{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/2j6833pr45/manifest","type":"Manifest","label":{"en":["Dr. Carolyn Lopez"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"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"]}},{"label":{"en":["Date"]},"value":{"en":["2007-07-02 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Lindsay Young (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","American Academy of Family Physicians","family physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Carolyn Lopez, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"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/2195/collection_resources/153069/file/281732","type":"Canvas","label":{"en":["Media File 1 of 3 - Lopez_Carolyn_Pt1_07_a.wav"]},"duration":3756.0206,"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/2195/collection_resources/153069/file/281732/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281732/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/281/732/original/Lopez_Carolyn_Pt1_07_a.wav?1752094222","type":"Audio","format":"audio/wav","duration":3756.0206,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281732","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281732/transcript/81622","type":"AnnotationPage","label":{"en":["Dr. Carolyn Lopez interview transcript  [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281732/transcript/81622/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Tape One, Side A of the oral history with Dr. Carolyn Lopez by Lindsay Young. Are you alright with me recording this over the telephone?   \n\nYes, I am.\n\nLet’s just start with some general, biographical data. Can you please give your name in full? \n\nMy name is Carolyn Catherine Lopez.\n\nWhat’s your present title? \n\nRight now I’m in between jobs, although technically I suppose…this is a side story in itself but I am currently unemployed but I still hold the medical staff appointment of Chair of the Department of Family and Community Medicine for Stroger Hospital in Chicago.\n\nWould you like to talk a little bit about what jobs you’re in between or do you want to get into that later? \n\nWhy don’t we get into that later and just continue with the biographical because we’ll just go off on a little tangent if we do that.\n\nWhen and where were you born? \n\nI was born here in Chicago on October 13, 1951.  \n\nWhat were your parents’ names? \n\nMy father’s name was Joseph. He also had the middle initial C, Lopez. My mother was Angela and her maiden name was Silva.\n\nWhat did your family do for a living? \n\nDad was a postal clerk. He worked for the Post Office for many years but did not do the actual mail delivery, he worked in the office as a clerk. He also did a lot of part-time jobs too. As long as I remember him, he always had a part-time job.\n\nHave you ever been married? \n\nI have not.\n\nDo you have any children? \n\nI do not.\n\nWhere did you grow up? \n\nI spent my entire life here in Chicago. My education, as well as everything has been here in Chicago.\n\nDo you have any kind of stories you’d like to share from your childhood? \n\nOh my goodness. Well, I was thinking about this and there’s a couple but probably not. Some may come out a little bit. The only thing, I guess I would say is, I liked to read. I always liked to read. Growing up I was a bit of a tomboy.\n\nDid you have any role models when you were younger? \n\nYes. I was very fortunate in having a family physician. In fact, she was the one who had delivered me. If I had any story, it really isn’t so much about growing up, I think it speaks to the family medicine part of this in that when I was about to be born, at that time my parents lived around the corner from our doctor’s office. It was October and dad was busy with our older brother who was about four at the time. It was a Saturday. He was listening to a football game on the radio. Mom told him she was going out and of course only my dad would be so oblivious to his surroundings that he would just say fine. She went over to the doctor’s office and the doctor said, “Baby’s going to be born right now.” Mom said, “Get me to the hospital.” The doctor said, “Think of the presents, think of the publicity.” Mom said, “I am, get me to the hospital.” So the doctor is the one who drove Mom to the hospital and of course, me being me, I wasn’t born for another two hours. It may be in part because of that, the doctor showing up with my mom and just because of the care that she took of Mom. The doctor had just changed her hospital affiliation so this was a new hospital and not everybody knew her well so some of the nurses in the labor and delivery area thought that she was my grandmother. That got straightened out quickly. And there I came. That doctor I would have to say was my role model.\n\nDid you personally have any special dreams or goals when you were young? \n\nAt first, I think this was a vague sort of thing, of just wanting to make a difference. That was just sort of it.\n\nTo move onto education, where did you go to high school and what were your early years in school like? \n\nI went to a Catholic girls’ school here in Chicago that now, no longer exists. It was called Madonna High School. It was interesting. I was a teenager. It was a fascinating time in a lot of ways, just kind of growing up. Being in an environment where you could just sort of express yourself and be yourself. That was cool.\n\nWhere did you complete your undergraduate work? \n\nI did my undergraduate work at Loyola University here in Chicago. By that time I had decided I wanted to be a doctor when I was about ten. Everything I did after that was sort of focused on that. I even took Latin in high school because I thought that’s what one should do if one wanted to be a doctor. I was a pre-med, majoring in Biology when I was in college.  \n\nDid the Latin pay off? \n\nIn some ways it did. In a lot of ways it did, I guess but perhaps not in the way I thought it might. As a kid, I also had this rather curious concept that I would do Latin in high school and Greek in college. Trust me, I didn’t do Greek in college. In some ways, because Latin is not only a root language for a lot of medical terms, as is Greek, but for a lot of English terms as well. It’s helped me in a variety of different ways, some that I didn’t anticipate.\n\nDo you have any stories from your undergraduate years you’d like to share? \n\nFunny stories. When I was in high school I had taken a course…I was in honors classes and mostly I did non-offered stuff. I took a course in typing and personal notehand, which was a kind of shorthand. It wasn’t business shorthand but it was just this side of it. I did it thinking this could help me taking notes in college. What I found myself doing, which was okay, wasn’t so much taking notes but taking dictation. But I stuck with that, for most, if not all of my college time. There was one class, again, as a Biology major, I took a class in cell biology. It was just brutal. It was a really, really tough class. The following year, a fellow that I was going out with was taking the same class, he was also pre-med. He was taking the same class so he asked if he could borrow my notes. My notes were virtually dictation. So he would go into class with my notes in front of him and all he would do is…sometimes he wouldn’t even have a pencil with him, he would just look at my notes and turn the page and occasionally he might write a little addendum in my notes. This was mostly dictation that I’d taken. Apparently the professor, who again, he was kind of a real stinker, it must have been getting on his nerves, I wish I had been there to see it but one day he just changed his lecture. Apparently Bob, who was the name of the fellow I was going with, he was starting to get nervous and flipping pages back-and-forth wondering where his things had been left off. Finally he was forced to take his own notes. But yes, that was one.\n\nYou’ve already talked about wanting to be a doctor from an early age. Did you know you wanted to go into family medicine? Or what made you decide that? \n\nIt’s an interesting question because the short answer is no, even having had a family doc for my role model, my high school yearbook says that I wanted to be a pediatrician. How I wound up with my selection of family medicine was more towards the position of…from the experience of how I approached my clinical clerkship and I will share this with medical students because I think it wasn’t actually a bad idea. Even though I thought I wanted to be a pediatrician, I approached each clinical clerkship as if that was what I wanted to specialize in and as if I wouldn’t ever again have another chance to learn anything about whatever it was. So the end of it all was that I had worked extremely hard, had gotten really good grades but I learned a lot about what I liked and what I didn’t like and what I wanted and what I didn’t want. What I realized was that I really did like dealing with kids but the thought of chasing 30 screaming children every day for the rest of my career kind of left me cold. I really did like dealing with adults but the thought of only dealing with adults, again, really left me cold. I liked surgery but I liked talking to people more than having them not…I liked the sewing part of surgery, more the minor stuff, lumps and bumps kinds of things. I liked psychiatry but the kind of psychiatry I liked wasn’t the kind that most psychiatrists have to deal with. I like dealing with people who were probably about as nuts as most of my family and my extended family. Most of them would never be caught dead in a psychiatrist’s office and they weren’t loony enough to be there. What I realized is that I liked the variety and I liked the challenge of unlocking the mystery. That really was what led me to the decision that I wanted to be a family doctor. We didn’t have clerkships… they existed, you could make a selection of a clerkship at the time but to have required clerkships or anything of that sort, that was a later phenomenon. It wasn’t because of any exposure of that sort that I could say that was what convinced me.\n\nWhere did you go to medical school? \n\nI went to medical school at the University of Illinois in Chicago.  \n\nCan you describe your early years of medical school training and share any stories that you want, of those years? \n\nMedical school was really, in many ways, a culture shock and its own interesting challenge. It was an extremely intense time. I think I decided some time in my second year that there was something wrong with medical education and somebody ought to do something about it. It was a difficult time and it was a time when I saw a lot of friends of mine struggle a lot with medical school and with getting through medical school. That wasn’t the only reason that I thought there was a problem with medical education but it was certainly among the reasons that I was convinced of a problem. It was certainly one that opened me up to a lot of different experiences. In some ways, I think I had led a very sheltered, perhaps, that may be overstating it a little bit, but I’d certainly been in a very defined and not expansive environment up until medical school, even college. In part, because I had been a product of the Catholic school system here in Chicago so grade school, high school, college. It wasn’t a completely homogenous experience, there were other ethnicities, there were other races and interacted in that way. In terms of a much more secular approach to education, to thinking, the whole schtick. That really didn’t happen for me until medical school. It was an important experience for me in order to get a different viewpoint of the world. Those were interesting times. From the first year where you have…the anatomy lab was up on the top floor of the building and at that time the building still had elevators that had an operator running them. The operator was notorious for not wanting to take the first-years up to the anatomy lab because your clothes would smell. From having to deal with things like that, just the host of experiences was really something.  \n\nIt was a huge class and that was another thing that I really was not accustomed to but there were…in high school there were 300 people in my entire class so our individual class sizes, again, I was in the honors business, that was all very small. And college, Loyola wasn’t a small school but it wasn’t huge either. You’d be in a big lecture hall and you’d have maybe 100 people in it. In medical school, you’re in a mega classroom because the University of Illinois always had a huge class size and that was an introduction to a concept that I hadn’t experienced before. Co-op notes where there was an expectation that people would be going to every class. I didn’t know how else one could function but every class. The sign up for co-op notes was kind of a new experience for me. Especially the end of the first year, some of the shenanigans, if you will and just a whole different kind of experience, people coming to class. One guy in our class did bird calls. If the lecture was particularly boring, suddenly there would be bird calls. Again, a different sort of experience.\n\nDid you pursue any further education after that? \n\nI did because I started doing it while I was in medical school and it was fascinating. I took time to do coursework over at the School of Public Health and my area of concentration was health resources management, which in some ways, was very consistent with how my career later evolved in terms of managing health resources. But one of the courses that I took during that time, it was one of those things where you think, my goodness, it all came together. It couldn’t have been planned because it was the only time this course was offered. They were trying to cover two things, death and dying and alternative approaches to healing. Because you couldn’t exactly do both of these really justice, in the course of one semester, the lectures were spent on the death and dying piece and the alternative approaches to healing were left more for independent study and papers and such like that. It gave me a chance to do things. One, it really introduced me to the work of the list of [Elisabeth] Kübler-Ross. Her work had not been out for that long when I had started taking the course. Then just learning about different things that I think we’re seeing a lot now in healthcare with people looking to other options, whether it’s acupuncture, whether it’s herbal things, but just getting some, at least awareness that those other things are out there and people were talking about even then. That was fascinating, it was time well spent from my perspective.\n\nWhere did you go on to do residency? \n\nMy residency was with the Rush Christ Family Medicine Residency Program. Rush, at that time had an academic affiliation with Christ Hospital, which is a large tertiary institution in the south suburbs. It was [   ] to have a family practice residency that had been a free-standing but we were going to be the first class that would be actually Rush residents, not just Christ Hospital residents. It was really taking it up a peg and it [   ] to be medical college rigor, I guess, what was a sound, clinical experience and clinical training. So that was where I set off and I did okay.\n\nDid you have any specific stories you’d like to share about that? \n\nAgain, there are a number. One, I was named Intern of the Year and it was supposed to have been a surprise. Somebody squealed, I don’t remember who it was. Then the other story, more towards the end of our training, a colleague of ours…I have several stories involving her but she had had a patient who was an alcoholic. This particular patient had this uncanny ability to call after hours asking for her doctor when her doctor wasn’t on call. It was, of course, the things that were completely inappropriate for an after-hours call. One guy got awakened in the middle of the night with a call from a woman who was obviously drunk and asking for help with Social Security. There were all sorts of wacky things. It got to the point where the hospital…we would take a family medicine call in the hospital at that time and the hospital operator recognized the woman’s voice. She would call you up and she’d apologize. She had no choice, she had to put the call through. Because everybody knew her, this really got to be sort of the talk of the class and so when we were finishing up, one of my colleagues who played the guitar, he and I got together and we put together a rhythm and blues song about this whole experience and it was quite a snappy little tune if I say so myself. We had everybody clapping at the party. It was certainly an educational thing for everybody.  \n\nI’m assuming you don’t want to sing a few bars for us.\n\nIt was “The DT Blues” and it was a long time ago.\n\nWhat was the world of medicine and then family medicine, specifically like when you were finished with your residency? \n\nIt was an interesting, interesting time because I had finished residency in 1981 and what had been happening in medicine in the years immediately preceding that was the passage of the managed care laws and the further development and evolution of that. Rush had started the medical college that was my training program, had started a staff model managed care program. They did this really thinking in terms of saving money, as I understood it, on their employee health insurance. Again, it was this new concept that people were very unfamiliar with and the staff model concept in particular, was a wild and crazy thing. My department chairman was involved in that. He was a senior administrator in that program. At that time, doctors who were involved in managed care, who were involved in staff models because Rush didn’t have the only staff model in town, Michael Reese (?) had done the same thing. My God, they were called everything but a child of God. It was a time when they were Communists, they were this, they were that, they were awful. My first position after residency was actually with something else. It was a cut-your-teeth management kind of thing. After about a year, again, my department chairman talked to me and said, I’d really like you to join the staff model HMO and be the office medical director out at our office in Oak Brook. What did I know? So I said okay. It was really then that I got the full force of what happened to be just an enormous amount of change. That was 1982. In the early to mid ‘80s you saw a lot of things happening. You saw the DRG, the Diagnosis Related Groups, being developed. The focus on cost savings, trying to save money because the expense of healthcare was just…even though they had tried to respond in the ‘70s with the managed care legislation, it was still coming up again only this time, because the original managed care companies were staff models, it started, because of the number of them and the cut into business that it created, it caused a real furor in the medical community as well as in the insurance community. In addition to having people think you were Communists, then you had the other people who were really quite unethical, in my opinion. I didn’t hear this myself but people who I know and trusted heard this, heard a doctor in a doctor’s lounge in a hospital somewhere say something to the effect of, “I give my managed care patients second-class care because they only pay second-class fees” or something like that. Really outrageous things like that. Physicians who weren’t involved in managed care and now you’re going to get a certain managed care bias out of me, who weren’t involved in staff models, who were more traditional fee-for-service and insurance companies, I think together, misunderstood what staff model managed care companies did and how they did it. What they saw was the discounted fees and so that’s what they thought it was about. In fact, when it’s done well, yes, there’s discounted fees but it’s also about actually managing care. What happened with the entrée, more of the traditional insurance companies into the so-called HMO market, that entrée was just managing money, it wasn’t about managing care so much. Yes, they would do utilization management but the focus was really on saving money, not how can we take better care of this patient and save some money too? That was really, at least in my experience, the mindset of the staff model HMOs at the time.  \n\nSo that was what was going on. In the mid ‘80s, that was when they started in order to accommodate this stuff, creating the concept of network models managed care organizations and the whole alphabet soup with the creation of the Independent Practice Associations or IPAs and then you had your Preferred Provider Organizations or your PPOs and then you had your Physician Hospital Organizations or your PHOs and those were all developed as a mechanism to provide an entrée into the so-called managed care market. Again, focused on the discounting of fees. That’s how that all…it was living through all of that, really fascinating.\n\nYou said that you had a different first position briefly when you came out of medical school. What was that? \n\nWhen I came out of residency. I was the Wholistic Health Center of Oak Lawn and that was wholistic with a W. There’s wholistic with a W and holistic with an H. The wholistic with a W really added another dimension to the healthcare model by adding the spiritual dimension and so the concept was, yes, considering alternative approaches, whether you’re talking about non-pharmaceuticals or what have you, but also introducing the concept of spiritual. Part of our office team included a pastoral counselor so again, that was an interesting little side adventure.\n\nHow did you come across that position? \n\nAgain, that was something that had been started by the hospital. The Christ Hospital at that time was operated by a religious organization, although not a Catholic one. One of their local ministers had actually started this wholistic movement and they had invested in it by creating this clinic that was attached to the hospital. It had just started, they had one physician but they felt they need to make a change. I was finishing up my residency at that time so they offered me the opportunity to go there and I did and it was fine.\n\nWhat other positions have you held throughout your career and what duties went along with each of those positions? \n\nThe managed care thing, I stayed with the staff model from 1982 until about 1986 so that was about four years. It was actually through the end of 1986. In that time I went from managing just in my office in Oak Brook…as the managed care organization expanded they were adding offices and felt they needed to put another layer of clinical management in, so created the position of a Regional Medical Director where you have a medical director who would be responsible for managing multiple offices in a given area. I moved up to that and then I had one of the most…when I felt it was time to leave that, I wound up almost serendipitously in one of the more fascinating jobs I ever had. That was Medical Director of the Parks District in Chicago. At the time I didn’t even know that the park district had a medical director, as a lifelong resident. But it was really a fascinating position. At the same time that I was doing that, now with all these positions I have always had a hand in academic medicine in some way, shape or form. It was about the same time that I was getting into the park district that I also had an opportunity…that was pretty much, not completely, but pretty much a part-time job. Maybe a half-time, three-quarters kind of job. I had an opportunity at that time because my department chair was also changing his roles and I’m trying to remember at what point he became Vice Dean of the medical college. In any event, while I was working with the Park District, I had a chance to become Assistant Dean for the pre-clinical curriculum over at Rush. I did that along with the Park District thing for several years, for about three years and then I left both of those things around ’91, summer of ’91.  \n\nI left both of those things to go back to the managed care piece but this time not with staff models but with the network model HMO so the thing that I had seen kind of develop as a reactionary that I actually went back to take over, like about six, seven years after it had had some growth time so I was doing that and by that time and this was another program of Rush. Rush had started with a staff model HMO and then added this network model HMO. As they were adding other products they actually evolved into something called Rush Health Plan. Then a decision was made to merge Rush Health Plan with Prudential managed care health piece in Chicago and it became Rush-Prudential Health Plan and I was the first Chief Medical Officer for Rush-Prudential. This all happened relatively quickly.  \n\nI wound up leaving that in the spring of 1995 then began my search for my next great job. What was kind of interesting about that…life has certainly been fascinating, some wonderful coincidences. Not only was I always involved in academic medicine during this time but I also had been very involved in the Academy. I had been President of the Illinois Academy of Family Physicians, started getting involved in the AAFP and at about the time that I was going to be leaving Rush-Prudential and didn’t have a job yet, the Academy, completely separate track, had decided to start their Fundamentals in Management course and I was recommended to be the director of that course. They contacted me and lo and behold, how I really spent, not all, of course, but some of my time during that hiatus, was working on the FOM, Fundamentals of Management. That was a really enjoyable piece to it. There are a lot of reasons why it was a very tough time in my life but this was really, and much because of the work stuff, this was good. It gave me something to focus on while I was also looking for other positions. It was nice because it turned out so well. I’m very proud of the investment in time that I made and what came of it afterwards.  \n\nThen I went to work for the County of Cook as the Chairman of the Department of Family Medicine at Cook County Hospital. That’s the position I had until a couple months ago.\n\nWhat did you do in that position? \n\nIn that position, I chaired, again, the department and really did a couple of things during that time period. One, when I got there, none of the attendings in the department were doing deliveries for a lot of complex reasons. The County had been losing deliveries and were starting to defer to our training program. Prior to the time I had got there, some people in the department had done a study of where the patients were going and so we had a concept of where in fact they were going and approached the leadership about getting permission to get privileges of at least one of the hospitals that our patients were going so that we could offer our patients an option and it was up to us to start building happy attendings. Bring in new attendings, retrain whoever needed to be retrained and was willing to be retrained and get people up and going because it was going to be up to the attendings. This was going to be in essence, an attending practice that we would be able to train our residents at. By the time I left, a little over half of the attendings were doing deliveries. Very busy maternal care practices. It was very successful and very successful for the County although they never took advantage of it. Very successful to the County. It got to the point where very early on we were asked to…the deliveries that we were doing were all coming from one of our family practice centers. That was fine, it was going so well that when the County opened a new clinic not that far from that particular site, even though it wasn’t going to be a training site, it was going to be a regular patient care clinic that the county ran, we were asked to take on the deliveries from that clinic as well, which we did. We did because it would provide some additional delivery experience for the residents. Then they added another clinic. They had started another clinic too far from this one to end up at the same hospital but again, looking at the success of the family practice model, they asked us to continue and set up a delivery group with this new clinic, with a different clinic, a third clinic, at a new hospital. At the time that I left, there were three clinics being served at three different hospitals if you count our main hospital, our tertiary hospital, there were some deliveries there and they were all by family medicine. At the same time that we were doing that, unfortunately but understandably if you’re willing to think about it, the deliveries at the County were still going down. At our top, we had combined deliveries from all three clinics at both hospitals, family medicine was involved in over 600 deliveries and this was at a time that the total number of deliveries being done at the County was less than 1,000 and so we were doing two-thirds of the volume with fewer people. So it was really something that was being looked at and people paid attention to. Again, the County didn’t, unfortunately, for reasons, I understand them a little bit more now but I don’t understand them, they failed to take advantage of it. That is unfortunate. Anyway, that was that.\n\nThe other thing we did was just look at how we were serving or not serving our patients. Asking the question, again, the County had structured its clinic hours, for the most part, along historical patterns, meaning you’re open Monday through Friday, 9:00 to 5:00 and that’s that. At one of the clinics that we ran and this long preceded me, it was clearly focused on what the community needs were so they were open two evenings a week, which was a novel thing for the County. I introduced a further novelty and that was the concept of Saturday hours and again, in looking at what it is we’re supposed to be doing, that clearly was something that was an essential piece for a working class community. That was another thing that I look back on and say, I’m glad we did it.\n\nThroughout your career, what unique challenges did you personally face? What barriers or obstacles did you come across? \n\nI think there were different things in the different positions because I clearly had a lot of different positions. The barriers and challenges were quite different in each one. I think in terms of the one that simply could not be overcome, that was…I have to be careful how I say this. It’s an older situation and again, I do have to be thoughtful about this. Again, going back to what I see as misunderstandings about what is managed care and what is the value of a staff model, I think having to address the issues of a staff model and recognize…a staff model HMO and how it’s different. The real value of a staff model HMO is not having physicians who will just do what you tell them to do because you’ll never have physicians who will just do what you tell them to do. It’s in how you look at and how you organize your thinking around taking care of patients. It’s the whole concept of quality utilization and they really aren’t…a lot of times things are set up as if they’re competing and in fact, they should be natural partners, quality and utilization management. Good quality to me, is making sure people get what they need and in the amount that they need. That’s good utilization too because if you scrimp too far back on utilization you’re going to end up with lousy quality and in the final analysis, that’s going to hurt your finances. Those are problems that I think were tough to overcome but not just for anything that I say that I think were issues that were really part and parcel for what happened to managed care in general. Managed care – I haven’t seen Sicko yet but what I’ve heard about Sicko and some of the problems that were outlined are things that I heard a long time ago about managed care. In some respects, managed care did it to themselves. They made foolish, foolish decisions by not putting the patient’s welfare first. In defense, there were also a lot of things going on at the time that again, if you step back from it, it wasn’t putting the patient’s welfare first if you have a broad concept of the patient’s welfare. Managed care got it in the teeth for it. The one example that I’m thinking of, managed care is an industry for a period of time and I don’t know how long a period of time it was but it wasn’t that long. Took a stand against paying for bone marrow transplants for women who had Stage 4 breast cancer. The theory behind the treatment was, you would do this and you’d do the harvesting of the bone marrow and you’d completely destroy the cancer and then because you had also destroyed the bone marrow, you’d have this bone marrow to put back. Managed care had stood against paying for it, it was a very expensive treatment and they stood against paying for it because it was unproven. There was no evidence to support it. There was no evidence to support that it had any significant effect. How long did it extend somebody’s life? What was the quality of life that people experienced? But they got sued and they lost. When you step back on it, they were ultimately proved right. When the studies finally came in, there was insubstantial time added to the lives of these patients and horrific morbidity. You don’t hear so much about that treatment plan anymore because there’s no evidence to support it. I think that’s an example where managed care lost and got a black eye in doing it. They were doing the right thing, they were even doing the right thing for the right reasons but because they had already gone down an unfortunate road in terms of too often looking like they were making decisions more for the benefit of the plan than for the benefit of the patient, they lost. They lost those battles. I think in the final analysis, we always lose if we don’t begin with what’s in the best interest of the patient really? So that’s some of the stuff.  \n\nIn terms of other barriers and obstacles, again, another one I couldn’t win and it’s an archaic concept and I will say this point blank. It’s one of the reasons why I’m unemployed today. There is somebody in charge of the Bureau of Health for the County with what I think, an archaic notion about family medicine. He will tell you and he will say it in all sincerity, he believes this, that he loves family medicine. He thinks family medicine is the greatest thing since toast. His mother is a family physician. But you see, family medicine doesn’t belong in a tertiary institution and because of that, even though my department was successful at the County for over 35 years and even though the patients that we serve don’t know tertiary from the man in the moon, they just saw the County as their hospital. We didn’t belong there and they moved us out. He severed relationships because they made us close our Kansas (?) clinic, severed doctor/patient relationships that had gone…and he left bad. He’ll tell you even now he felt bad about it but I think it’s a very archaic and ill-informed concept and it’s one that I tried to fight against, I lost. It’s one that I think family medicine needs to continue to fight against. Those are the biggies.\n\nSide Two, Tape One of the oral history with Dr. Carolyn Lopez on July 2, 2007, recorded by Lindsay over the telephone. \n\nWe’ve just been discussing kind of the challenges you had to overcome. What sorts of things did you draw on for ideas and experiences? People or things or how did you come up with ways to address these challenges or other challenges or how did you learn what you needed to learn to do with your jobs? \n\nThere were a number of things. One of the things that I always did, again stick close, in many ways, to the Academy and to my colleagues and friends that I met from across the country. I would learn a lot, both from talking with them one-on-one as well as just by attending different conferences here and there. In addition to that, I mentioned that I love reading. I particularly enjoy reading both mysteries and historical novels. One of the things that I think is fascinating about reading historical novels, when we read and learn about history, mostly we’re just sort of getting a couple of facts here and there and we know how it came out. Whether we are happy or not with how it came out, we know how it came out. What happens when you’re actually going through some of these traumas or challenges, you don’t know. I think it’s interesting then to go and read certain types of books that are able to go into more depth and kind of flush out what was really going on and you get a feeling for the fact that it wasn’t always clear. When Lincoln gave the Gettysburg Address, he didn’t know that Gettysburg was going to be the turning point of the war and it was his job to continue to inspire and lead regardless of that. Same is true for whomever you want to talk about and so you kind of get at least some encouragement from that. The other thing that I think helps and I have attended management classes, as well as them being a participant in the management, the Fundamentals of Management, both as a teacher and eventually I gave it up but just kind of following that along and reading, not only what we were teaching but reading what other people were doing, people who had come to the class, getting some idea, you’re doing this and these people are doing that. It’s that engagement with other people. That was a lot.  \n\nI also learned, for myself at least, that I lead the best when I don’t surround myself with yes people. I was very fortunate in being able to find in each of these positions that I had, people that I could trust and rely on but who didn’t always see things exactly the same way I did. That, I think is crucial. Yes, you have to have people who are loyal to you but you have to have people who know what they’re doing. And if you have people who know what they’re doing and you can inspire loyalty among them, then I think you’re in the best of all worlds.\n\nOf the positions that you’ve held, which would you say you’ve enjoyed the most and why? \n\nIt’s hard to pick one. I’m going to give you two. One was the Park District job and that one because it was fun. It was the kind of job where I learned an awful lot, it was almost a vertical learning curve for me because it wasn’t just one thing, it was the ultimate in family medicine, it was many things. It was based on the responsibilities we have, it was like running a mini-public health department so it was about doing public health…food sanitation, water quality, it was about occupational health, it was about not so much emergency preparedness but preparation for mass events. From a per state perspective, we staffed the major events that the Park District sponsored. In some ways it even involved veterinarian health because the city of Chicago…they actually have two zoos. Lincoln Park Zoo that everybody knows about and then there’s another much smaller collection of animals in the far north side of the city. I learned the interrelationship of this. I was Park District Medical Director the year that we had this incredible drought in Chicago and the lagoons on the lakefront had dropped their water level. We had ducks dying. I learned about high speed botulism which only affects ducks, thank you very much. There was always something like that. It was a time of transformation for the park systems. That was another thing I was very excited about.\n\nThe other job that I really, really, really liked was the one I just left. I liked it for different reasons. It was much more of a clinical position in terms of…but still pretty expansive. It really got me to a place where I had wanted to be in terms of public health and providing care for people who need it. That’s really what the County has and had been all about so that was one of the reasons why I enjoyed it and remained committed to it and concerned about what’s happening to us.\n\nWhich would you say was the position you enjoyed the least? \n\nProbably the last managed care role that I had. That was probably because it was evolving to a type of managed care that I was less comfortable with because it wasn’t so much provider driven.\n\nOut of your positions, which do you think you accomplished the most in? \n\nI would have to say the last one, it was chairing the Department of Family Medicine with the County. That’s for a couple of different reasons. One, because we evolved the service levels in the way that we did, in terms of going back to the full scope of family medicine for the department as well as providing the Saturday hours. But in addition to that, because of the training program. You end up having an effect, not just on the people in your immediate service area but many more people through the kinds of people you train and the type of training that we do.\n\nYou’ve mentioned a couple times how you’ve been involved in education kind of throughout. What ways have you been involved in education and what has your experience been like that way? \n\nWhen I first finished my own training, I had an appointment to the Rush Medical College and I was involved in various ways, mostly minor but I do occasional student teaching and education of that sort. I maintained my appointment even when I was in the managed care thing. My stint with the Dean’s office was an interesting one, as much because it was with the pre-clinical piece of the educational programs as anything else. It was a different look at what you were doing. Also, at that time, Rush also had an alternative curriculum that was problem-oriented and I was active in teaching that and enjoyed that a great deal because it was fun. One of the things that I always struggled with in my own medical education was your first two years you’d be learning a lot of facts and you didn’t have anything to hang it on. What the problem-based curriculum provided was the connection. It was okay, yes, you’re learning the Krebs cycle but this is why you’re doing it. It was just easier to learn, from my perspective and easier to teach and just a lot more fun.\n\nThen of course much more involved in teaching during the last eleven years with the department because we did teaching, not only of the residents but of medical students as well. Those were always fun. Not always easy, sometimes very, very challenging but always gratifying.\n\nAnything else about your involvement in education you’d like to talk about before we move on? \n\nAgain, whether it was true that the flirting with problem-based education to now people are continuing to look at medical education saying, okay, what is it really you ought to be doing with it? How ought we be doing it? I think it’s very healthy for those kinds of questions to continue to be asked as we’re looking at expanding your work force to look beyond and say, not just the numbers but what is it that we are trying to produce? I think those are vital questions that haven’t been answered yet. Maybe not so much in the what but in the how. How do you get to the kind of person that you’re trying to get to? That remains to be worked out by the generation that’s up and coming now.\n\nYou’ve received numerous honors and awards over the years, starting out as Resident of the Year and Chief Resident and then being included as one of the 100 Most Influential Women in Chicago, a Local Legend, an Hispanic Hero, a Technology All-Star. Been named a Fellow at the Institute of Medicine in Chicago, received the US Public Health Service Primary Care Policy Fellowship, received various awards of recognition and been listed in the Who’s Who of Emerging Leaders since 1991 and the Who’s Who in the Midwest since 1990. That’s quite a long list of accomplishments. How do you feel, just to accomplish so much? \n\nI’ll tell you what’s interesting about it and I guess I learned this trick from the beginning. The whole process of medical education is a daunting one, especially when you decide that you’re going to do this when you’re ten. I look up every now and then and I see all this stuff and I say, oh, actually I guess I’ve done pretty good. It wasn’t anything at all that I was paying attention to as I was going for all this stuff, you just keep working at it. As you look up, you see this stuff starting to come together. I’m really very honored to have been recognized, not only in the ways that I have but by the various organizations that I have. That’s been very, very gratifying.\n\nDo any of these honors kind of mean especially a lot to you? What’s the most…?\n\nThere’s an interesting question. It really is very hard to pick out just one. I guess if I had to do just one and there’s a method to this madness, I would say the IOMC, the Institute of Medicine of Chicago. The reason for that is that in some ways even now, it affords the bully pulpit, it allows for a convening of people who are very distinguished themselves and lend their weight to issues that matter. We’re starting to stick around now doing something with respect to the safety net here in Chicago. It’s not that it wouldn’t be possible without the IOMC I think it makes it even more so.  \n\nDo you have any kind of general or specific descriptions of how you’ve been able to achieve so much? I know you’re talking about going along doing it, not kind of aiming for certain things. \n\nThere are a couple of things that I would say. One, I was willing to take opportunities, which also meant taking some risks. The reality is, especially earlier on and these were calculated risks but they were risks nonetheless, there were positions that I accepted that carried some risk with them, whether it was the Park District position, leaping into the abyss when you didn’t even know the Park District had a Medical Director. That was a risk. So being able to do that, being willing and able to leave a comfort zone in order to take another position that might have some risk, recognizing that there might be, if not failure, at least not the measure of success that you thought you would have and do it anyway. Those were all things that I think that if I’d been unwilling or unable to do them, I’m not sure that I would have… it would have been very easy to stay stuck in one thing. I could have left my residency and instead of taking the one wholistic health center job, just going into practice with one of the senior docs, that would have been fine. It would have worked out completely okay and life would have been very, very different. It’s not that either one was right or wrong, it’s just that it was a willingness to take a risk made it easier to move to the next thing and to have another door open. The other thing that I can’t emphasize enough is the importance of the Academy in my life and the connection that it gave me, the opportunity, again, to interface with other people, some of whom thought similarly, some of whom thought quite differently and yet, we still had the commonality of being family doctors. Even at a time when I was less connected by virtue of not being very actively involved in practice, it still kept me connected to practicing physicians. I never felt like I was completely out of sync or at least unknowing of what was going on and the perspective of practicing physicians. That was all very important for me. \n\nWhat would you say is the toughest decision you’ve had to make, either in or about your career? \n\nThe toughest decision is that I’m sort of in the middle of right now. Just in a nutshell, what’s happening right now, the official term for what happened to me was that I was laid off. It would have been very easy for me to have simply said, I lost the fight, I’ll just move on. What I’ve opted to do instead and history will prove whether this is right or wrong and sometimes you don’t know if you’re persevering. There’s a quote that a lot of people failed when success was just around the corner and didn’t know it and stuck to it long enough or some words like that. There’s also the song, knowing when to leave may be the hardest thing anyone can learn. When are you pressing on to prove a point that’s an important point to prove and when are you just hanging on past the point where it makes any sense? So that’s sort of where I’m at right now. Where I’m at specifically and the reason I had this little thing at the beginning of this tape with what my title is, technically I’m unemployed because I have been laid off by the County but because of a quirk in the County structure, I still hold my medical staff appointment. My medical staff appointment is as Department Chair so I’m technically still Chair of the Department of Family Medicine. They have initiated formal proceedings. There’s a bylaws mechanism for removing a Chair. I received the final letter of resignation so in order for them to remove me from my position, since I didn’t resign, they’re having to go according to the bylaws to remove me. I’m appealing that and so we’re sort of in the middle of that appeal right now, where I’ve had my first hearing, I’m represented by an attorney. I think we made a good pitch. The current Bureau Chief wasn’t at the meeting and my appeal raised enough questions that they couldn’t act on the matter at that meeting without getting some additional answers to the questions that had been raised. Now I’m in the middle of trying to get the answers to the questions and figure things out from there with my attorney to see how we’re going to respond to that, what methods, what the issue is, etc., etc. I’m still sort of in the midst of it and in the meantime, because my appointments to the medical staff in the title of Chair, makes me a member of the executive medical staff. I’m continuing to go to those meetings and I know it’s making some people uncomfortable and I don’t care. I’m glad it’s making them uncomfortable. It’s a constant reminder to them of what they’ve done. It’s like people would like to forget and move on, not letting them forget that they’ve still got a problem. To the extent I can do this in a way that’s helpful to the department, I think is important and I think I am doing something. I have a suspicion that the Bureau Chief I hear, asked for a meeting with the department last week. He was trying to find a way to appease them, to make them happy because there was so much bad publicity. I have been busy talking to reporters. They’ve been calling me, I haven’t been calling them. They’ve called me, I’ve talked so I’ve talked a lot. I did a presentation on a panel and I talked a lot at that presentation and one of the commissioners was there. He asked for a copy of my slides, which I gave him. I suspect it may have been that that actually prompted this whole adventure with the department because I didn’t say anything that was untrue. I was saying what the issue was and what the consequences were for the department. Again, with the things that I do, what I’m hoping to do is to A, help the people that we’ve been trying to serve and help the department, help family medicine. I don’t know if people realize the significance of what happened to us in terms of what does it mean for family medicine? We have lost a department for no reason. It didn’t save any additional money to push out of the main hospital. It was just a pure power, political thing. I don’t know what that means for family medicine in urban Chicago, quite candidly. That’s one of the reasons why I’m digging in. So there you go.  \n\nHopefully that will come out for the best.\n\nI agree.\n\nIn general, what has your biggest satisfaction been from working in medicine? \n\nThere have been two things. One, I have had the pleasure of working with some extraordinary people, both in my immediate environment and again, with the people I’ve encountered in the Academy. These are such high quality people that I would not have had a chance to really engage with if it weren’t for being in medicine.\n\nThe other is being able to have an impact and being in medicine, you can have an impact in so many, many ways. Being a family doc you have an impact in so many ways. Being a leader in family medicine, it increases exponentially. Knowing that…one of the things when I was with the Park District that we were able to do, our administration was very environmentally-oriented so we did a survey, we did two surveys actually, that were environmentally-related. One was an asbestos survey and what it allowed us to do when that was completed was to know where in the park buildings, all of the park buildings and there are a lot of park buildings. Chicago has a very large park system, a lot of park buildings. Where was the asbestos? And that became part of the park system’s portfolio. They could go back to in, in other words. If they were going to do something at this particular fieldhouse, they already had something on the shelf that they could pull off and say, okay, this is what’s there, we need to handle it this way. The work that we did with the first aid with all the stuff. There were a number of other things and I bring this up only to say, I remember thinking at the time, what we did was going to have a positive effect for an incredibly large number of people, most of whom would be completely clueless as to the fact that they were in fact better off. But it didn’t matter they wouldn’t know, we would know that they were better and that it was better because of it. I think there’s a lot of satisfaction in that. And the kind of work that you do in medicine, I think especially in family medicine and in leadership in family medicine is that kind of thing.\n\nIf you’re looking back and if you were starting all over again, would you do anything differently and if so, what? \n\nI probably would not do anything differently. You have to assume that you would know and maybe that’s entirely true but you have to assume your knowledge base was the same. There are some things that I might have done but in terms of big decisions that I would have made, however it turned out, even the ones I would say didn’t turn out well, at the time I may have experienced it as not having turned out well but it led to other things that I can look at and say, you know, that was actually okay. So perhaps the issue is not in so much looking at what went wrong but when things did go wrong, what did you get out of it?\n\nWho are the people you’ve worked most closely with and what’s your impression of those people? \n\nAgain, there have been so many different types of people that I can speak to with that. I would say three come to mind and they’re very, very different people. One was my Department Chair. I don’t know if I worked really as closely with him as other people but he was so influential in so many different ways. He opened doors for me early on in my career. He was the one who really helped clue me into the management piece. I learned more about management from him than in any class that I ever took. It was Erich Brueschke, he was really, really terrific in that way. We would be polar opposites in terms of our politics but in terms of working with someone who had just a basic sense of fairness. He would do things, not because it was politically popular to do but because in his mind, it was the right thing to do. So that was I think an early professional thing.\n\nShe’d probably laugh to hear this. The general counsel when I worked with the Park District, the general counsel who I worked with there, I had an opportunity to work with her closely and in some ways she was really the first…I had friends in college who became attorneys but in terms of working closely with an attorney, because I didn’t work with them, she was the first one that I really worked closely with. We’re friends to this day. She again, was a very sincere and committed person, was part of the vision of making the transformation in the Park District and had a sense of the politics, a much better sense of the politics than I had. I had an understanding of the medical politics to some degree. She had just a better sense of the politics overall and knew how to get things done.  \n\nI think that my Associate Chair at the County, Janice Benson was another one who over the years I worked very, very closely with. The funny thing, I’m sure a lot of people at the County thought we were just good friends and we are good friends but the funny thing about it is that we’re really very, very different. We compared our Myers-Briggs one day and realized that we only shared one trait in common but in some respects that was one of the reasons why we worked so well together. Over the years, she would sometimes give me advice and over time I seemed to recognize that if I got real, real irritated with the advice that she was giving me, it really meant that I needed to do it. She was pointing out something that was important that I didn’t want to see. I don’t think I ever made a mistake in following the advice that she gave me. Again, this is the value of not surrounding yourself with people who think exactly like you. She was seeing something that I couldn’t see and as I said, there were probably times when I not only couldn’t see it but I didn’t want to see it. And I would sometimes get cranky about it but she had the guts to tell me anyway. Those are times that I really value. And she’s a person that I really value.\n\nThroughout your career did you have much travel? If so, do you have any travel stories you want to share? \n\nA lot of the travel that I did was with the Academy and that was certainly travel that I enjoyed. I shared some of these stories with my niece. She’ll sometimes look at me and say, “You’re very crafty” and I haven’t quite figured out how she means that but I think she means it as a compliment. But where she gets that, there was one travel story that I will share, just because in some ways, again, it’s interesting and I think it explains why Angela says I’m crafty.\n\nI was on the Executive Committee and we were meeting in Quebec City and the meeting was fine. When I had made my travel plans, because the part of the meeting that I needed to be at was going to be finished with on a Friday and I chaired the Medical Records Committee at the hospital so I had the illusion that if I left really early from Quebec City that given the time change, I could get back on time to chair this meeting. It was a noon meeting and so I made my plans to leave on the first plane out of Quebec City. I was flying through Toronto and I was flying Air Canada. This becomes important. Just go through, do what I need to do, get to the airport, get on the plane, the plane takes off. So far, nothing amiss as far as any of us know. Unbeknownst to us, on the plane, we were probably the first and one of the last planes to leave Quebec City because that was when they had the big, massive, mega power outage in the Northeast. By the time we landed in Toronto and there were no particular announcements on the plane as I recall, we landed in Toronto and I was expecting to get my luggage and change planes and to get back to Chicago. Things aren’t quite right at the airport in Toronto. You go to the gate where you’re supposed to be and you realize your flight’s cancelled and you realize that so many flights are cancelled and there’s this long line at the Air Canada service desk. It’s starting to not look good and little by little the story is coming out that there’s been this massive power outage. So I’m in line along with everybody else and you try different things. You get on the phone, they have these emergency phones and it’s busy, busy, busy, you finally get through and nobody can help you. You stand in line. While you’re in line you’re on your cell phone, nothing, nothing, nothing. At first, you’re automatically on this flight, they had rebooked. Okay.  So I thought, I’ll just go have breakfast. That didn’t work out. They cancelled that flight. Little by little, it was starting to show itself for what it is. I’m noticing that while nothing in Air Canada is flying, that United is getting some flights in and out so I thought well, hmmm, since Air Canada is a partner for United, perhaps I can call United. Got on the phone with United and the night person was telling me, well, it doesn’t look like…oh wait, a flight just opened. I can get you on a flight that’s leaving at such and such a time. I will take it. It turned out that as the story came out, the power had gone out across the entire Northeast of northeastern North America, apparently but Air Canada’s computers had gone out and they didn’t just go out in the northeast, they apparently just shut down and they couldn’t get them back on again. I don’t know if their backup failed, I don’t know what the deal was to this day but they couldn’t come back online so that’s why they weren’t flying. In the meantime, I’m sure there were many people in Chicago trying to get back to Toronto as there were in Toronto trying to get back to Chicago. So United would up running an unscheduled flight and that’s the one that I wound up on. It was an interesting travel experience. Again, you learn a little bit how to travel and so you learn how to get on the phone and try and press your luck and know that, well, there are always options.  \n\nSo you’ve been in Chicago your whole life, how has Chicago changed over the years? \n\nIt has gotten even prettier. The current Mayor Daley has really made a point of making Chicago a more livable city. So for that, it’s really been beautified. Things we sort of chuckled at, we now just appreciate. He was talking about putting flowers in the middle of Lakeshore Drive. Well everybody was chuckling about that but it actually happened and it looks quite nice. He’s done some great things with the public school system here but still has a ways to go but they’ve really done well. The downtown Chicago is a livable place. Chicago is a living city, it’s not a city where everybody sort of lives in the suburbs and commutes downtown and at the end of the day goes back to the suburbs. People live in the city, people live downtown. There’s been, even though the census doesn’t show it so much, there’s actually been a reverse migration. People moving back into the city and I think it’s because the city is a very livable place.\n\nWhat kind of advantages or challenges have come from working in Chicago? \n\nI think the advantages are several. One is that I’ve had a lot of different positions in my career, different types of positions even and different levels of positions and I could do it all in Chicago. I can get a flight to almost anywhere, certainly in the continental United States and have it be pretty much at the time that I want it and non-stop. From a travel perspective, there’s a lot of options.  \n\nDisadvantages, I guess in terms of the central location, commuting can be…even though it’s very livable and there’s a good public transportation system, I think the drive. I drive because I tend to run around a lot or need to be flexible during the day or I’m coming home late from work when I’m working. You don’t necessarily want to be waiting for a bus. So sometimes the commute can be annoying. Summer construction season can be annoying.\n\nYou were talking about how the Academy has played an important role in your career. How did you originally get involved with the Academy? \n\nI got involved in the American Academy because I had gotten involved in the Illinois Academy. How I had gotten involved in the Illinois Academy was kind of interesting because I wasn’t involved as a student, I didn’t really know that I could. Even if I did know, I didn’t have the time. I didn’t want to put my time to it. I felt my time needed to be focused on getting through school. My first year of residency, again, I was sort of oblivious and pretty much the same thing in my second year of residency. In my third year of residency, whenever it was, there was a meeting that I attended and it was a residents’ meeting. They were trying to find a delegate for the Illinois Chapter’s annual meeting. At that time, the Illinois Academy ran a Congress of Delegates with a committee/commission structure that kind of mirrored what the AAFP had at the time. I figured what the heck. It was one of these, Carolyn, you live in Chicago, do you mind? Sure, I’ll do it. So I went and I did it and it was fascinating. The Illinois Academy had had a certain pattern, a tradition. I don’t know if you’d call it that but what they sort of generally did, they had a nominating committee and the nominating committee would come up with a slate of candidates and there would be a call for nominations from the floor, it was an unopposed slate. While there might be a call for nominations, nobody would make a nomination from the floor. This year was different. Here there was a revolution and there were two nominees from the floor for the office of President-Elect. Suddenly it was exciting. It wasn’t this dry thing, there was this hubbub of revolt that was in the air. It seems to me like this is kind of an exciting thing. That was my first sort of intro to the Illinois Academy. Then I was tapped to be involved with something else on a special ad hoc group because they knew my name and then one thing led to another and I was on a commission. Then I was on the Board. It sort of evolved from there. The more I got involved in the Illinois Academy, the more I learned about the American Academy and so then it came time, well, let’s apply for a national committee/commission, so I did that and eventually got on the New Physicians Committee. Again, just a lot of things that sort of tripped after that. Just because you’re involved, [    ] makes sense, at least most of the time and people get to know you. That was it, that was how I got involved and it was always an experience where I felt like I got something out of it, whether it was enthusiasm, encouragement, affirmation, there was always something I got out of my involvement.\n\nWhat do you feel that the American Academy of Family Physicians is doing better nowadays than it did when you first got involved? \n\nI think they’re paying more attention to membership and member needs now. While I still think there may be a ways to go, I think that whole concept of the service membership, which I think was always there, is expanding to include groups that had been evolving and developing, subsets of family medicine that I think were not always readily addressed before. Coming from an organization, they’re starting as an organization that really we’re dealing with physicians in private practice and small practices, at that. There was a rapid evolution in healthcare that we just described and people in those arenas have different needs. I think they’re doing much better… they’ve always been open to input from others that are not necessarily mainstream and they’re incorporating it and I think they’re learning that it’s helping that, it’s keeping them a strong organization. And they’re doing better, much better politically in terms of where their politics are and should be and that’s in Washington, and advocacy for family medicine. The obvious is the technology piece but that gets to some of the membership. What are the real needs of the membership? And taking a leadership role in technology, which I think is an important thing.\n\nIs there anything you feel that the organization was doing better before compared to now? \n\nI think those things that I just mentioned are what they’re doing better, the political advocacy, certainly. Although they were always doing it, I think they’re doing it in a much more organized and effective way.  \n\nI think I phrased it the wrong way. Is there anything they used to do better than they’re doing now? \n\nThe short answer is yes but I think this is true of the state chapters as well as the national. My understanding of how many people got involved is that somebody they knew would bring them in and I don’t think we’re doing as good a job of that anymore. There’s a struggle with what’s the meaning of the Academy? What’s the value of the Academy? If people are employed and in group practices, what do they need the Academy for? I think some of the things are things that I’ve just described. Yes, I’ve gotten my education from the Academy and I still do educational courses from the Academy but certainly cannot be the Academy’s, nor is it, the Academy’s sole source for being with its membership. In order to communicate that effectively to people, to members, you really need to have that engagement come, not from…it gets to the question, who is the Academy? What do you think of?  Everybody who belongs to the organization, we’re the Academy. It’s up to us to say to those who follow us, this is a really nifty thing to be involved with, I encourage you to do it. So for example, when I was here, I would encourage, not only my faculty to be involved locally, as well as nationally, but I’d encourage our residents to get involved in the opportunities that they had locally, as well as nationally, if they had an opportunity to get involved nationally. I think we need to do a better job of that.\n\nTape Two, Side One of the oral history recorded with Dr. Carolyn Lopez on July 2, 2007 by Lindsay Young over the telephone. \n\nWe’ve just been talking about the American Academy of Family Physicians and other academies. You were the first woman and the first minority woman to be Speaker and Vice Speaker for the AAFP Congress of Delegates. How does it feel to have held those positions? \n\nI felt very privileged to have held those positions, period. The fact that I went in them, in essence, breaking a glass ceiling, I think just lends more gratification to having held those positions. From my perspective, the significance of it was not to be the first if it turned out to be the only, but rather to be the first and then be followed by others. So for Dr. Mabry, she’s Vice Speaker now, to me it’s significant because it just lends even more meaning to my having been the first.\n\nWhat sorts of things were accomplished during the years where you were kind of responsible for helping to guide the AAFP as Speaker and Vice Speaker? \n\nWe did a couple of things, both with Mike Fleming and with me. One was to really look at how the Congress was running and what could we do to make it run more effectively? I look at it compared to being just fresh from the AMA, I look at it compared to what happens there. I’m not well enough into the AMA process, nor am I sure that I want to be, to be able to do an analysis. However, I sat in a [AMA] reference committee a week ago Sunday and thought I was going to die. It was scheduled to last four or five bloody hours and it’s just too wearing. I don’t know that it accomplished that much. I certainly didn’t feel particularly enlightened and I was testifying at that reference committee but I really tried to keep my comments focused. I know that’s the way reference committees work sometimes is that if only a couple of people testify, they may make a different decision than if they hear a lot of people testifying so I’m not so much against a lot of people getting up, even if they’re in agreement but there were a couple of times where I just got up and said my name, that I was representing the AAFP and that we were in strong support of the resolution and then sit down. Just because you’ve gotten a three-minute limit to your testimony doesn’t mean you have to take all three minutes or more. I don’t think we were ever, not in my memory, we were ever at that point in the reference committee from the AAFP but I think we really looked at those reference committees, how we could help them be more effective. In one case that meant creating the Reference Committee on Special Issues, recognizing that we didn’t have a lot of bylaw things every year and instead of having a standardized reference committee on bylaws that wouldn’t have a whole lot of business, that we could have a reference committee on special issues, throw bylaws issues in there when there were bylaws issues if we needed to and use it to download other reference committees if they were getting a lot of stuff. It would vary from year to year, it’s the other thing you couldn’t always predict. Some years Public Health just had an enormous amount of material that they had to deal with, some years it was Education. It would be variable depending on what was happening and you couldn’t always know so this really gave us that flexibility of having the Reference Committee on Special Issues and I think that was very useful to deal with. That was one of the things that pops to mind. Now that was something that happened when I was Vice Speaker. Then moving that forward and continuing to promote and trying to solidify a culture where the business of the Congress needs to get done but it doesn’t have to get done in a way that is stilted. It should be orderly, doesn’t have to be rigid. So that was that.\n\nI also saw that you’re a member of the newly-formed Chicago Neighborhood Health Center governing board. How and when was that formed and what does it do? \n\nThat is an interesting little thing that I’m involved in. There is something called Federally Qualified Health Centers. These are entities that are designed to help care for underserved populations but they enjoy certain benefits, such as favorable reimbursement on Medicare and Medicaid, they also can get malpractice coverage from the Fed so they’re covered by the Federal Tort Act and that helps them in terms of their cost so that’s why they’re able to survive serving underserved people as opposed to just somebody going out and setting up a storefront clinic and having a lot of expenses and not a lot of income.  \n\nIn addition to those benefits, this is a roundabout way but it’ll make the explanation of the Chicago Neighborhood Health Center Board much easier. In addition to those benefits there are also certain requirements and one of the requirements is having a community board. There are certain mandated characteristics to the composition of the community board, from just having people who are consumers and a percentage of the board who are consumers, as opposed to just having a full…like the business community come in and making decisions, board level decisions on things that they know nothing about. The city of Chicago’s Department of Public Health has operated community clinics. Not many of them, about seven, and they’ve done this for a number of years. There is an ability to get something called look-alike status so when you are not a federally qualified health center and can’t necessarily meet all of the characteristics of a federally qualified health center but you can get close enough, you can be a look-alike, then you can enjoy at least some of the benefits, not all but at least some of the benefits of being an FQHC. The principal benefit is a more favorable reimbursement rate so obviously it’s something you kind of want to do if you can. The folks at the Department of Public Health decided that although it would be tricky, since they are a municipally-governed entity that it would be worth their while, financially, to try and get look-alike status. One of the things they needed to do in order to get look-alike status was to develop a community board and a community board that would meet the characteristics of an FQHC community board. That was why the Chicago Neighborhood Health Center Board was born. It served as the community board that allows the city of Chicago’s Health Department to have achieved look-alike status so that they can get the more favorable reimbursement for the care that’s provided. Obviously that helps in terms of the finances and supporting the care they’re giving.\n\nWhen was that born? \n\nWe’ve been on the Board now, I want to say it will be three years old this coming January, so about two and a half years old.\n\nI saw that you help support the future of family practice through significant gifts to the AAFP Foundation. Can you describe what the Joseph and Angela Lopez Fund, the Carmen Lopez Pollina Fund and the Margaret Perez Lopez Fund each support? \n\nSure. The Joseph and Angela Lopez Fund I named for my parents. It’s a fund at this point, looking for a purpose. Its original purpose had been to provide some support for a component of the Residency Repayment Program when that was an active program at the Foundation. It was really targeted to predominantly people working and who wanted to work in the inner city and with preference to applicants that came from Chicago. Now that the RRP as a program of the Foundation really doesn’t exist anymore, I’ll have to double check with Craig but I think we had the last payment due to the last resident who was given a grant under this so I think at this point that fund is just building its corpus and not really paying anything out. I have to redesignate where the funds should go with that.\n\nThe Carmen Lopez Pollina Fund is a fund that was named for my youngest sister. This is a fund that again, we made a strategic decision to allow to build a corpus on it. The intent of this fund though is quite different. One of the things that I think family physicians are positioned to be able to do is to help families who are facing catastrophic disease and end-of-life kinds of things. At some point this will fund the initiatives that are geared to helping family physicians either learn about, do a better job at, whatever. Again, working with their patients who are facing catastrophic illnesses and end-of-life issues.\n\nThe Margaret Perez Lopez Fund, I named in honor of the aunt who left me the money that I used to fund all this stuff anyway to begin with. I felt she should get something out of it. She had put me in her will. I have a vague recollection that my mother may have said something about that but she didn’t make a big deal about it and I didn’t think a whole lot about it and I had completely forgotten about it. She had put me in her will I think when I was in college, with the knowledge that I wanted to go to medical school. Her intent was that I would be able to use it to help fund my medical education so she passed on in the mid ‘90s, obviously long after I was out of medical school, out of training and my last student loan had long since been paid off so I really didn’t need this for that purpose. In thinking, she really didn’t give this money to me so that I could be rich, she gave this money to me so I could achieve my own dream of being a doctor and in my case, being a family doctor so in thinking about how I could keep that going, I thought one thing that I feel very strongly in and believe in supporting is the summer externship. With that externship, to be able to expose students to family docs, I thought would be something that really would be in keeping with the memory of Aunt Margaret. So that’s what those are all intended for.\n\nYou’re a member of the Chicago Board of Health and a Chair of the Regional Health Committee and a member of the Board of Governors at the Institute of Medicine of Chicago. Do you have any stories from those experiences you’d like to share? \n\nLet me get all this straightened out. I am now President of the Institute of Medicine of Chicago, as well as still a member of the Chicago Board of Health. Some of the IOMC things are still evolving and not the least of which is what I hope to be our role in support of Safety Net in Chicago. In that regard, I think the Board of Health stuff works as well. Probably nothing much more to add on those at this time.\n\nYou’re an influential member of the Illinois Academy of Family Physicians, which we kind of talked about a little bit earlier. The Delegate and the Speaker and the Chairman of the Board of Directors and again, the first woman and first minority position President. Do you have any stories about that organization or your involvement there you’d like to share? \n\nOh yes. It was when I was on the Board. Again, I make no pretense. I was politically extraordinarily naïve. Then I got to be a third-year Board member and not completely oblivious. At that time when you were a third-year Board member one is apt to be elected Chairman of the Board and so I thought, well, gee, maybe that’s something I would like to do, so I decided that gee, that is something I would like to do. I’m at the meeting and I’m realizing that one of my other third-year Board member colleagues is busy talking up people and I’m realizing what he’s doing, he’s also interested in being Chairman of the Board and that’s how he’s doing it, he’s talking to people. I realized, my God, I don’t even have anybody to nominate me. Undaunted, when it came time during the meeting, I nominated myself and a colleague seconded the nomination because it had to be seconded. It was a defeat. It was a resounding defeat because I hadn’t done what I needed to do. And I hadn’t done what I needed to do because I was unaware of what I needed to do. But what I decided at that moment was, so you lost, so you be gracious, you continue to support. It was Bruce Jenkins, I liked Bruce, I thought Bruce was a really neat guy and I lost, he won, fair and square. So I continued to be involved, continued to be supportive, to me that’s what you did. A few years later there was a moment to become an Alternate Delegate to the AAFP and Bruce was up for it in terms of seniority. It was his to take. He looked at me and said, you know what? You can go a lot further in the Academy than I can so you need to take this position. I leapfrogged him but it was at his initiation that I did that and it was because he had a vision that involved more than just him and his personal ambition. It was what could the Illinois Academy achieve in having somebody moving up and who is the best person able to do that? I will never, ever forget that.\n\nYou’re also involved in a variety of other medical organizations, including being Counselor to the Chicago Medical Society Council, a delegate to the AMA Young Physicians Section, and a member of the Society of Teachers of Family Medicine and the American Medical Women’s Association and the Royal Society of Medicine. Do you have any stories from your experience with any of those or any other organizations that you want to share? \n\nA couple. One, I reminded everybody last week because the occasion arose to remind everybody, I was actually the first AAFP representative to the AMA Young Physicians Section and I was a member of the New Physicians Committee at the time for the AAFP. Again, I remember vividly, I didn’t belong to the AMA at the time. We were talking amongst ourselves how this was now a new opportunity that’s opening up to us, this is great, the Young Physicians Section is now allowing specialty representation, we should go. Who wants to do it? I’ll ask Carolyn, you live in Chicago. That’ll save money. Oh, all right. So I joined the AMA. We must have made that decision at the summer meeting because the first AMA meeting that I had a chance to attend as a YPS delegate was the interim meeting. That year the interim meeting was in Dallas. Well, whoop de doo, Dallas. With all due respects to my friends in Texas, whoop de doo, Dallas. The next meeting, of course, was in Chicago and that was fine. The next interim meeting, however, was in Hawaii. It was great. I brought back chocolate-covered macadamia nuts. It was my first trip to Hawaii. The next meeting that we had of the New Physicians Committee, I shared the largess of the meeting and thanked them all and thanked the Lord for living in Chicago because that’s what got me into that one.\n\nBeing the Counselor to the Chicago Medical Society Counsel, oy, I can tell you that certainly in the years that I was involved with it, it was just everything I imagined an organization shouldn’t want to be and I remember an IAFP board meeting where I literally threw myself across the table and said, please don’t make me do this anymore, I can’t stand it. I hear that they’re evolved some, since then but it was something. You talk about a fish out of water. Every time I would go to a meeting and see an agenda item and I would think, well this makes sense, slam dunk. It would be defeated. It was like the antithesis of being progressive, that’s what was going on at the time. These folks just don’t even want to change. They need to change. That was frustration. But there you go.\n\nYou’ve also been involved in the AAFP Foundation as a member of the Board of Trustees and a member of the Board of Curators for the Center of the History of Family Medicine, where this oral history will actually be kept. Do you have any descriptions of that experience you’d like to share? \n\nI’m still on the Board. That’s been an interesting experience in that I think it’s been very interesting to see the Foundation evolve. I think there are just certain steps that organizations have to take and certain phases that organizations have to take and I think the Foundation has been moving very nicely into a maturing foundation that is really trying to look at what it is and what it does and how it can best fulfill it’s mission as a foundation so that’s been great. Same thing with the Center for the History of Family Medicine. I have just been so delighted with what Don Ivey has been able to bring to the Center in organization and in terms of professionalizing our approach to the collection and to our business as being what we are in essence, which is a museum. It’s still kind of a mini-museum but that’s what it is. Just oral histories being done for the Center so it’s more than just a museum, it’s a museum in what is hopefully a more modern sense, which is not just a place where people come but a resource that people can access through a variety of means, utilizing different technologies. I think those are just really dynamite approaches and experiences that I’m continuing to enjoy.\n\nOn the grander scheme of things, how has family medicine changed since you first became a family physician? \n\nI think family medicine, in many ways has gotten stronger, in some ways it’s fighting the same battles they were fighting when I was first coming into it. It’s stronger in the sense that there’s more of us, stronger in the sense of having a very active center, the Graham Center that is able to produce the kinds of studies and reports that we desperately need right now that are helping us make the case. It’s one thing when you go to somebody, a congressman, a businessman, whatever and say, we believe that family medicine is the right thing for America and for America’s health. It’s another thing when you can go and say that and here’s why and show them numbers. I think the whole move toward evidence-based practice and not just evidence-based practice although that’s very, very important but evidence-based practice that makes a difference for patients. People are starting to become aware that the FDA, as an example, approves things because they work but the question remains and is left too often unanswered, are they really what’s good for patients. Just because they work doesn’t mean that they are the right thing to use for patients. I think that we’ve been able to reasonably articulate what that distinction is and reasonably advocate for that distinction and in support of practicing in a way that makes a difference in people’s lives.\n\nWhat’s your sense of where family medicine is headed in the future? \n\nIt’s an interesting question. I think we’re in some ways at a crossroads. It’s frustrating knowing that we’re still, again, fighting the same battles that we were fighting 30 years ago. It’s frustrating to know that somebody in a position of power and influence can decide that family medicine doesn’t belong in a tertiary institution and act on it. I think those are the kinds of things that I find very troubling and worrisome. In and of itself, what meaning does it have? Well, I think it has more meaning locally than it does at this point, nationally. However, that doesn’t mean that some day it won’t happen nationally. We’ve often seen things that started at the County or were busy at the County long before they were adopted elsewhere so I don’t know what this means. That’s very troubling. On the other hand, there are some very exciting developments with the recognition that business is starting to acknowledge and embrace the role and the focal points of family medicine as the foundation of healthcare for the country. That’s an optimistic trend because I think even though fewer and fewer people are covered by employer-sponsored insurance, they still are viewed as big players. Even when they don’t, because I think the day will come when business becomes the smaller player still, in terms of providing health insurance for individuals, even when that day comes, because of their reliance on a healthy work force, I think they will still have a very powerful voice in how things transpire in healthcare. I’m optimistic because of events of that sort that look like we’re making some headway there. I get discouraged that within the house of medicine, have we really made any progress? Yeah, we’ve got more medical schools with departments of family medicine but really, really, really, have we made any progress? And for 40 years’ worth of a lifetime, where are we in the progress that we’ve made? We don’t have people coming into…in spite of having more medical schools covered with departments, we have fewer medical students choosing family medicine. I think there’s still challenges ahead.\n\nAre there any other views on important issues in the specialty that we haven’t addressed that you want to share before we…?\n\nI think this is a critical time in healthcare in general. The system that we have and other people and I have talked about this and agreed, we’re as close to collapse as we have ever been and I think that with this coming election and I’m talking about the presidential election in ’08, I think we may come out of this with something because healthcare is going to be a topic. There is no doubt about it. It’s too much on everybody’s mind and candidates are talking about it now. This is the time and I know the Academy is stepping up to it but this is the time when we really have to do a full court press with everybody. In some ways I suppose, while I think it’s worrisome to know that I don’t think, as I said, we’ve made much headway relative to our specialty colleagues and in academic centers, it may not be a battle that we want to invest a lot of energy right now, I don’t think we can afford to give it up but I think student interest will follow if it appears that that’s the direction things are going to go. For example, if we were successful enough politically to get a lifting of the cap on residency positions but only for primary care and we could aim toward something like that, if not only for primary care, at least have the majority going to primary care. I think that could be an influence in what happens in medical schools and in tertiary institutions like the County. I think those kinds of things, again, you need to be pushed politically but with the sound foundation that we’ve been able to provide in terms of evidence.  \n\nAs this seems to be where family medicine is going to be involved but just in general also, what’s your opinion of the state of healthcare in America and what would you think needs to be done to fix it? \n\nThe state of healthcare in America is really not good and it’s not good for a number of reasons. It’s not good because of the obvious, not everybody has insurance. It’s not good because I think we have not done…we’re so enamored of technology that we have paid insufficient attention to prevention and we’re only now really starting in a very organized way to focus on the topic of chronic disease management. So even people with insurance, I think we can legitimately ask a question, are they getting what they need? Going back to the managed care thing, are people getting what they need when they need it? I don’t think that’s always true right now, whether you have insurance or you don’t have insurance, are they getting too much or too little or just enough? I think people without health insurance are getting too little and people with health insurance are probably getting too little and too much. Every system, every organization is built to get exactly the results it produces and I think we have to rethink what we’re…everybody’s unhappy with healthcare but before we continue tweaking, which is what we’ve been doing. Sometimes they’ve been big tweaks, sometimes they’ve been smaller tweaks but that’s what we’ve been doing, we’ve been tweaking. Before we continue tweaking we need to think, what is it that we really want and then, build a healthcare system around that. Something that’s going to be more likely to get us that.\n\nYou’ve held various leadership positions throughout your career and you’ve spoken about the importance of not just surrounding yourself with yes men. Can you describe for us your style of leadership and your philosophy of management and how you developed that over the years? \n\nFor me, leadership and management isn’t about doing everything yourself. It’s about helping people achieve what they want to achieve. If you’ve got people who are all buying into a common set of goals and principles then helping them achieve what they want to achieve should be moving everybody towards the full achievement of our common goal. I believe in a participatory management. I feel I have a participatory management style. I believe in sharing information. I know some people, some managers who hang on to significant pieces of information. I have been told by people who should have known what their budget was because they were sort of left in charge, I have been told that their department chair didn’t leave that with anybody and they had no idea what was in it. Now one of two things was happening in that encounter. Either the people who were telling me those things were lying, or that department chair really was hanging onto information beyond the point of reason. And based on other information, I suspect it was the latter and not the former. I think that department was really hanging onto information, very controlling. And to me, that kind of controlling, rigid, protective, almost secretive approach is one that speaks to the insecurity of the leader and their own sense of inadequacy. That doesn’t mean that somebody with an open style always wins, as I do. Not that I always win but I have an open style. Or that somebody with a closed style always loses, at least in the short-term. What I do know and what I do believe is that in the battle of hearts and minds, there’s one style that is more likely to win than the other style. The more open style is more likely to win and in the long run, in the final analysis, when everything finally unfolds, I think the open style is more likely to have generated more positive than negative. Again, it’s not that the closed style is unable to achieve positive, it can, it’s like when you deliberately stunt the growth of something. Yes, it looks great but if it had been allowed to be more expansive it could be even better. So I think it misses an opportunity but it is what it is.\n\nDo you have any last thoughts you’d like to add? This is your opportunity to share your thoughts with future generations listening to this tape or to set the record straight on anything you feel might be important to address. \n\nI don’t know if there’s anything I need to set the record straight on. Perhaps there is but I won’t find out about it until after this paper is done and then I’ll have to just write something. In terms of future generations, I would say this. You have to keep doing what you believe is the right thing, that’s sounding like my parents now. If you know in your heart that it’s the right thing to do then that’s what you have to do. It doesn’t matter if you have everybody on your side or if you have nobody on your side. It doesn’t matter if it means a difference between staying in a job or losing a job, you have to do what you think is the right thing to do. Actually, as a very wise person once told me, you either have to stand for something or you stand for nothing. I would rather be known as somebody who stood for something. That isn’t always easy to do but you’ll live a happier and more satisfied life if you pull it off.\n\nDo you have any summary of what it is you stand for? \n\nProfessionally, I stand for providing optimal care for people regardless of who they are or what their resources are. I stand for trying to promote health and not just hearing or ameliorating disease and I think those are different. In life as well as in my professional arena, I stand for honesty, I stand for candor and persistence.  \n\nThank you.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281732#t=0.0,3756.0206"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281731","type":"Canvas","label":{"en":["Media File 2 of 3 - Lopez_Carolyn_Pt1_07_b.wav"]},"duration":3653.69754,"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/2195/collection_resources/153069/file/281731/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281731/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/281/731/original/Lopez_Carolyn_Pt1_07_b.wav?1752094220","type":"Audio","format":"audio/wav","duration":3653.69754,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281731","metadata":[]}]}],"annotations":[]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281730","type":"Canvas","label":{"en":["Media File 3 of 3 - Lopez_Carolyn_Pt2_07_a.wav"]},"duration":3112.03519,"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/2195/collection_resources/153069/file/281730/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281730/content/3/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/281/730/original/Lopez_Carolyn_Pt2_07_a.wav?1752094204","type":"Audio","format":"audio/wav","duration":3112.03519,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153069/file/281730","metadata":[]}]}],"annotations":[]}]}