{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/1r6n011n4q/manifest","type":"Manifest","label":{"en":["Dr. Edward Shahady"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1991-05-07 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. William Ventres (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","family medicine","family physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Edward J. Shahady, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eThis interview was conducted in 1991 and reflects on much of the early development of family medicine education. Dr Shahady attended medical school at West Virginia University, then entered a 2-year general practice residency in Akron, Ohio. His residency was interrupted when he was drafted and served as a pediatrician in Vietnam during the Vietnamese War. After two years in Vietnam he returned to complete his residency. He became the residency director of the same program in 1970, when it converted to a family medicine residency program. While he felt the GP residency prepared him to provide good medical care, he became aware of the complexity of patient care and learned to integrate behavioral skills into his practice and the educational program. He served as chair of the department of family medicine at a new medical school, the Northeast Ohio University College om Medicine, and subsequently the chai at the University of North Carolina. Always interested in international work, he helped develop family medicine in Latin America through the International Center for Family medicine. This interview provides excellent insight into the development of family medicine in the 1970s and 1980s, and is a valuable recounting from someone who was deeply involved in this development.\u003c/p\u003e (summary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}}],"summary":{"en":["\u003cp\u003eThis interview was conducted in 1991 and reflects on much of the early development of family medicine education. Dr Shahady attended medical school at West Virginia University, then entered a 2-year general practice residency in Akron, Ohio. His residency was interrupted when he was drafted and served as a pediatrician in Vietnam during the Vietnamese War. After two years in Vietnam he returned to complete his residency. He became the residency director of the same program in 1970, when it converted to a family medicine residency program. While he felt the GP residency prepared him to provide good medical care, he became aware of the complexity of patient care and learned to integrate behavioral skills into his practice and the educational program. He served as chair of the department of family medicine at a new medical school, the Northeast Ohio University College om Medicine, and subsequently the chai at the University of North Carolina. Always interested in international work, he helped develop family medicine in Latin America through the International Center for Family medicine. This interview provides excellent insight into the development of family medicine in the 1970s and 1980s, and is a valuable recounting from someone who was deeply involved in this development.\u003c/p\u003e"]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/156792/file/286747","type":"Canvas","label":{"en":["Media File 1 of 1 - Shahady_Edward_91.wav"]},"duration":3847.91844,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/156792/file/286747/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/156792/file/286747/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/286/747/original/Shahady_Edward_91.wav?1755101445","type":"Audio","format":"audio/wav","duration":3847.91844,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/156792/file/286747","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/156792/file/286747/transcript/82483","type":"AnnotationPage","label":{"en":["Dr. Edward Shahady Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/156792/file/286747/transcript/82483/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Ed Shahady\n\nMay 7, 1991\n\nPhiladelphia\n\nQ. - William Ventres, M.D.\n\nA. - Ed Shahady\n\n________________________\n\nQ.  So Ed, with that preface, again maybe that beginning question is to ask you, how did you get involved in family medicine?  How did you become both a family doc or a general practitioner before, and then got involved actually into family practice?\n\nA.  Well, I was in the bimodal curve, I was real down, far in the hump, 4 percent of my class became general practitioners nationwide.  Went to the University of West Virginia, graduated in 1964.  I--role model uncle who was a G.P. surgeon, so that's what I thought I wanted to do.  I thought I wanted to be a surgeon, loved anatomy, got into that, really start liking medicine, peds, so I had a generalist interest and had a model back in my small home town.  I have an uncle, Uncle Doc was his name, so we called him, still alive today, you know, he's in his '80s, still does a little bit of practice, you know.  And so that would--but I thought I was going to be a surgeon, but really what I saw in him, that I now realize that I loved, is, was his diversity in his dealing with people, his--our respect for him in the family.  There's probably a major role model there.  Although I had an internist cardiologist uncle, also had a dentist uncle.  But that probably had a lot of influence, took me a while to realize that.  Went--thought--you know, took a G.P. residency in Akron, Ohio, that was back when G.P. residencies were popular--\n\nQ.  Two-year program, or--\n\nA.  Well, it ended up being a 4-year program because I had 2 years in the service, I got drafted out of my internship during first-year residency, went to Vietnam.  That helped me, too, because I did all pediatrics while I was there.  I was fortunate enough to build a children's hospital in Vietnam, come back and practice pediatrics.  I think that one thing I learned there was I, although I was happy being only a pediatrician, I was unhappy because I didn't get to deal with the moms and the dads, so I knew I wanted to be a generalist.  I think that sort of, it was theoretical before I actually experienced 2 years probably as a specialist.  Very proud to be a G.P., went to I think a very good G.P. residency program in Akron, Ohio.  It was one of the 10 or 12.  We had residents in, really sharp residents, good people, who are some of the leaders in the field today, you know, we really, very impressive people.  So that was a model, Akron, Ohio was where the first president of the AAGP came from, Dr. Davis.  It was also the place where the first, AA was formed in Akron, Ohio, Alcoholics Anonymous.  So I think that's important because there was a strong foundation for behavioral medicine in that community.  So it was a nice community to come out of, went out and practiced and in 1969, I'll never forget this, a fellow named Tunis Zondek(??) came in looking at our G.P. residency and says, 'Why don't you guys have this, this, this.  There's a place in Wichita that has all this.'  And he talked about this guy, I thought he was crazy.  He was talking about Gale Stevens, is who he was talking about, about this.  So at that time I was responsible for recruiting for the whole hospital, we had 50 interns we recruited at that time.  So we started talking about family practice.  I became, in 1970, the director of that residency program in Akron, Ohio.  I think after I went out and practiced for a couple of years, very successful practice, with three other docs, very much involved in the educational programs, so I think my point in coming into this was a real strong commitment to being a G.P., a tremendous commitment to this hospital, I really loved Akron City Hospital and the people there.  It was a tremendous support for G.P.'s.  It was an environment where I really felt good, I had status, you were supported, the surgeons were, and not just from the economic perspective, I think they respected quality.  And so general practice had a strong, strong foundation in Akron City Hospital.  So that was, I was birthed out of strong role model, the medical school it was plus/minus in support, but a tremendously supportive hospital.  A service experience that probably convinced me that being a generalist was important.  I think another thing was really important to me, I might say this is this children's hospital that we built in Vietnam.  'Cause that gave me an appreciation for another culture, which 10 or 15 years later and still today involves a lot of my life, international family medicine.  I learned, I became (????), 'The doctor who speaks Vietnamese.'  And that was a really fun experience because in a war that was unpopular, that you read that they don't want you to be there--\n\nQ.  ??\n\nA.  Ah, you were there, too!  You know--?\n\nQ.  No, I worked in a refugee camp.\n\nA.  Okay, yeah, so the--that feeling towards the Vietnamese people, we started with a little tent, we built a--we--there was a--the other person who was there with me, the other doc, two battalion surgeons, he came from medical--we went to medical school together and did our residency, or did our internship together, and then he was out there.  He had a surgical interest, so it was beautiful.  You know, he was interested in the surgical problems, I in the medical problems, and that really taught me the value of people, their lives, who were these people that you would see--there was a 14-year-old little girl that they were using as a prostitute yet--because that was the only way that they could bring in income, or how life could quickly--you know, just go from a disease, saw cholera, saw bubonic plague.  These diseases just were frightening and really--and then how those people.  I remember the first case of bubonic plague is we lost this beautiful strapping 14-year-old boy, he just came in and died, and what looked like pulmonary edema, and then we finally made that diagnosis of plague, because we seeing bubos and this was pneumonic plague, is what it was.  And a priest helped us understand it, because he says, he called it 'pestis,' pestoril, pestis, as the organism was called then.  Well, all that began to help me understand science, help me understand community medicine.  I think--we didn't call it that then, but we went to the village and had house calls.  We had the hospital.  We had a different culture, although we could communicate.  Learning another language, the language of illness goes across continents, you know.  I think you can be a neurosurgeon--the brain--once you have the person asleep, the brain's the same, whether it's a Vietnamese or American brain.  But trying to understand abdominal pain in the Vietnamese, (dao bung??), and it's not just (dao bung), pain in the belly, there's so much more going on.  There's (dao bung) from an ulcer, (dao bung) from a, 'I'm scared to death I'm going to die tonight.'  Well, that was a powerful influence on my life, I think, it came out, so here I come into this tremendous desire to be a G.P., this tremendous influence of Vietnam, which was very positive for me.  The negatives were there, obviously, being away from your family, etc., getting shot at every day, and coming back to a community that's very supportive of general practice and wanted me to become the leader of the G.P. residency, and the family practice residency.  So that was a beginning.  Now that's my philosophical point up to starting this residency program, August or July, 1970.\n\nQ.  I'm going to stop you for a second to ask you about, you said that someone approached you about this guy in Wichita and they were doing some things.  What was different about, and you kind of said this crazy guy in Wichita--what was different about this new field that people were talking about and what you understood as general practice?\n\nA.  Well, our G.P. residency, which I did, so it had to be good, obviously, the dollar of our daddies(??), was an inpatient rotation.  I mean it was, you went here and you went there.  It was really learning how to be an internist for 3 months, a pediatrician--you didn't have a family practice center, you didn't have a curriculum that was outpatient-oriented.  There was no such thing as behavioral science.  Some of the other things.  You just went on the tradi--you did a rotational internship and then you went to your second-year residency and you were a rotator for another period of time, then you elected some in your third year.  So what was different was, this probably the family practice center and behavioral medicine.  That was the main thing, having a panel of patients to care for.  Although we had a continuity clinic, that was where I didn't want to go, I had to go there once a week for a half a day and I didn't want to go, it was the worst--it was all the indigent patients and the preceptors rotated.  So I think that was the main difference.  And of course that was, in 1969, is that was when these first programs were being formed.  They were only about a year or two old, there were about 15 or 16 of them in the country.  Somebody recounted that history for you, the first 15 or 16 programs, (??) Lynn Carmichael.\n\nQ.  They (??) 15 programs they'd go to the board and say 'look, we've got programs,' all put together by the seat of their pants.\n\nA.  Sure.  So they were doing that, and here, you know--well, I was not in any mainstream at that time, I was just a guy out in, who finished his residency, fresh, didn't know what was going on, and that just hit me like a--you know, either this guy is from the moon or there's something else going on in the world.  This world.  He was--thank God I met him.  Never forget his name, I don't even know where he is now.  Tunis Zondek--with a name like that, you either forget that one easily or you remember it.\n\nQ.  Okay, and so you--I'm also wondering if we should, maybe this is the time to take a break.\n\n[tape interruption]\n\nQ.  --especially 'cause we were talking about getting into what it was like in the residency, during the residency.\n\nA.  Get in one of the first--we were in the second wave of programs getting started.\n\nQ.  So outside of the--so the first 15 got started for the board basically, and then you were in the second wave--\n\nA.  We were approved in August of 1970, and those were approved in February of '69, so we were in like the second group--there might have been 20 or 30 programs when we got approved, something like that.  We on?\n\nQ.  Yeah, we're going.\n\nA.  So Akron City was in that second wave of programs, I don't know exactly where, but it was August 1970 it got approved.  So it built on a strong general practice residency.  It was difficult getting it approved.  It took us three tries, and I think that's probably one of the real credits of the residency review committee, is it was not easy to get your program approved.  You really had to meet a rather rigid criteria, and our initial application was very loose.  In fact what we were going to do was have the--we had a basement in the place where I was in practice, about 15 miles away from the hospital, and we said, well why don't we just put the family practice into that, we'll bring the residents out here and teach them while I practice upstairs and them come see.  And that was not acceptable.  We had to have a full-time director--\n\nQ.  And that was you.  \n\nA.  Yeah.  And I committed myself to doing that.  Really scared, you just figure back then that you drop your practice, which was really building and fairly lucrative and with a young family and--but again, when you had all that support and the support of the many people in that hospital to--\n\nQ.  What was it about it that attracted you to do that even though it was a risk?  Why did you decide to do that? \n\nA.  You know, some desires that I still have, because it was very clear to me as I tried to articulate what it was, you know--I really, as I did my general practice, and I probably would see 50 patients a day, I said 'This is okay, but it ain't right.  There's got to be a better way to do this.  I think I was really good, a good G.P., well-trained, but like, first patient I had that killed himself, I never recognized his depression.  He overdosed on Valium.  I said, 'My God, I missed something here, I--and the guy had pericarditis, and I was really sharp about that, I was extremely well-trained in picking up a broad spectrum of disease, and I knew that.  But I wasn't hearing other things.  I wasn't seeing other things.  I wasn't picking up on, you know, 'cause I recognized--yeah, you know, some of the classical symptoms of depression--chest pain can be heart disease but it also can be other things, you know, panic disorders and things like--so I began to realize I was missing some things in practice.  Although picking up a lot of fascinating disease.  Within 2 weeks of practice I had a (Guillaime-Barre syndrome?) and--but I realized with that lady that there was a tremendous reaction of the family to the illness that I was unprepared to handle.  I really knew how to be a damn good doctor, dealing with people who couldn't ventilate.  Damn good doctor, knew how, people like chest pain and abnormal cardiogram.  But that wasn't enough.  So I said there's got to be something else, and that's when I began to realize that there was a lot more to medicine.  The--as Gale Stevens would call the unconditional positive regard.  As Sassel, the English general practitioner, I forget the name of that book--and see a lot of this is--it's awful hard to separate your fields now from (crack? prac?) today or where you came about.  But I was missing those.  The other thing that drove me that I though was extremely important was, phone calls drove me crazy.  And I says there's a better way to do this, that--patient education, I said there's got to be a better way to really educate patients.  I still, though, still don't think I've solved that problem, so I had to really get people to understand their illness or what's their perception of their illness, to help them understand.  Still looking for ways to do it.  But it was those types of things that drove me--there's got to be something better, wouldn't it be neat to have time to do this?  To be paid to try to set up an ideal practice?  So I came into it with a real desire to set up a training program that was a lot better than the training program I had to help young men and women to be able to go out and do these things that I wasn't trained to do.  But I didn't have those skills yet either.\n\nQ.  Right.\n\nA.  I'm 2 or 3 years out of it, okay, I know there's got to be something better.  And so it was coming on the promise that maybe I could get those skills and have the time to develop them, or bring other people in.  That was the other thing, too, they talked about bringing in other people to help.\n\nQ.  Like--\n\nA.  People who did practice management, people who did behavioral medicine.  I went to a meeting in Kansas City and Marian Bishop was up on the stage and talking about behavioral medicine, interpersonal skills.  She says there's people like me that are available who can come help you.  And as part of the curriculum you had to hire people.  That was clear that you had to have a social worker, you had to have a behavioral science teaching program, that you had to have a practice management teaching program.  It was important to hire people like that.  You know, some of that we--I think practice management, I think I can take our program and take credit in Akron, Ohio for probably really introducing--we had the first full-time practice management faculty.  A man named John Aloise(??), I don't know if you've ever heard of him.\n\nQ.  I think he's written some books, thought.\n\nA.  Yeah, he's written a couple of books, you know--so bringing in a person like him into our program to realize that learning how to manage your practice was extremely important.  But not managing it just to make money, manage, more importantly, patient education, time, making sure I have enough time to take care of people, knowing how to set that up--not so I take care of more people but I can effectively give my patient 30 minutes if they need it.  So bringing someone in like that.  These are some of the basic founding ideas that I think were pushing, at least pushed me back.\n\nQ.  And some of the interesting self-development, it sounds like, to do a better job, to learn these things and pass them on to others.\n\nA.  Oh, absolutely, see I was how old?  Maybe 31, 32 at that time.  Very young, you know--so what?  'Cause I went through, I went to college--high school, college, medical school, the 2-year interruption in the service, so you're 28 when you start out, so I'm 30, 31, starting being the director of a residency program.  Naive.  \n\nQ.  What were your biggest fears at that time about family practice medicine?\n\nA.  Not doing a good job as a teacher, failing the learners, not meeting that promise of--I knew the, had the vision.  And of course the vision was, 'here's what I am and here's what I'm not.'  \n\nQ.  Almost a real personal vision.\n\nA.  Oh, yeah, sure, see you know you base it on what--I think that fortunately, and I'll say fortunately back then that I didn't know the world of deficiencies.  I didn't know the literature on what doesn't exist.  There was the Millis Report and there was the Willard Report, but we didn't have a real large literature base then in family medicine.  So it was myself plus maybe a couple of other people and what they thought.  It was just our little world in Ohio--I probably, I had very little--I didn't even have a feel for the state of Ohio, I had a feel for Akron, Ohio.  But I think that was okay, I think that was very helpful initially.\n\nQ.  You mentioned the Willis and Millard Report.  You were in school--[interruption].  I was kind of asking about the residency program and talked about the failures, or, I'm sorry, about the fears, and I remember I was going to ask you about the Willis and Millard Report.  You were in medical school at that time.  I haven't really talked to anyone about this, but what kind of effect did those reports--did you know anything about them, had you heard anything?  You were intending to be in general practice, but what did those mean to me?\n\nA.  Oh, in medical school they meant nothing.  I heard nothing about them in medical school.  Although they were being probably created around that time.  In fact, it probably wasn't until 1970 that I really began to realize that those existed.  I don't think I read them until that time.\n\nQ.  So really until you got involved with the--\n\nA.  Thinking about education, family practice residency education.\n\nQ.  And what did they mean to you when you started reading them?  Can you remember the first time, maybe, or--\n\nA.  Yeah, well, the Millis Report was just sort of okay, this is nice.  We should have primary care docs.  The Willard Report, I call that the Bible of family practice education.  'Cause that really gave you some real, if you--I think the whole--in order to get our residency program approved, they said, 'Why don't you read this report and see what we're really trying to come at here?  So the Willard Report was very instrumental, I think, in helping us understand the new idea of family medicine, how it was different.  The Willard Report talked about the function.  You know, general practice describes the content of what I do, family practice the function of what I do.  And I think that that helped me understand, 'cause you know, and I don't know how many people have talked to you about the fact that--but I didn't want to be called a family physician, I wanted to be called a G.P.  Have many people talked to you about that?\n\nQ.  Not so much, no.\n\nA.  And I can remember the feeling, I don't know why, but it was a macho--family doctor didn't feel very good.  The fact that--I think I used to say well, okay, I'll call myself that but I'm really a G.P.  It's interesting that worldwide general practitioner is a much more common term than that.  Are you going to talk to Ted Phillips?  Have you talked to him?\n\nQ.  Ted's not coming here.  I wrote to Ted, but--\n\nA.  Well, he's got an interesting perspective on that, he's actually given some talks about that, that we may want to reconsider that.  Now in this country the reason we had to do--we just needed a new name, it was pure gimmickry.  It still may be--and I think that what I like, when Ted brings it up it rekindles something to me, that people say, well you're family doctors, okay, but what do you do?  I mean people think a family doctor means a doctor for my family.  I think a general practitioner, it had a negative connotation to American medicine, particularly medical students, back in the late '60s, early '70s, so we called ourselves family physicians.  The reason I say that, we've got the same negative connotation of family physicians today.  So we haven't overcome what we wanted to overcome. And I think going back, the name general practice--I'm a generalist.\n\nQ.  But you were, I'm sensing that you were real proud to be a generalist, a general practitioner at that time, I mean you didn't want to change the name.  \n\nA.  Right.\n\nQ.  What was the difference between your perception and the negative--\n\nA.  That I think that we were losing our identity.  'Cause we--taking on the new--it was real clear what I did as a G.P.  It was very clear how I was different from, I was generalist.  And although we didn't have those words back then, I think being the primary entry, unconditional positive regard, Gale Stevens' words, that people could come in no matter what and I would positively regard them.  There's no conditions on coming in to see me.  And that I could handle anything.  A lot of it was macho, that I didn't stop you if you were a woman, if you were a kid, or you had a G.I. complaint or a chest complaint, that I would handle you no matter what.  Now part of that was the great rugged individualist, you know, Doc, and Festus and Matt Dillon--you know, there was Doc, he could handle anything.  'Get him to Doc,' Festus would say.  You know, and then if you look at the history of the English general practitioner, you know we have a strong--I mean that's where we came from.  That English general practitioner I think is probably our heritage.  It was probably the greatest influence--you know, in this country, has been England, our mother country.  \n\nQ.  I'm going to switch a little bit to more, larger sphere.  What were the big challenges for this rekindling of general practice, this refurbishing or this--there were some things, you know, it sounds like, I mean what Gale Stevens was talking about and--it was adding process to that content.  What were the big challenges as a--either in your own setting as a new residency director or in a larger context of, around the country, to getting this going.  \n\nA.  You--why, it's almost like why was it working, too?  I might add that in there.\n\nQ.  'Cause it really started out from--you know, 300 programs within 10 years.\n\nA.  Blossomed, yeah, they talk about the movement of the '60s, the reverberation in the '60s and the anti-authoritarian, you know, the counterculture type of things.  Well, I think to me it was much simpler than that.  I think that there was a tremendous need for doctors in the rural areas.  I remember one thing we talked about then, if you were in Chicago, two out of three people in Chicago identified the emergency room as their primary source of medical care.  People didn't have doctors to go to.  We were looking at, where I was in Ohio, tremendous need for physicians.  So there was this hue and cry for doctors in rural areas that would be nonspecialists, would be people there--we'd, you know, the statistics were very obvious that in 1930, 80 percent of the doctors were generalists and we were on our way down to 80 back at that time.\n\nQ.  You said 4 percent of your class?\n\nA.  Yeah, 4 percent of my class went into general practice.  So I think that there was, an obvious need was developing and these other specialties were taking off.  I think the mood of the country was Sputnik and science and technology, which has not changed, you know, (??).  So I think the fervor, the real fervor that got me going was, that we needed doctors who had a generalist perspective.  And alongside this I think what was beginning to develop was this whole idea of family or behavioral medicine, the Peckham experiment, although it was done a long time before that, and a variety of other things which I can't remember the titles of.  I think this whole phenomenon, sociology was just developing, you know, as a valid science.  You begin to realize that at this time not everything was scientific.  You know, we could almost go back to, that started with Bacon in the 18th century.  [Have] you read, not Millis's but Odergard's book, Dear Doctor?\n\nQ.  I haven't, no.\n\nA.  I think that would be very interesting, you know, to see how that tied in.  He looked at the (Fol???) Report and what that did.\n\nQ.  He's the last surviving member of the Willard Report.\n\nA.  That's right.  The--\n\nQ.  You looked at the F?? Report, you were saying?\n\nA.  He looked at the--I think he looked at the, I think he looked at the--he wrote Dear Doctor, and I think what he was trying to say, guys were in trouble.  He's not a physician, and you're in trouble for a variety of reasons, you know, and he talked about the negative impact of the F?? Report, and called the--how we just got ourselves into a scientific thinking--I think the thing I appreciated most out of that, and it was articulated, so I use these words, although I couldn't say it back then, was that if it wasn't scientific, it wasn't good, it's almost like qualitative versus quantitative.  And--\n\nQ.  Big discussion--\n\nA.  Oh, yeah, well, what's science?  And the thing that he talked about, he said, you know, we've been held hostage by the Marie Curie definition of science, which says the scientist has to be separate from the experiment, cannot be influenced by the experiment.  So what--I think that's the snobbery, in fact I see it maybe even somewhat existing, coming out in our society here with quantitativeness and P values and multiple regression analysis.  But what I was feeling back then was that hey, you know, taking care of people, I'm in here, I'm taking care of people and something's going right.  And they're feeling good about it.  And I'm judging what I do differently than I used to.  I used to judge what I did by the disappearance, an X-ray's changing, a lab value changes, but now I can base it on, maybe this family's functioning better--in fact with a hell of a lot of things, like if they got COPD, you know, those lungs aren't going to get any better.  A lot of what I'm dealing with are chronic diseases, hypertension, diabetes, and I'm just delaying the inevitable.  I'm trying to get exci--I like to always tell my residents--you gotta get excited about nothing, nothing happening.  So I'm almost changing my whole framework, the way I think, that instead of--it's curative versus caring, it's almost--the talk yesterday by Callahan, you know, that I--that the primacy on caring, Lynn Carmichael's, the primacy on the patient.  I didn't understand all that back then, but I was beginning to feel it.  I didn't have the words.  I was saying, 'God, this is really fun to do, I'm really enjoying working with this lady that has Guillaime-Barre's(??) syndrome, not just because I--it was fun diagnosing it and making sure she went through these pulmonary complications, but now she's getting better.  And everybody else is leaving.  The neurosurgeon's leaving, neurol--they don't want to do it, if she's not--she doesn't have any bad problem.  But she still can't walk, (??) rehabilitated, she and her husband are bitching at each other, the kids are doing this over here, so I say, 'God, this is really important stuff that I get involved in.\"  But I don't know how to do it.\n\nQ.  (??) thing that's going on.  But you didn't know how to do it.\n\nA.  Yeah, but I've got to get excited about stopping this, you know, the nothing.  Here's the hypertensive.  The other beauty of this too, think about things that I think--(??) call you young, Bill, 'cause I get--'you young whippersnappers don't know'--but do you know that FDR had, that his doctor didn't think his blood pressure had anything to do with his stroke?  And you know, guys, when do you think that we just started getting smart about hypertension and treatment, you know.  That the first VA study was done in the late '60s, early '70s. It's only been probably between 1970 and 1990 that we really start saying it's important to treat hypertension.  So it's been in my lifetime, all right?  So--I used to treat hypertension with 30 mg of phenobarbitol a day.  That's the way we were taught to do it, that was state-of-the-art medicine.  So I had to get excited about nothing.  I had to get excited, 'cause I used to take it for granted that these things would happen to people, that there weren't, there weren't some things we could do to delay the--\n\n[tape side ends]\n\nQ.  --something or doing something.\n\nA.  Sure.  Or I can feel it, I can see it.  You know, nothing is in so many ways.  They're going to come in and their blood pressure's running okay, and they feel good, and that's success, guys.  But God, it's not pulmonary edema, they don't come in at 2 o'clock with rales up to their clavicles and at 2:30 the rales are down to their nipples and the next morning they're gone and they say, 'You're a lifesaver.'  They aren't going to say anything like that.  They're going to say, 'Why do I have to come in, Doc, my blood pressure's okay.'  So how do I get excited about nothing and make the patient excited about nothing.  That's skill.  So that's, that was a challenge then; it remains a tremendous challenge, I think, to teach that.  How do I keep myself excited?  How are you going to keep yourself excited 15 years from now?  It's hard.  It's easy to say, 'Oh, shit, what the hell.'  So maintaining excitement is the--I think I love to think about ways to do that to students and residents.  \n\nQ.  You know, what were the ways--maybe that's a good starting point.  In the next, what were the things that kept you, in developing this program from '70 on, that really kept you excited?  And they have been the kind of, the initial changes or some of these things you've talked about, but were there other big challenges that kept you excited, either in your practice or in the development of this?\n\nA.  What's interesting to me is I, you know, I almost went from micro to macro and back to micro again, now the micro in sphere of influence.  In Ohio we started this medical school, Northeastern Ohio University School of Medicine, which was, came about with all these other community-based medical schools, as the federal government would begin to say, we need new schools, and created community-based community across the country.  In Ohio we got three extra ones there, Wright State, Toledo and Northeastern Ohio.  And an osteopathic school too, in Athens.\n\nQ.  But Northeastern is in Akron, isn't it?\n\nA.  Well, it's a consortium, in Akron, Canton and Youngstown, which actually was, the basic science building got located sort of geographically in between a town called Rootstown. So there I got asked to be the chairman, first chairman of that family practice department, and helped develop the other programs.  There was one at Akron General, but the others hadn't developed yet.  So I sort of, you know, my job then became, in addition to directing the residency at Akron City, and by this time you know there was additional faculty and you know we had some help, was to go out and help develop those other programs.  So I got a natural inroad into the excitement.  And we all got accelerated at that time.  I mean there were 20-some programs.  If you were director of the 20-some programs and realized how quick we grew to almost 400.  So you would call the--you know, who spoke at the national meetings for 20 program directors.  You figured that we were going to get there as part of it.  So you spoke and then you had to help develop locally and then--along this time, I'm going to talk about development.  Tom Stern, 1973, became director of the Division of Education of the Academy.  He followed a fellow named Tom Johnson.  Have you heard the Tom Johnson stories?\n\nQ.  No, I haven't heard the stories.  I know about the award, but I haven't heard the stories.\n\nA.  Well, that's his award, you know, and a lot of people you've been talking to have won that award 'cause they were innovators, but Tom helped us get our programs started, and he told us about the Willard Report.  In fact what happened, when we couldn't approved at Akron City, we had to invite him--[I'm going to do this and won't hurt your ears when you listen]--so he helped us, then Tom Stern came and that's when I was a consultant, and I'd go to--I went everywhere, God, I went to Chicago, Hawaii, Puerto Rico, so you start getting known, you know, 'cause you go there and I think this original group of people, you know, start metastasizing--we wanted to get out and spread the word, it's almost like you were preachers.  So a lot of the ways my enthusiasm got handled was, I think it was, here I was doing my residency, then you got to start to do Ohio, and then you start getting a more global perspective of going out and sharing, and there were a lot of us that were doing that.  There were--the LAP(??) program began, have you heard about the beginnings of RAP, and--\n\nQ.  Nic Zervanos talked to me about that.\n\nA.  Yeah, and crucial, because what we did then, although interestingly I think that may be our death knell right now, but we needed to have criteria.  I think we, what's a residency like, and what do we do?  So we begin to develop, if you, you need 200 hours of urology, you need 100 hours of this.  You know, initially you have to have guidelines.  But I think those guidelines are now beginning to constrain us.  So I think our strength is now becoming our weakness, because something is going on right now, especially in university programs, that residents don't want to go there.  But initially there was so much need, because people were--'well, let's go learn urology.'  'Well, you're--I gave one lecture in urology, that's enough.'  We (??) needed more.  So initially because the piece of paper was blank we needed to develop something.  We needed--just as we needed a literature base, we needed to write some things down.  So they got some, again, original people, got them together, and we started developing those guidelines.  There were you know, Tom Stern I think deserves a tremendous amount of credit for helping us develop those guidelines.  And those guidelines, I think we probably met five or six times over a couple-of-year period, you know, and just begin to write then.\n\nQ.  And revising and--\n\nA.  Sure.  Came--a beautiful document was developed, sort of the minimum criteria that one fulfills to have--it was almost like the, if the RRC wrote legislation, the RAP guidelines were the enabling legislation.  You know, you must have a significant component of urology, which means that you achieve these goals.  Well, how do you do it?  Well, you do a certain amount of lecturing and a certain amount of classroom work and there has to be teaching of vasectomies or teaching--so nice (??) stuff.  And that helped us begin.  It helped--'cause what we needed was consistency.  We needed consistency in programmatic development nationally.  We couldn't have programs that just were--'cause we had some programs that were trying to get started and a couple of them did get started that were really (??).  And we couldn't stand to have that, we needed to have--if we were going to have someone--first of all, we wanted to be honest with students, if we were to say a program was approved, that we wanted it--that they'd get a damn good education.  Sure, there has to be regional differences, population differences, but we wanted to guarantee good programs, that would graduate someone that was good.  All right?  So we could guarantee that to students and also, remember we were getting a lot of flak by our colleagues in other specialties.  And so we had to, we were held hostage by their demands, both real and perceived, because our--the American Board of Family Practice still has a strong representation from other specialties on it.  But there were some real strong leaders, like Hodd(??) Lewis from Oregon, who was prior chairman of medicine at Oregon, very sharp man.  I remember sitting--he's now dead--sitting on committees with him, wanting to make sure that we knew our medicine.  I think the message he gave us was important, that we really knew our medicine.  But we took it and used it I think in a way that has constrained us.\n\nQ.  Yeah, I'm hearing two things, and I'd like you to comment.  I'm hearing that in the '70s was a time for really two things that went on.  One was establishment of programs in universities, you went from a community program--both communities and universities--you went, yourself went from a community program, got that started, went to a university, worked with a consortium (??) places, then kind of branched out on your own.  And the second thing was establishing guidelines, standards of appropriate--not care, but appropriate education so that students could be recruited and reassured and so that the medical profession could also be reassured.  And I'm hearing that--the second, tail end of that is that things have changed now.  What are the challenges at this point that face family medicine?  So we've expanded and we have these great--what are the challenges--and I also I see is this last decade has been kind of, there hasn't been a huge increase in programs, that came in the first 10 years, and the guidelines have been pretty well established.  And it's almost been a process of here we are, consolidating and improving.  But what are the challenges for the next 10 or 15, 20 years?\n\nQ.  We'll go back to--well, I mean relook at, we just--the last 5 or 6 years we've experienced a decline in the interest of family medicine.  Now if your students are doing--the absolute numbers have not decreased as dramatic as the percentage has.  We don't have as many students that--I think it's under 10 percent that went into family medicine this year?  Whereas we had reached a much higher--we're not filling as many as our programs--and we have a, what was it, 55 percent filled with graduates of American schools this year?  So that's--that's, now we fill after the mats(??) and go up to a higher number, but I think we have to remember that the quality many times, that groups, there is no doubt that we've had a decrease in number and a decrease in quality.  The quality, and I'm not talking about quality as measured by cognitive knowledge, although I know that's down, but really just overall quality of people.  So I think it's important that we ask ourselves what's happening.  'Cause I think students are great crap protectors.  Crap.  C-r-a-p protectors.  I think you just have to look at that.  So they're out there, and they no longer believe, especially in university programs.  The university programs, very few university programs filled this year.  Filled their residency.  So why is that, I think it's saying.  And I think that part of the reason--it's a complex issue--part of the reason, and I think if we don't change the community hospitals will have the same trouble soon, is I think these guidelines.  I think the guidelines, which were initially enabling, are now restricting.  I think--they're rigid.  They, you know, you must study into this.  It's a cookbook approach.  It's a cookbook approach which when we had a blank piece of paper I think was very helpful.  But it's been that the rules have now become the philosophy, and I think the rules should enable the philosophy.  And we've lost, I think, sight of that fact, 'cause those implementing strategies to meet these goals, I don't think, are no longer meeting the goals, because medicine has changed.  How do I mean that, that the way you take care of people today is like I think that I could have, being a doctor who's a jack of all trades I think was fine when the knowledge base was less than it is.  I think the way knowledge has increased itself with technology I obviously can't do as much.  So I think what I've got to do is take those things which I do extremely well and know how to do them extremely well.  And that's what the training program should be.  I think instead of saying that we've got to go to a urologist's office for 2 weeks and so on, I think we've got to retrench some of those.  We ought to look at new strategies of achieving that, and focus more of our time on training people to develop the principles of family medicine, family practice.  And I think almost retrenching to the family practice center, doing a lot more training in the family practice center, taught by family physicians.  Realizing, you know, urology--to me--I'll take that as an example, is, you know, you better know damn well how to take care of urinary tract infections.  I think we see a tremendous amount of urinary tract infections.  We could just look at the epidemiology of what we have to know.  Now what's the best way to know that?  And I don't think that the urologist's office is the place to learn it.  I think that we've got to know how to take care of it in our setting, you know, the infectious disease part of it, the bacteriology part of it, I think, you know, taught within our setting.  Probably develop unique ways to teach that, you know, how many urinary tract infections do we see in our practices?  I don't think a residency should be approved that doesn't have a clinical information system that can't tell you what every resident is seeing, the outcomes of it, we're talking about computerization of that.  So we have clinical information systems that allow us to look at that.  And you know, okay, but in our practice we see 500 UTIs a year and it's E. coli in 70 percent, and here's what we do for them, you know, and we follow--it's just automatic.  So I know that my patients are being treated with such and such and this is my success rate and this is how I follow them.  So what I'm learning is, how to really do some real quality assurance with that group of people.  It's not longer fly by the seat of your pants.  The technology we now have is, our practice management technologies, that you ain't going to learn about that in the urologist's office or up on the ward.  I think you're going to learn about that in the family practice center.  And I don't think that our RAP criteria allow that.  They've just--they've stayed the same, although they think they've changed.  So what--originally our fear was, we're so flexible we're flaccid.  Now our fear is that we're so rigid we don't have any flexibility.  And that's my diatribe, I apologize.\n\nQ.  That's okay.  Actually, that gives a new insight because some of the other folks have talked about more systemic things, but no one's talked about what we do in education.  And that's really a different perspective.  You know, I know you've been interested, and this is a little bit of a divergence--I only bring it up only because I wrote for several grant proposals for this, and kind of put in a line that this can be used as a coffer action for programs abroad.  I know you've been interested in developing programs abroad.  \n\nA.  Right.\n\nQ.  It goes back to your comment about general practitioners.\n\nA.  Right.  \n\nQ.  What's--maybe, what's general practice about, what do you see that is versus what's family practice?  I mean you talked about you came from this general practice tradition, but were called something different.  What's going abroad versus here?  Maybe that's too hard to say, 'cause each program's different.\n\nA.  Well, it is, I think if you look at England, or New Zealand or Australia, I mean they're very sophisticated.  And they call them GPs there and they're not having any trouble identity.  Of course there the GP is in the majority, and of course they've got a nationalized health system, so it's different.  And they're more and more embracing some of the aspects of family medicine and the function of keeping their identity clear.  I mean England is sort of the bastion of general practice, World College of General Practitioners, a lot of, you know, tremendous history there.  So they're not having a problem that we're having.  Of course a lot of that has to do with the way they've, you know, their national health care system.  And that's, although I've been there and seen that, that's not where I spent the majority of my time.  Mine more is in developing countries and primarily South America.  There what's fascinating is they're taking, and I think they're doing it right, they're embracing the principles of family medicine.  They're doing ambulatory training.  I just heard beautiful, yesterday, the four Venezuelans.  Were you there for that?\n\nQ.  I was there for part of it.  I heard the introduction part.\n\nA.  Okay, well, but their studies, okay they--although it was broken English, but just admire the hell out of them for--they went and were teaching--you didn't see the videotape, it was beautiful, the last thing shows a videotape, and here's this--the residency director teaching the residents how to go out into a community and help organize the community.  And they're showing the tape.  Now you know we're going to have small groups and we're going to do this, right now--demonstrating, doing it.  You know we talk about community medicine.  What we do is nothing compared to what they do, they go out and help the community organize this--what are your health problems?  Obviously their system allows it.  There's a group of doctors that takes care of this geographic area.  Ours is a capitalistic system and won't change.  But I think they're really saying let's get serious about this, or we're going to teach people to be changing the community, you take them out in the community, you demonstrate.  That's what you do with your residents.  You don't put them in a big hospital.  So I see, you know, much of that, you know, and I--this International Center for Family Medicine, you want to know about the history of that development?  Have you heard that?\n\nQ.  No, I haven't.  I don't know if it's relevant to this, I'd be interested, but--\n\nA.  Well, it's--I think it's a significant movement in family medicine of North American and probably mostly the United States, helping Latin America.  Fellow named Julio Seitlin(??) is involved, Julio, I'm there, Steve Span's there, Tom Stern was there, Dan Ostergard of the Academy is there, we're part of the group now, but you know, some of the leaders in family medicine in North America have worked with them to help develop their programs.  Well, they started from nothing.  They now have over, I think, 500 residencies in all of Latin America.  \n\nQ.  Were the motivations the same for starting these programs?  You know, talking about needing a change in medicine, generalists, you know, were there many generalists, or did they have different motivations?\n\nA.  No, absolutely, it's all, it's very similar motivations.  Their ministers of health and their social securities realized that they're putting all this money and it's going into these big hospitals.  So here in Caracas, Venezuela, you have a neonatal intensive care unit right in the middle of the city, it's second to none in the world.  And right outside you've got hundreds of kids dying from diarrhea.  And somebody might just go out and teach them oral rehydration.  So they're realizing that that's an issue, and trying to change that, and so that, I think the motivation is the tremendous--they have very limited resources in contrast to us, so they really--and unfortunately they bought the Western model.  They bought, hook, line and sinker the--\n\nQ.  Maybe we sold it to them.\n\nA.  Well, they asked us.  What do I sell?  If I have hammers, that's what I sell, hammers.  They went and asked the academic medical centers.  PAFACMS, the Pan-American Federation of American Colleges and Medical Schools is the organization, and it's like the, you know we have the AAMC in this country, AAMC is part of PAFACMS, so PAFACMS talks to AAMC, AAMC sends all their experts down there to help them.  So we sold them a bill of goods.  And it's really hard to get out of it.  They're really stuck in that model.\n\nQ.  So now they're facing some of the same things that we faced here 20 years ago and they're still facing, actually.\n\nA.  Absolutely.  And you see cholera in Peru.  And Bangladesh, there's--God, you talk about the true sadness.  I'm sure in Bangladesh you could find some tertiary care centers.  But they don't need tertiary care centers right now, they need some basic public health principles to take care.  Transportation would help a lot.\n\nQ.  I'm going to change again.\n\nA.  That's all right, keep changing, I'm just free-floating.\n\nQ.  And this is kind of the purpose of this is to get different ideas.  You know, you've done a lot in your career.  But I want to know what's been the most satisfying in terms of working with family medicine, working with the development or working with establishment of, new foundation of--not maybe what's the biggest thing you did but what's been most satisfying.\n\nA.  What makes you feel the best?\n\nQ.  For you.  For you.  And looking back over--\n\nA.  Oh, it's clear, it's very easy.  Oh, I can--the names--personal relationships with learners, seeing them happy in what they're doing, visiting their practices, coming to this meeting.  Paul Fisher's one of my residents, Paul Fischer's the treasurer of the Society and Journal of Family Practice editor, and seeing him grow, be happy, be effective.  Bill Geiger, who was in practice for 12 years in Ohio, just started in academic medicine 2 years ago, to see him here.  That's 'cause I see him here, then I go to a North Carolina Academy of Family Physicians meeting and I see all my residents, or I go--I had the honor 2 years ago of going to--a year ago going to Ohio to the (??) Family Physicians and installing one of my former residents as president of that.  But it's not their fame, it's their happiness, and their happiness because they're good, I think they're good doctors.  So--'cause I go back to, I wanted to teach people how to do that thing that I couldn't do, and I think it worked.  I think--I don't know if they learned it because of me, but they seem to be out there, practice of--you know, doing the thing that we wanted them to do.  So that dream was, and I see that dream being fulfilled.  So it's very, very clear, when I see these people being happy, practitioners, doing what we hope we would teach them back then, that that feels good.\n\nQ.  What was that dream again?  What was that dream that's being fulfilled?\n\nA.  Probably can't articulate it as well as I'd like to, but here I was, with all this great practice but missing something.  There was a lot I wasn't doing, patient education, behavioral medicine, recognizing depression, that that needed to be done.  I wasn't a complete practitioner.  I was a general practitioner, I knew content, but I didn't know function.  Maybe those are the right words, function versus content.  So I began, I appreciated that there was function to what we do in addition to content, and that was the dream.  To be able to produce doctors from residency training who didn't go out handicapped like I did.  That came out a little bit better prepared and able to take care of patients.  \n\nQ.  I'm a new residency graduate.  I'm pretty new as a residency graduate anyway, but--or I'm a medical student, maybe even better, I'm a medical student--\n\nA.  This is theoretical.\n\nQ.  Right, thinking about family practice.  I'd like you to talk to me about what dreams I can, now, 1991, what dreams I can look forward to fulfilling in family medicine, and why should I do it?\n\nA.  First think I'm going to do is find out a little bit about you.  'Cause I mean, you know, I told you I went back to the micro level, that's what I do all the time, I talk to students, I talk to residents, I influence mainly at the University of North Carolina, that's where my greatest sphere of influence is.  And like Friday I took--my graduation present to this one student was take him fishing, took him fishing with another resident, and I wanted to get those two together, 'cause--but this student's not going to go into family medicine.  And my resident's doubting family medicine, I think it's symptomatic of the times.  So what I, I talked to them about it, and I think, 'What do you want to do, what turns you on?  What turns you off?  What makes you happy?  What makes you unhappy?'  So you know, get to know you personally, it's just--you know, I really believe in continuity of care with--the principles of family medicine to me are very clear, I've written a little article on this, and you know, one of the prime ones is continuity.  So continuity means trusting each other, building relationships, so before I really advise someone, well, I'll give a speech to anybody, but if I really want to advise you, I got to know what--\n\nQ.  What makes me tick.\n\nA.  What makes--and you ain't going to believe me even if you find out what makes me tick.  I think that you'll believe me if you see in me a little bit of what you want to be.  So I got to first hook you, getting an anchor in there, and so that's why I try to see if I'm resonating.  'Cause some people, they don't have--what they want to do has no relationship to what I value, so I sort of say, well, what I do is try to find them someone.  'Cause there may be someone in our department that they're more like.  'Cause I find that I might turn them off, because I'll start telling them what family medicine means to me, and that ain't what they're looking for.  So I try to find out what you're looking for.  Now fortunately most of the time they come seeking you because they've heard from someone.  Say 'what do you think, what do you want to do,' and I say, 'okay, I want you to look'--I ask them this question--'I want to look at yourself 20 years from now and how are you going to make sure that you're happy and doing what you're doing 20 years from now.  What type of things are you going to set in motion now?'  Well, '20 years from now!'  So I talk about how to make sure you stay happy.  And I just tell them some of the things that help you do that, if these are your values now, where did they come from?  Are they well-founded?  Because those things will carry you through.  And a lot of them I think are superficial values.  Where did you grow up?  Did you grow up in downtown Atlanta?  Did you grow up in Little City (??)?  To me it's very clear, I grew up in a little town in West Virginia, I'm an old hillbilly, and that's what I like.  Small town, hillbilly stuff, I'm married to a hillbilly girl, and we got hillbilly kids.  That's what we like, you know?  That's what we are, small town folk, and I think that type of practice and that type of doing things--so I build my values from that.  You are what you been.  We all know that.  So okay, what have you been, what do you want to be, what are your dreams?  And I start, okay, now, how can you take that dream and put it into practice?  A lot of people have--they've come out of poor environments where there's been low self-esteem and they don't want to get into anything where their self-esteem is going to be challenged.  I think you have to have a lot of ego strength to be a family doc.  So I tell them, you know, seems to me, you know, your ego--you may need to be a cardiologist.  Like this one kid that's going to go to Mass. General to do his internship.  Very bright, I think he just needed that support of, not only going into internal medicine, he's got to go to Mass. General.  And I says, okay, I applauded him and said that's the way to go, I think, do that.  Now you may be out and be able to do primary care, we'll see, come talk to me in 3 years.  I doubt it, because they'll turn him into--they'll tell him how inferior he is and make him a gastroenterologist or something. But there are people that need that.  So if I see people got ego strength, I look at where--many times, you know, what their parents were, teachers, nurses docs--doesn't matter, really, I don't think one thing (??) the other, but how are we going to take those values and build on them?  And then, how does family medicine allow you to do that?  You know, what's your dream?  What's your practice going to look like?  Another trick I can use, I know I like to ask them if, you know--we put on your tombstone at your death, what would your patients say about you?\n\nQ.  What do you want them to say?\n\nA.  What do you want them to say?  That's a little bit of trickery, but it helps me see what they value, what do you want to be and how can you do that?  So--and then I sort of tell them about what family medicine's meant to me, you know, what does it allow me to--you know, I say I'm a teacher, I love to teach, and it means this to students.  And I can tell them some of the things with patients.  I tell them about sports medicine is special to me, and how I took a sports medicine fellowship 4 years ago.  Talk to them about burnout, I said, okay, how do I know I'm going to be happy, I says, I can guarantee you, if you're doing the same things 20 years from now that you're doing now, that you were doing the first day of practice, you will be burned out, you will be depressed, you're going to be an alcoholic.  Every 7 years you've got to do something different.  Nobody can be in the same place.  You don't have to change wives every 7 years, you don't have to change locations every--but you better change--\n\nQ.  How you're processing.\n\nA.  --what you're doing, something's different, you know.  So I got--I wrote a book on sports medicine a couple of years ago, you know, I tell them about that.  I took this fellowship, I do something different--I'm out at the high school--\n\nQ.  You actually went back to take the fellowship?\n\nA.  Yeah, but it was easy, though, it was easy because I was able to do it right at UNC during my sabbatical and so it wasn't hard, it wasn't a big change, but you can become a learner. \n\nQ.  Are there any other areas that--you know, we've talked about a lot of stuff, and I--this is kind of what I like to do is start way back and get into personal issues, but--\n\nA.  Sure.\n\n[tape ends]","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/156792/file/286747#t=0.0,3847.91844"}]}]}]}