Incredible people have spent time at BHC as medical residents, interns, pre-med students, and clinical research coordinators as a waypoint in their educational journeys. As a part of our mission, we train upcoming medical professionals and researchers to help be a product of change in the medical and scientific fields surrounding these illnesses. In the following post, Dr. Grach reflects on her time at BHC doing a clinical rotation as a Mayo Internal Medicine resident.  

“The problem before us is so to exchange information, and so to educate men through travel that there shall develop a…system of medicine which will combine the best elements to be found in all countries.” – Dr. Charlie Mayo, 1936 [1]

In college, I majored in the history of medicine – technically, the History, Philosophy, and Social Studies of Science and Medicine (HIPSS for short!). The history of medicine inspires us with stories of Edward Jenner’s smallpox vaccine and Janet Rowley discovering the Philadelphia chromosome, but it also tells of failures: not least, the devastatingly dismissive label of hysteria, the effects of which can be argued still linger in the modern day [2]. Although many such diseases have now been classified appropriately (multiple sclerosis being a commonly cited example) and the term itself is no longer acceptable, there are conditions with which the greater medical community remains uncomfortable. Coming from one of the major referral centers in the U.S., I was able to encounter patients from around the country who struggled to have providers believe their symptoms. A subset, usually with fibromyalgia, were able to be diagnosed but still told in some way or another that the symptoms were “all in [their] head” before finally finding a kind primary care provider who could start basic management. The ones we have with myalgic encephalomyelitis/chronic fatigue syndrome [ME/CFS] are usually less lucky – not surprising, when only one third of medical schools may mention ME/CFS, despite conservative estimates that it is twice as common as multiple sclerosis [3,4].

Looking back at my experiences as a physician-in-training before residency, I can remember multiple times when patients presented with symptoms that my attendings couldn’t quite explain to me. The good ones could empathize but generally had little to offer; others would simply move on to whichever tangible condition they wanted to address instead. We passively learned through the hidden curriculum that the symptoms of patients with fibromyalgia or variances of such should be met with doubt, that most likely whatever they had would not have actual pathology. These encounters never sat right with me, but what was I to say when I had no knowledge of what was happening anyway, and certainly no degree to back up any conjecture? That changed when I became a resident at Mayo. Suddenly, I had attendings who could explain fibromyalgia or POTS to me with scientific pathophysiology, and even had ideas for management that actually helped. I was finally able to confidently validate my patients and their symptoms, which was nothing short of exhilarating for me after sitting essentially useless on the sidelines of my prior experiences. But, I knew that I had much more still to learn – after years of falsely learning that there was nothing to do for fibromyalgia, what was there for me to actually know about the other “medically unexplained syndromes,” like ME/CFS?

As I wondered how best to improve myself, I turned again to the history of my own institution. Drs. Will and Charlie Mayo, referred to collectively as “the Mayo Brothers,” are known for evolving the Mayo Clinic into the leading example of cohesive clinical care, research, and education aimed at addressing the needs of the patient. The knowledge they had for their time was considered incredible. Possibly the most important contributor to the success of the Clinic however was not what knowledge the Mayo Brothers had, but how they obtained that knowledge—with one brother staying in Rochester to run the operations, the other would famously go across the United States and even across the world to learn new knowledge, skills, and attitudes on the various diseases in medicine. These new pieces of information would then be incorporated into the Mayo Clinic practice and research for the betterment of patient care. And so, I decided to take a page out of Dr. Will and Dr. Charlie’s book, and arranged a rotation with the Bateman Horne Center.

The difference between the Bateman Horne Center patient visits and my old encounters was palpable. Even in many severe cases, there was hope, and gratitude for the progress being made. Amongst the clinic activities, I was also able to learn about and help in research with important implications for post-viral and complex chronic illness. Morning case discussions, virtual national lectures, and patient Q&A sessions allowed frequent occasions to learn from each other and from patients; and in all of these events, I was impressed by the humility with which providers approached each learning opportunity. Watching the 10-Minute NASA Lean Test and seeing the physiologic dynamics of ME/CFS and orthostatic intolerance as it happened was an eye-opening experience after only having read the reports of tilt tables before. Most amazingly, in a field where most providers had nothing to offer, I was in a place where every patient I talked to reported at least some meaningful degree of improvement because of the Bateman Horne Center.

I feel so lucky to have seen the results of years of immeasurable hard work by Dr. Bateman and her team through my rotation – I felt like I was seeing history finally changing. Getting to learn new diagnostic and management techniques has given me again a new excitement about being in the field. Coming from a clinic that has long been synonymous with hope for many unusual or complicated diseases, I am proud to have the opportunity to build on my skills to become an effective provider for patients with complex chronic illness who may seek help at Mayo.

I am extremely grateful to both my program for supporting me in my endeavors and to the Bateman Horne Center for welcoming me with open arms. I also look forward to sharing my knowledge in the way that the team from the Bateman Horne Center has done for me, as learning from each other will be the best chance medicine has to improve the standard of care for ME/CFS, its associated conditions, and all future conditions yet to be explored.

Sincerely,

Stephanie L. Grach, MD, MS

Stephanie L. Grach M.D. M.S. is a current third-year resident in the Mayo Clinic School of Graduate Medical Education Internal Medicine residency in Rochester, Minnesota. After training, she will be remaining at Mayo as an attending physician in the Division of General Internal Medicine, where she plans to specialize in the Fibromyalgia, POTS, ME/CFS, Long COVID, and general diagnostic consultative clinics. She is also committed to continuing as a researcher and educator in her fields.

• Mayo Clinic History & Heritage. https://history.mayoclinic.org/toolkit/quotations/the-doctors-mayo.php.
• Sarmiento, S. (2021, August 10). The lingering effects of female hysteria in medicine. Berkeley Political Review. https://bpr.berkeley.edu/2021/08/10/the-lingering-effects-of-female-hysteria-in-medicine.
• Peterson TM, Peterson TW, Emerson S, Regalbuto E, Evans MA, Jason LA. (2013). Coverage of CFS within US medical schools. Universal Journal of Public Health. 1(4):177-179. Doi:10.13189/ujph.2013.010404.
• Jason LA, Richman JA, Rademaker AW, et al. (1999). A community-based study of chronic fatigue syndrome. Arch Intern Med. 159(18):2129-2137. doi:10.1001/archinte.159.18.2129.