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SPECIAL COMMUNICATION Andrew Taylor Still and the Mayo Brothers: Convergence and Collaboration in 21st-Century Osteopathic Practice Robert Orenstein, DO orn in Lee County, Virginia, in 1828, function were integrally related and that BAndrew Taylor Still, MD, DO, wit- he could use manual therapy restore nessed the ravages of many of the infec- health.1 tious diseases prevalent in 19th-century Attracted by Dr Still’s successful treat- America while traveling the country as a ment of previously “untreatable” illnesses, boy with his father, who was both a physi- many physicians began to embrace his cian and a Methodist minister. philosophies, adopt his techniques, and sup- At the time, the practice of medicine port the establishment of a new kind med- was a cottage industry with few proven ical practice known as osteopathy. People treatments. Therapies often were con- came from throughout the United States to cerned with ridding the body of disease Kirksville, Missouri, to learn osteopathic rather than returning the body to health. principles and practice. Dr Still shared his There was little standardization or evi- methods with others freely, demonstrating dence-based practice at the time. the benefits of osteopathy in the mainte- As a young surgeon, Dr Still wit- nance of health and the treatment of dis- nessed the inadequacy and lack of scien- ease. In 1892, he established the American tific basis for contemporary medical prac- School of Osteopathy with the primary mis- tice. Dr Still saw osteopathy as a science SPECIAL FOCUS ISSUE sion of disseminating the principles and and philosophy. The science was the practice of this unique form of medicine. understanding of anatomical, structural, Meanwhile, Dr Mayo’s sons, William and functional relationships. The philos- James Mayo, MD, and Charles Horace Mayo, ophy was that by maintaining normal structure, homeostasis MD, (“Dr Will” and “Dr Charlie”) joined the family surgical prac- and health could be maintained. Dr Still grew to understand tice in Rochester with a similar vision—to place the needs of the that illness was more than the interaction of infectious agents patient first. The Mayos believed that delivering the best med- with their hosts; the whole person and his or her family could be devastated by disease. Dr Still was one of several visionary physicians who Osteopathy is an independent system and emerged from rudimentary 19th-century medical practices to can be applied to all conditions of disease. seek improvements in the way healthcare was delivered. In 1863, a frontier surgeon and British emigré named William —Andrew Taylor Still, MD, DO Worrall Mayo, MD, arrived in Rochester, Minnesota, to Osteopathy: Research and Practice (1910) examine Union soldiers prior to enlistment—around the same time that Dr Still was establishing his practice in rural Missouri. Both of these visionaries would champion improve- ical care required that the physician was well educated in the ments in the existing system of medicine by basing it on latest scientific advances. In addition, they believed that a per- more rational and scientific models. sonalized, team approach should be taken to fully unravel the Dr Still envisioned the patient as a complex unit, encom- complexities of caring for an individual patient. passing mind, body, and spirit. He believed that structure and As medical knowledge expanded in the early 20th-century, so too did the Mayo brothers’ vision for this new collaborative approach, later dubbed the Mayo Model of Care.2 Mayo physi- From the Mayo Clinic College of Medicine’s Divisions of Infectious Diseases and cians felt this approach allowed them to provide the best care General Internal Medicine in Rochester, Minn. possible to each patient every day through an integrated Address correspondence to Robert Orenstein, DO, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN 55905-0001. approach. The Mayo Model of Care soon became the model for E-mail: [email protected] all group practices in the United States.2 Orenstein • Special Communication JAOA • Vol 105 • No 5 • May 2005 • 251 SPECIAL COMMUNICATION And, again, people came from around the country— ations of osteopathic physicians. Unlike the Mayo group prac- and throughout the world—to Rochester to learn from and tice, which grew into a large, integrated model of practice, be treated by physicians at the Mayos’ clinic. osteopathic physicians were scattered across rural and inner- Like Dr Still, the Mayo brothers too went on to establish city urban America, filling the medical needs of underserved a graduate school of medicine to prepare physicians for their communities. model of care. But now, much of the difficult foundational work of building, establishing, and fortifying is complete. The torch is The Mayo Model of Care being passed to today’s young osteopathic physicians, who and the Osteopathic Difference must now accept the new challenges of practicing medicine in From the embers of late 19th-century American frontier 21st-century America using Dr Still’s model of osteopathic medicine, two visionary models of healthcare founded on care. similar principles and honoring the primacy of the patient However, for as much as things change, history bears emerged. Their approaches differed, however. The Mayo important lessons. There are many similarities between our era Model of Care, as noted, emphasizes a team approach to and that of Dr Still’s: an almost–blind faith in pharmacologic solving “a problem”; while Dr Still’s model of osteopathy solutions to treat disease and an overreliance on technology takes an integrative approach attuned to the specific needs of alone to solve health problems. Reports in the media on public the body’s various systems. perceptions of the depersonalization of patient care are all too In the 20th century, these two models diverged, with common.4,5 The increasing complexity of health problems has Mayo physicians developing into an integrated, specialty- resulted in subspecialized care and sometimes disjointed or focused practice while osteopathy remained focused on the piecemeal approaches to the management of disease, with individual. each organ or tissue having its own “caretaker.” As in Dr Still’s era, many patients today no longer feel whole. They find they are longing for someone to treat all of As we grow in learning, we more justly them, not just their symptoms. They wish to avoid therapies appreciate our dependence on each other. that do more harm than good. They want to assert more con- The sum total of medical knowledge is now trol over their own healthcare decisions. All of these broad- based impulses have led to a growth in complementary and so great and widespreading that it would be alternative approaches to healthcare.6 futile for one man to attempt to argue, or any Many within the profession wonder how osteopathic one man to assume that he has even a good physicians will be able to meet the needs of 21st-century working knowledge, of any large part of the patients. What is the role of the osteopathic physician in the 21st cen- tury? How will osteopathic physicians demonstrate their unique- whole. ness in a setting where specialized allopathic care is the norm? —William James Mayo, MD There are clear roles and opportunities for osteopathic Quoted in Mayo Clinic Model of Care physicians who remain enlightened by Dr Still’s philosophy of [brochure] patient care, education, and research. It is time, however, to innovatively renew Dr Still’s original model of patient care Mayo physicians would contribute to and disseminate by taking advantage of an opportunity to incorporate some of the most current medical information on recent innovations in the time-tested and popular features of the Mayo Model of patient care, research, and education throughout the 20th cen- Care. tury.2 This single institution extended its reach, becoming the largest private medical group practice in the world.3 Mayo Patient Care Clinic’s focus on continuous improvement and innovation, Although osteopathic physicians are scattered broadly across while adhering to the basic vision of the Mayo Model of Care, the nation, information technology now provides us with the would continue to be the driving force in its long-term success. means to practice as an integrated team to deliver the best At the same time, however, osteopathic medicine began medical care to our patients. Osteopathic physicians serving in facing many unfortunate legal and practice hurdles in its rural areas no longer need to rely on their experiences alone to second century, forcing a generation of osteopathic physicians aid their patients. Today’s osteopathic physicians can access the (DOs) to fight for their identity and practice rights, instead of latest medical research and clinical practice guidelines through concentrating their energies on innovation in research, edu- the Internet. Telemedicine, the use of visual and electronic cation, and patient care.1 technologies, will revolutionize the delivery of care in rural While fostering excellence in patient care, much of the areas and urban centers. Already, this technology has enhanced energy of the osteopathic medical profession has been spent in the delivery of specialty care to rural areas and prisons, allowed rebuilding osteopathic institutions and training future gener- expert interpretation of complex imaging, and has provided 252 • JAOA • Vol 105 • No 5 • May 2005 Orenstein • Special Communication SPECIAL COMMUNICATION new opportunities to deliver timely and expert care to under- stood that osteopathic physicians must be at the forefront of served populations. Recently, telemedicine protocols have medicine and groundbreaking research, as these changes will been used to enhance vaccination rates in daycare settings, propel approaches to healthcare in the present century. freeing parents from lost workdays. Clearly, Dr Still envisioned osteopathy as more than Through the proper use of information technology, manipulation. He saw manipulation as a tool to impact struc- patients can feel empowered to make more informed health- ture-function relationships and enhance the body’s ability to care choices.

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