even take the time to review the exhaustive medical history questionnaire that the Mayo Clinic sent for Shawn to complete prior to his first appointment. The only questions he asked were based on the major symptoms Shawn wrote on a card in the waiting room. He never bothered to order a review of the CT scan from Northwestern showing a node on Shawn’s thymus. His working hypothesis was that most of Shawn’s symptoms could be accounted for by asthma, sleep apnea, allergies, and maybe a neuromuscular disorder like multiple sclerosis. After all those possibilities were disconfirmed, he blithely said everything looks good. He even had the audacity to suggest that maybe anxiety was responsible for Shawn’s flushing spells, blood pressure spikes, chest pain, and shortness of breath. If this pathetic excuse for a doctor had bothered to read the medical history, he would have understood why this simpleton hypothesis was rejected long ago. Ignorance of a case history is incompetence regardless of whether it stems from arrogance, disinterest, or insufficient time.
The Mayo Clinic also emphasizes the importance of involving loved ones in your care, encouraging patients to bring someone with them to ask questions, relate observations regarding symptoms, and help remember instructions. The internist coordinating Shawn’s care told him there was no need to include us in the initial evaluation and only grudgingly included us in the follow-up visit to discuss findings.
The Mayo Clinic also prides itself on taking a team approach to a case and integration of care. This is clearly another platitude masquerading as reality. Teamwork is not ordering evaluations from specialists. Integration of care does not consist of reading (and misinterpreting) summary reports from specialists. Here is my favorite example of teamwork and integration of care from our five worthless days at the fabled Mayo Clinic. The pulmonary specialist in the allergy clinic looked over the results from testing, saw no evidence of asthma or any allergic component to Shawn’s symptoms, but was very concerned about pulmonary weakness. He took the time to call the internist coordinating Shawn’s care to discuss the finding, noting that it should be followed up and could be due to a nasty variant of myasthenia gravis. The internist expressed annoyance that the pulmonologist had called him when he was “in the middle of doing something else” and dismissed the pulmonary weakness as probably just a “red herring.”
Here is my list of the top ten greatest twits from Shawn’s visit to the Mayo Clinic.
10. The internist told Shawn not to worry about his focal abdominal pain and bouts of diarrhea; it was probably irritable bowel syndrome. “My son, who is twenty-six, has irritable bowel syndrome and he gets relief from Metamucil. I have irritable bowel syndrome, too. Nothing to worry about.” The irony of knowing more about your doctor’s medical history than he apparently knows about yours is too great to pass up.
9. On Monday, “I will send your scans down to radiology to be read immediately.” On Friday, “ Well, I guess those scans should be sent down to radiology.”
8. “The flushing and other symptoms could be due to anxiety.” Never mind the medical history that argues against that possibility. Well, doctor, how do explain the fact that they occur in his sleep and during innocuous activities? “I don’t know – I have not seen that.” How do account for the recent change in the flushing pattern with the redness greater on one side of his body? (Hint: You told Shawn at the start of the week that asymmetric flushing could be due to something like multiple sclerosis.) And all that bleeding and bruising?
7. The neurologist suggested that his muscle weakness might just be due to inactivity and should be helped with exercise. When Shawn pointed out that his blood pressure and heart rate skyrocket with physical exertion, she said, “oh really, you really should have that checked out.” Thanks for reading the medical records in that pretty folder.
6. Hypertension? “The six hour average levels look fine. Don’t worry about those spikes. They are only a problem if you have an aneurysm.”
5. The endocrinologist spent a few minutes with Shawn after having a medical resident conduct the history and physical examination. Her words of wisdom were priceless. “There are no other tests that should be done at this point. Why would you want to have more tests?”
4. Pulmonary weakness? “Probably just a red herring.” How silly of the pulmonary specialist to be concerned.
3. “ It looks like you don’t have asthma or sleep apnea, so everything looks good.” But, but, but those were the things you thought might account for Shawn’s hypertension, tachycardia, and respiratory symptoms…
2. “Don’t worry about communicating the results to your hometown doctor. I talk to hometown doctors all the time.” Be sure to tell Shawn’s hometown doctor why you did not read the medical records. I am sure he will find your cursory knowledge of the contents to be extraordinarily amusing.
1. The parting words of wisdom from his primary care doctor: “If there had been something seriously wrong, we would have found it.” I seriously doubt it.
The Mayo Clinic has beautiful facilities, friendly support staff, and the best technology. Too bad the medical care Shawn received fell far short of its reputation.
Shawn has been blessed to be under the superb care of his physician in Chicago. I shudder to think where we would be without this doctor. He has been the answer to our prayers. The Mayo Clinic was just another trial to endure.
1 comment:
I hope the hometown doctor reports your experience to the AMA.
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