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Introduction

"My mother injured her back weeding my garden, but, of course, she didn't tell me," reports a Mayo Clinic physician. "And then she flew three hours back to her home, but she could hardly walk off the plane—pain was going down her leg, and it was numb." After three days, the Mayo physician had a phone call from her mother to report that she was not getting any better. "I told her she had an extruded disc in her back, and told her to see a doctor. Tell him you need a spine evaluation." The mother followed her daughter's orders. Her doctors were associated with one of the best-known hospitals in the country, "But after five weeks of running around and nobody really listening to her, they injected her knee, because that's where her pain was. And I'm thinking what on earth? Her problem is her back. She's got a disc problem, and they're injecting her knee." The doctors prescribed narcotics for the pain when the knee injection failed to help her. "When I was talking to her on the phone, it was clear she was overmedicated; she wasn't speaking English anymore—she reverted to her native language. She was not making sense, and she was slurring her words."

The Mayo physician asked her sister to put their mother back on a plane bound for Mayo. "She came here, she saw the neurologist the next morning, she saw the neurosurgeon that afternoon, and we put her in the hospital that night. They operated on her back the next day; she was pain free and out of the hospital in four days. Three weeks later, we took a safari to Africa, rode in a jeep, and she was fine!"

This story reflects Mayo Clinic's business strategy working the way it is intended to work for all patients—one does not need to be the mother of a Mayo physician to receive expedited service.

A young business consultant first noted weakness in his left hand while still in graduate school. Beginning with the student health service, he sought help from more than a dozen specialists—hand surgeons and neurologists—in four cities over the next four years. One doctor literally threw up his hands, saying, "I give up—we can't find anything." A hand surgeon in another city made an incision from the young man's wrist to the elbow in an attempt to relieve what he thought might be pressure on a nerve that could account for the weakness. Postsurgery, the symptoms remained the same. Then the other hand became weak.

A neurologist in yet another major city tentatively diagnosed multifocal motor neuropathy with conduction block (MMN), except that it did not manifest "conduction block." The patient reports, "He could not get enough evidence to definitively call it MMN, so he was not willing to take off the table other frightening and grim possibilities like ALS." (ALS—amyotrophic ...

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