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MedicalsystemintheUSMayoclinicZhiHuaRanDepartmentofgastroenterologyRenJiHospitalMedicalsystemintheUSMay1HistoryofMayoclinicMayoClinicevolvedgraduallyfromthefrontierpracticeofDr.WilliamW.MayoandhistwosonsDr.WilliamJ.MayoandCharlesH.Mayo.HistoryofMayoclinicMayoCl2Dr.MayoandhistwosonsDr.WilliamW.MayoDr.CharlesH.MayoDr.WilliamJ.MayoDr.MayoandhistwosonsDr.3HistoryKeyDatesDr.WilliamW.MayoemigratedfromEnglandtotheUSin1846Becameadoctorin1863AppointedasaCivilWarexaminingsurgeonfortheUnionenrollmentboard,firstMinnesotadistrictMovedtoRochesterin1864HistoryKeyDatesDr.Wil4HistoryKeyDatesHistwosonsbegantheirmedicaltrainingearly,firstbyobserving,andlaterbyassistingtheirfatheronpatientvisitandwithautopsies"Wecamealonginmedicinelikefarmboysdoonafarm"Dr.WilliamJ.MayoHistoryKeyDatesHistwo5Dr.WilliamJ.MayoTheelderbrother,graduatedfromUniversityofMichiganMedicalSchoolin1883Dr.WilliamJ.MayoTheelder6Dr.CharlesH.MayoTheyoungerbrother,graduatedfromChicagoMedicalCollegeofNorthwestUniversityin1888Dr.CharlesH.MayoTheyoung7HistoryKeyDates1864Dr.WilliamWorrallMayomovestoRochester1883and1888Dr.Mayo’stwosons,WilliamandCharles,joinhiminpracticeaftertheyhadfinishedmedicalschool1883AtornadostrikesRochester.MotherAlfredMoes,founderoftheSisterofSt.Francis,proposestobuildandstaffahospitalifDr.W.W.Mayoandsonswillprovidemedicalcare.

1889SaintMarysHospitalopenswith27beds1892FirstpartneraddedtoMayofamilypractice.Morephysiciansareinvolvedtojoin,thusbeginningtheconceptofmedicalteamwork.HistoryKeyDates18648HistoryKeyDates1905Dr.LouisWilsondevelopsarapidwaytodiagnosesurgicalspecimens(quick-frozentissuesectionstainedwithmethyleneblue),whichallowsMayosurgeonstoexplore,diagnose,andrepairallinoneoperation1907Patientregistrationnumber“1”givenout.5000patientsregisterat“Mayoclinic”,asithascometoknown1914Mayoisolatesthroxin,theprincipleactivecomponentofthethyroidgland.Thisisonlysecondtimethatapurehormonehasbeenisolated1915Organizationoftheworld’sfirstformalgraduatetrainingprogramforphysicians,theMayoSchoolofGraduateMedicalEducation1919TheMayoturnovertheassetsoftheMayoclinictothenonprofitMayoPropertiesAssociation,theforerunnerofMayoFoundationHistoryKeyDates19059HistoryKeyDates1920Mayodevelopsasystemforgradingcancernumerically,whichisadoptedworldwideandstillusedtoday1925Dr.WilliamH.Goeckermanreportsontheuseoftarandultravioletlighttosuccessfullytreatpsoriasis.Thisisatherapeuticbreakthroughthatremainsahighlyeffectivetreatmentforpsoriasis1926MayoClinicProceedingsbeginspublication1930sMayoscientistspioneermethodsformeasuringmotilityoftheesophagusandadaptthemforclinicaltestingnowusedworldwide1934EdwardC.Kendall,Ph.D,isolatescortisone,ahormonefromthesuprarenalcortexthatwilllaterbeusedtotreatrhematoidarthritiswithdramaticresultsHistoryKeyDates192010HistoryKeyDates1938Dr.FrederickMoerschfirstreportsmedianthenarneuritis(carpaltunnelsyndrome)1939WilliamandCharlesMayodiewithinafewmonthsofeachother1944Firsttherapeuticapplicationofstreptomycintotreattuberculosis.1947DiscoveryofFactorVII,ablood-clottingcomponent1950Drs.EdwardC.KendallandPhilipS.HenchareawardedtheNobelPrizeforisolationandfirstclinicaluseofcortisoneFirsthumandiagnosticcardiccatherization1955MayoisamongthefirsttoperformsuccessfulopenheartsurgerytorepaircongenitalheartabnormalitiesafterrefiningtheGibbonheart-lungbypassmachineHistoryKeyDates193811HistoryKeyDates1965ComputermonitoringofpatientsintroducedinCardiacCareUnitatSaintMarysHospital1966Dr.LeonardKurlandintroducestheRochesterEpidemiologyProject,amedicalrecords-linkagesystemthathasmadeOlmstedCountyoneoffewplacesintheworldwheretheoccurrenceandnaturalhistoryofdiseasecanbeaccuratelydescribed.Theprojecthasgeneratemorethan1,000publicationonlong-termincidence,prevalence,andmortalityratesformanydiseases1969FirstFDAapprovedtotalhipreplacementintheUS1972MayoMedicalSchoolopens1973MayointroducesthefirstCTscannerinNorthAmericanHistoryKeyDates1965--12HistoryKeyDates1976TheNorthCentralCancerTreatmentGroupiscreated1980Mayoresearchersareamongthefirsttoproposeintensiveinsulintherapytoreducethecomplicationofdiabetes1986MayoClinicRochester,SaintMarysHospital,andRochesterMethodistHospitalintegrate1986MayoexpandsoutsideMinnesotaforthefirsttimewiththeopeningofMayoclinicinJacksonville,Fla1987MayoClinicopensinScottsdale,Ariz.AndSt.Luke’shospital,Jacksonville,FlaMayoClinicRochestergoessmoke-free,ofthefirstmedicalcentersinthecountrytodoso1990MayoresearchershelpidentifythesourceofillnessaffectingpeopletakinghealthsupplementL-tryptophanHistoryKeyDates1976--13HistoryKeyDates1992Mayobeginstoformaregionalnetworkofclinicsandhospital1994Mayostudyfindsnolinkbetweenbreastimplantsandconnectivetissuedisease2019Mayoopensitwebsite2019MayoEugenioLittaChildren’shospitalopens,partofSaintMarysHospitalinRochester2019MayoClinicHospitalopensinPhoenix,Ariz.2000MayoClinicTransplantCenteropensinRochesterprovidingasinglesettingwherepatientreceivealloftheirtransplantservice–fromevaluationtofollow-upHistoryKeyDates1992--14TheBeginningofGroupPracticePressedbythedemandsoftheirbusysurgicalpracticeandtheexplodinggrowthofmedicalknowledge,theMayobrothersinvitedotherstojointtheirpractice:AugustusStinchfield(1892)ChristopherGraham(1895)MelvinMillet(1898)HenryPlummer(1901)addeddiagnosticskillLouisWilson(1905)developedthelabMaudMellish(1907)developededitorialservicesHarryJ.Harwick(1908,localbanker)improvedbusinessproceduresTheBeginningofGroupPractic15TheBeginningofGroupPracticeThegroupwasthebeginningofanewwaytopracticemedicine‘Ithasbecomenecessarytodevelopmedicineasacooperativescience;theclinician,thespecialist,andthelaboratoryworkersunitingforthegoodofthepatient’‘Individualisminmedicinecannolongerexist’

TheBeginningofGroupPractic16GroupPractice‘Nooneisbigenoughtobeindependentofothers’AquotebyDr.WilliamW.MayoGroupPractice‘Nooneisbige17TheBeginningofGroupPracticeGrouppracticewasalsoanaturalexpressionoftheMayobrothers'personalities.

AsHarryHarwick,whoworkedalongsidethemfor31years,wrote:"ThefirstandperhapsgreatestlessonIlearnedfromtheMayoswasthatofteamwork.For'mybrotherandI'wasnomereconvenienttermofreference,butrathertheexpressionofabasic,indivisiblephilosophyoflife."TheBeginningofGroupPractic18ArchitectoftheMayoPracticeDr.WilliamMayoclaimedthatthebestday’sworkheeverdidfortheclinicwasthedayhehiredHenryPlummerArchitectoftheMayoPractice19Dr.HenryPlummerHeintroducedthedossiermedicalrecordssystemthatfacilitatedsharingofinformationAllofapatient’sdata,frombothclinicvisitsandhospitalstays,wasenteredintoasinglefile,whichtraveledwiththepatientandwasstoredinacentralrepositoryDividedadiagnosticindextofacilitateaccesstotheserecordsforresearchDr.HenryPlummerHeintroduce20Firstbuildingforanintegratedmedicalpractice1914OnthesiteHaroldW.SiebensbuildingRegisteredpatients:30,000Firstbuildingforanintegrat21GrowthofSpecialtesOrthopedicsin1912Neurologyin1912Thoracicsurgeryin1915Dermatologyin1916Pediatricsin1917Neurologicsurgery/proctologyin1919GrowthofSpecialtesOrthopedi22IntegratingresearchandeducationwithpracticeTheMayoschoolofGraduateMedicalEducationopenedin1915withanendowmentfromtheMayobrothersTheirprogrambecameoneofthefirstintheworldtotrainmedicalspecialistsIntegratingresearchandeduca23AnintegratedmedicalpracticeMayoClinicAnintegratedmedicalpractice24AgifttothepeopleTheMayobrotherscontributedthebulkoftheirlifesavingtoaprivate,non-for-profit,charitableorganizationMayofoundationin1919AgifttothepeopleTheMayob25Agifttothepeople“Wewantthemoneytogobacktothepeople,fromwhomitcame,andwethinkwecanbestgiveitbacktothemthroughmedicaleducation”SaidDr.WilliamJ.MayoAgifttothepeople“Wewantt26AgifttothepeopleFromthispointontheMayos,theirpartnersandallfutureMayoClinicphysicianswouldreceiveasalaryandwouldnotprofitpersonallyfromtheproceedsofthepracticeAllproceedsbeyondoperatingexpenseswerecontributedtoeducation,researchandpatientscareTheyestablishedaboardofgovernorsandacommitteesystemtoprovideeffectiveoversightofmanyaspectsofMayolife,therebyreinforcingthecooperativespiritofthefoundersAgifttothepeopleFromthis27ThepresentMorethansixmillionpeoplehavebeentreatedatMayoClinicsinceitsfrontierfoundingItencompassesthreeclinicsandfourhospitalsinthreestates,employingmorethan40,000physicians,scientists,nursesandalliedhealthworkersThroughgrowthandchange,MayoClinicremainscommittedtoitsguidingprinciple“Thebestinterestofthepatientistheonlyinteresttobeconsidered”ThepresentMorethansixmill28LocationofMayoClinicRochester,MinnesotaJacksonville,FloridaScottsdale,ArizonaLocationofMayoClinicRoches29Rochester,Minnesota1500doctorsandscientistsMayoClinicSaintMarysHospitalRochesterMethodistHospital

Rochester,Minnesota1500doct30Rochester,MinnesotaGondabuildingRochester,MinnesotaGondabuil31Rochester,MinnesotaGondabuildingRochester,MinnesotaGondabuil32Rochester,MinnesotaGondabuildingRochester,MinnesotaGondabuil33Rochester,MinnesotaRochesterMethodistHospitalRochester,MinnesotaRochester34Rochester,MinnesotaPlummerbuildingRochester,MinnesotaPlummerbu35PlummerbuildingKahlerHotelSiebens-PlummerPlummerbuildingKahlerHotelS36RochesterMethodistHospitalLicensedbedsavailable794Admissions18,412Averagelengthofstay(days)4.5Operatingrooms41Surgicalcases18,159RochesterMethodistHospitalL37Rochester,MinnesotaSaintMarysHospitalRochester,MinnesotaSaintMary38SaintMarysHospitalLicensedbedsavailable1,157Admissions42,328Averagelengthofstay(days)5.6Operatingrooms58Surgicalcases29,849SaintMarysHospitalLicensed39Rochester,Minnesota2019StatisticsMayoClinicUniquepatients321,900Outpatientsvisits1.42millionPersonnelStaffphysiciansandscientists1,509ResidentsFellows1,414TemporaryprofessionalsAlliedhealthstaff(clinicandhospital)21,077

TotalStaff

24,000

Rochester,Minnesota201940Rochester,Minnesota2019Statistics80%ofthepatientsoutpatients20%hospitalized80%ofMayoClinicpatients:fromMinnesota,Iowa,Wisconsin

Rochester,Minnesota201941AtypicaldayatMayoClinicNew(outpatients)arriving266Admissionstothehospital238Surgicalprocedures204Labtests33,653Radiologyprocedures4,064CTscans563ChestX-rays726MRIs219Electrocardiograms670Unitsofbloodandbloodcomponentsused3262019StatisticsAtypicaldayatMayoClinicNe42MedicalResearchBiomedicalresearchatMayoClinicincludesstrongprogramsinbasicandclinicresearchMostMayomedicalstaffparticipateinsomeresearchactivityResearchFundingSources(inmillions)Mayofunds$121Extramuralfunds$251NationalInstitutesofHealthOtherfederalsourcesCommercialsources

Total$372MedicalResearchBiomedicalres43MedicalEducationMayoSchoolofGraduateMedicalEducationtrained>17,000alumnisince1915Clinicalresidentsandfellows1,390MayoGraduateSchoolhasgranted459graduatedegreesinsevenspecialtiessince1917Predoctoralstudents150MayoMedicalSchoolhastrainedandgraduated>1,000studentssince1972MedicalEducationMayoSchool44Jacksonville,FloridaMayoClinicSt.Luke’sHospitalJacksonville,FloridaMayoClin45Jacksonville,Florida325doctorsandscientists253Residents,fellowsandtemporaryprofessionalsOpenedin1986Deliveringhealthcareservicesin>50medical/surgicalspecialtiescancertreatmentorgantransplantationheartsurgeryneurosciences>91,000patientswerediagnosed/treatedin2019>13,000patientsunderwentsurgeryJacksonville,Florida325doct46Scottsdale,ArizonaMayoClinicArizonaMayoClinicHospitalScottsdale,ArizonaMayoClini47ArizonaOpenedin1987Servicesin>65specialtyandsurgicaldisciplines,includingprogramsincancertreatmentandorgantransplantation.MayoClinicisapremieracademicmedicalcenterintheSouthwest.Staffphysicians/scientists344Residents,fellowsandtemporaryprofessions101Served>100,000patientsArizonaOpenedin198748SysteminMayoClinicClinicBulletinWeeklyannounced;FromMondaytoSaturdayAsearlyasat7AM;Noontime(12:30~1:30);6PMMedicalgrandrounds(everyWednesday)H.LeeNewTechnologiesincriminalinvestigationGIgrandrounds(everyThursday)SysteminMayoClinicClinicB49SysteminMayoClinicWell-organizedandadvancedsystemshuttlebusevery5mintelephoneeverywhereComputerconnectedincludedallpatients’informationHumanitySysteminMayoClinicWell-org50SysteminMayoClinicResidency3yResidentinchief:theforthyearGeneralInternalMedicine2mo(outsideRochester)CommunityInternalMedicine2mo(Rochester)UrgentCare1mo(outpatientw/oappointment)PrimaryCareClinic1mo(outpatientw/appointment)Pulmonary1mo(inpatient)Oncology1mo(inpatient)Cardiology2mo(inpatient)MICU1moSysteminMayoClinicResidenc51ResidenttrainingMorbidity&Mortality(everyMondaynoontime)

JournalclubFriday7:30~8:30Morningreport(teaching):8:00-8:308:30~11:30:workroundLectures:groundroundsmorbidityandmortalityResidenttrainingMorbidity&52GIfellowtrainingPickmentor1styearWeeklycorelecturesJournalclubStatisticsEndoscopy2rdyear:research3rd:clinicpracticeGIfellowtrainingPickmentor53QuestionsaboutMayoClinicWhydopatientscometoMayo?HelpwiththediagnosisandtreatmentofadifficultmedicalproblemthemainreasonBecauseofitsexpertise,reputationforthoroughnessanditsteampractice,whichletspeoplegetalltheopinions,testsandtreatmentstheyneedinoneplace,inacoordinatedwayQuestionsaboutMayoClinicWh54QuestionsaboutMayoClinicHowmuchtimewillamedicalevaluationrequire?sixworkingdaysDoesMayospecializeincertainareas?MayospecializedinvirtuallyeverythingMayo’sstrengthisitsc