{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/2z12n51b10/manifest","type":"Manifest","label":{"en":["Dr. John Frey"]},"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":["2023-03-27 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. John Saultz (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","Society of Teachers of Family Medicine","American Academy of Family Physicians"]}},{"label":{"en":["Subject"]},"value":{"en":["John Frey, 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/159336/file/290298","type":"Canvas","label":{"en":["Media File 1 of 1 - FREY_JOHN_(3-27-23).mp3"]},"duration":6558.37733,"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/159336/file/290298/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/290/298/original/FREY_JOHN_%283-27-23%29.mp3?1756911682","type":"Audio","format":"audio/mpeg","duration":6558.37733,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298/transcript/83660","type":"AnnotationPage","label":{"en":["Dr. John Frey interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298/transcript/83660/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"John Saultz:My name is John Saultz. I live in Portland, Oregon where I am former chairman and emeritus professor of Family Medicine at Oregon Health \u0026 Science University. Today, it's my honor to conduct an interview with one of my best friends and most important mentors, John Frey.\n\nJohn, it surprised me when I saw that the Center for the History of Family Medicine did not have an official oral history from you. They have many oral histories from you about others, but they didn't have an oral history about you. My first reaction to that was to be delighted because it would give us a chance to talk and for me to learn some things about you and your life and career maybe that I didn't know.\n\nThis is your story, so my goal is to help you to tell the parts of it that you think are the most important. The mission of the Center for the History of Family Medicine is to capture ideas that might be useful to coming generations from those of us who are no longer part of a “coming generations”, and I think you and I both fall into that category now.\n\nJohn Frey:Right.\n\nJohn Saultz:I don't know very much about you and your story growing up, and prior to becoming a family doctor, the story about your family of origin and how you grew up. I know that you went to college, I think, at Notre Dame and to medical school at Northwestern, but our discussions in the past have always tended to start at Cook County when you were an intern, which is post-MD.\n\nJohn Frey:Right. Right.\n\nJohn Saultz:What would you like people to know about your history prior to that?\n\nJohn Frey:Well, and first of all, thanks for doing this, John. I have actually been somewhat reluctant to do this for quite a number of years. The irony is I love to interview people, but I was a little concerned about being the center of attention. But I think it's worth going over and I appreciate you doing it. I mean, we've known each other for 40 years, I think. \n\nThere's a lot of attention these days on genealogy. ... I'm basically a first generation college kid from a family of five. I'm the oldest sibling. My mom and dad were both high school graduates. My dad was in World War II in the Army Air Force and flew bombers over Germany and got back in time for me to be born in 1944. I mean, I was a pre-boomer, and that's a funny thing to be these days. In a little bit I'll tell you why that factors in to how I ended up doing what I'm doing.\n\nThere was a middle class in those days. And we grew up in a three-bedroom, sometimes four-bedroom house depending on who slept in the basement, outside of Milwaukee, Wisconsin. And I went to a Jesuit high school, Marquette High. That had some effect on me because one of the things that I picked up from the Jesuits, who I really do value very much, (Francis is a great example)  is you're dedicated to communities, you're dedicated to service, you're dedicated to social justice.\n\nThere are tremendous parts to the mission of a school like that, which was really important in informing me because I did a lot of experimenting with volunteerism in communities, going to places like the Milwaukee County Asylum. (Remember days of asylums?) I was crossing over a threshold between the familiar and the unfamiliar. Walker Percy is an author I really enjoy reading and who had a big effect on my life. Robert Coles wrote about Walker Percy. Percy wrote this story about a man on a train. The man on the train commutes to work every day on a train in a city and looks outside into houses and places as he goes by, so he has an everyday routine. And he sees in one of the windows, there's always a woman up making breakfast and obviously looking over. And then, he imagines what that life would be like.\n\nAnd then, one day, the man decides to get off the train and walk over and knock on the door of the person who he's been watching for years just to say hello. Coles talks about that being a zone crossing, you're going from one zone of what you know to the zone you don't know. That was a very powerful image for me for most of my life.\n\nI realized that as a high school kid, I was zone crossing, I was going into places where there were poor people and people suffering from mental illness and people who were very different than when I grew up in suburban Wauwatosa, Wisconsin. So that was part of my thinking when I was looking at a career. My dad and mom had friends, so it was also a measure of how the world was different. Their two best friends were both physicians, they were surgeons, and our families would do things together. Every spring for about five years that I remember through high school, they’d pack up the station wagon, put their five kids in the car and put all sorts of things on the roof with suitcases and everything else, and drive on two-lane highways down to Florida. And all the way down we'd chat. I'd sit in the car with one of the surgeons who I got to be really particularly fond of and we'd talk and we'd debate. And somebody else would say, \"Where's Johnny?\" And they'd say, \"Well, he's over with Doc and he's having an argument, but he holds that stuff.\" So it was this sense of being treated like an adult, being treated like somebody who had a mind of his own.\n\nAnd the other thing to remember is these was a surgeon and he was  driving a station wagon down to Florida. And it was some measure of what medicine was, it was a profession. They did well, they had a comfortable income, but they were not rich. Maybe doctors were rich in big cities, some, but in ordinary places, people were wealthy and fine, but they were not rich. And so, we were all very middle class. And that was a lesson I took away is that doctors are just like us, they're not something to be genuflected before.\n\nSo then, I went to college and I had no idea kind of what I was interested in, kind of vaguely interested in medicine because as I think back on it, John, the thing that attracted me about medicine in a weird way was that doctors were admired, doctors were admired by communities, they're admired by neighborhoods, they're admired by friends because they were doing something selfless, at least that was some element of it. And in a strange way, you take a 18-year-old kid and say, \"What would you want to do with your life?\" And one of the things I thought about was, \"Gee, it'd be nice to be a doctor.\" So I thought about that and I got into a liberal arts pre-med because I didn't want to do science, science, science, I wanted to do some other things and Notre Dame had one of those tracks where you could do that.\n\nSo I went to Notre Dame and went into class, I mean then the liberal arts pre-med and I take biology because this high school didn't teach biology, so I didn't take biology until I was a sophomore in college and here I was headed for medicine, so that was kind of a make or break experience. And so, I liked it, I really enjoyed it. I had a good teacher. It got to be more and more interesting. I took courses like psychology and a bunch of other courses that said, oh, this is medicine too. And then, got to the point where I graduated in '66 from Notre Dame and applied to medical school.\n\nAnd the thing about being a pre-boomer is that that was the smallest cohort of people applying for medical school in the 20th century, the cohort born in 1944.\n\nJohn Saultz:Wow.\n\nJohn Frey:So I had nothing great in terms of my grades, I don't know, it was a 3.3 or something like that, total, I had nothing spectacular. My MCATs were average, they were okay. But the thing I remember about my MCAT was that I aced the general knowledge section because I was broadly educated. I was accepted to all the medical schools I applied to, which were various schools and various places. But the one that kind of attracted me was going to Chicago, going to Northwestern, and going to an experience that was really different from suburban Wisconsin. And so, by that point in my life, I think I had met or known, well three or four non-White, non-Catholic people. And so, I went to medical school and that was a big broadening of my experience. And Chicago was Chicago in 1966, and that was pretty interesting.\n\nAnd I was engaged to be married to a woman from St. Mary's who was a biology major, and she was going to go into graduate school in biology, and we were going to do that together. And she became ill. And for the last semester of my first year in medical school, I would run across the street to the hospital that she was in for the whole six months and then go back and try and take my tests and be a medical student. And she died in June, of that year,  my freshman year of medical school.  They never did really tell me what she died from, so I had this historic, for me, distrust and anger about medicine and the way it wasn't honest and wasn't straightforward. I don't know, I can't go back there and do that, and the sense that her physician never paid attention to me even though I was sitting there every day in the ICU. So I quit. I just said, \"I don't want to be around people like this.\"\n\nSo I had no idea what I was going to do. I was really a lost soul. And nobody helped me, I mean, it was one of those things where I was just adrift. Then a friend of mine from high school called, someone I swam with in high school, and said, \"I'm doing a job up here in central Wisconsin. I need somebody to teach daycare to a bunch of migrant students, would you do it?\" I mean, he didn't call to say, \"I'm sorry about what happened in your life. I'm sorry.\" He just said, \"Do you want a job?\" And I said, \"Sure.\" I jumped on it because I wanted to get away from things that were familiar, and because I found it interesting. And so, I went up to central Wisconsin to migrant program, which was not migrants from Mexico and South America.  They were migrants from South Texas, that's how the old migrant system worked in those days.\n\nSo I worked at all sorts of things I was incredibly not competent in. I had to drive a bus. You ever drive one of those old yellow buses you got to double-clutch it when you try to shift and stuff? So I literally had to practice up and down the road to get the damn thing to shift. And I drove around to migrant camps and picked up kids in my bus and drove them back. And I had to make up a curriculum for them. They were kids from eight to 12, 13. And the idea was to keep them out of the fields because they would go in and help their parents in the fields if you didn't do something to educate them. And so, the idea was teach them, feed them, bring them there, do something.\n\nSo I was in this town of a hundred people in the middle of nowhere, not really knowing what I wanted to do, having told the dean of the medical school that I was gone and he said, \"Stay in touch with me.\" And I said, \"Okay.\" But I was just determined to go become an English major like I thought I was and go to graduate school, which would've been a quick trip to South Vietnam. But the thing that was interesting in that experience was not only the pain and loss I had to work through myself but also how I realized that there are a lot of people  who were working through pain and loss by themselves, and that's persisted to this day. And that's one of the roles that doctors can actually play. But I didn't have that experience before.\n\nAnd my friend, who was like a sphinx, the guy who hired me, he was so quiet, and that was exactly what I needed: somebody to be with me and be quiet and let me try and figure out my way through. So I started driving this bus and this doctor in the community, he's not there anymore, but the clinic is in this very rural community, it's called the Appalachia of Wisconsin, it's very rural, said to me something like, \"You're a medical student, right?\" And I said, \"I used to be a medical student.\" He said, \"Well, look, here's a case of Dicloxacillin and here are some scrub brushes from the OR and here's some fingernail clippers and here's some bar of soap. You go around.\" And he showed me patients who had impetigo, really bad cases of impetigo. Some had mosquito bites, but they were picking pickles. And one of the things that you got to look at when you're picking pickles is that they're very spiny and they can scratch and they can do all sorts of things. So they had a lot of impetigo. And he said, \"You ask the kids to get anybody in the camp who has this. You give them a bottle of Dicloxacillin and tell them to take it a certain way and give them a scrub. He says, \"You're going to be the impetigo doctor for Waushara County.\" And I said, \"Okay.\"\n\nSo I went around and I talked to the people and I went in the camps and I visited them in their homes and gave them the stuff and impetigo got better. So it was a kind of wonderful experience. Then I went back and cooked lunch for the kids and tried to teach them. The curriculum, I don't want to get into because it was embarrassing. I mean, I had no idea what to teach 12-year-olds.\n\nBut anyway, so I ended up, at the end of that summer, I was going to go back. I had talked to Notre Dame about doing a graduate school maybe and stuff like that. And this doctor who I remember, but I don't remember his name, John, this guy turned me and said, \"What are you going to do?\" And I said, \"Well, I'm going to go do something else. I don't know what.\" And he said, \"Go back to medical school. You could do this stuff.\" He said, \"You did it all summer. You could do this stuff.\" And he was kind of notorious in town because he was a very loosey-goosey doc, he probably had a little bit of a drinking problem. So I called the dean and I said, \"Can I still come back?\" And he said, \"Yeah, you can come back.\"\n\nAnd so, I was late. I was about a month late getting back, which is not good when you're in your second year and all you're doing is sitting in classrooms. But I went back. But what I did when I went back is I found ways to volunteer in the community. So I did stuff in the west side of Chicago, I did stuff in neighborhoods around Pilsen, which was the Mexican neighborhood. And I had some language skills by the end of that summer and I got more language skills. And I felt like that kept me alive, it did. I mean, it kept me alive and it kept me in school.\n\nYou've heard me talk about A Fortunate Man, which is a book that sits on my shelf and never moves except for me to read it again. And I was back in the fall. Winter in the Midwest is not pretty, and it was cold and wet and awful and miserable. And I thought, \"Oh, I'm failing again. I'm not going to make this. I don't know what I'm going to do.\" Just felt despair. And I was going back into a lot of memories and things like that. So this book came out, it was reviewed in the Chicago Sun Times, it said, \"A Fortunate Man, story of a country doctor.\" And I had this fantasy having been out in the country, that I could become one of those doctors out there like the guy who was out there.\n\nSo I went to the bookstore down on Michigan Avenue near where I was working. My lab was in the downtown complex in Northwestern, second year. And in the middle of the rainstorm, I walked into whatever the store was then and I said, \"Do you have a copy of this book.\" And they had a copy of the book, which is almost miraculous because it just never got to the States. I got it and I took it home and I read it that night and it basically set the tone for me to think about what my job was going forward.\n\nThen I ended up going to Cook County Hospital. I love County. I have stories about County. One of the reasons I don't talk a lot about County is because I write so much about County, just about everything I write is about County because it was this huge, formative experience. And one of the things that happened in county is we closed it; the Interns and Residents Association healed in County. That was when a lot of public hospitals were striking and doing a lot of things and Intern Resident Associations and had a rally that said, \"We can't continue in these conditions.\" I mean, County was beyond imagination, 35 people on one side and 35 people on the other side and screens  you could roll back and forth in between, no privacy, no nothing, nothing we could do. We didn't have labs after six o'clock at night. If you couldn't do it yourself, it wasn't done until the next day, think of that. I mean, it's just unbelievable. And we just said, this is bullshit.\n\nAnd we got organized and we had these rallies and one day we got together and we got in the dining hall and everybody said, \"We're going to do this.\" And the entire residency group, and there were a lot of international medical grads who, to this day, I admire. They put their lives on the line, I mean, they could have gotten kicked right out of this country if they had somehow gotten on the wrong side of the law.\n\nAnd we decided that starting in the morning, we would admit everybody who came to the emergency room at Cook County Hospital. And so, we admitted, I don't know, 400 people and put them in the hallways. And I remember being there and I said, \"What are you here for?\" \"Oh, I got this cough, doc.\" And I said, \"Well, we better put you in the hospital.\" And the guy would say, \"It's that bad?\" And I said, \"No, it's just we're doing something here.\" And so, we shut it down. And that's a long political story.\n\nSo what I learned at County is I could have power, that you could engage in public policy as a physician because you had power for reasons which were totally not me. It was the profession I was a part of that could act for good. And I talked a little bit about this, I mean, here I met you and you were in the service and had your own issues that you had to deal with. And I was coming up. So I had applied to be a conscientious objector (CO), which I had no basis for because I had left Catholicism by that point. Benji was born, he is a couple of months old. I didn't know what I was going to do. It was another one of those, jump off the high board without knowing where you're going to land kind of things.\n\nAnd I ended up, believe it or not, getting my CO, which was stunning because they didn't know what to do with doctors. So they wrote and said, \"Oh, what are you going to do for your alternative service?\" And I said, \"I don't know.\" And I started writing clinics around. There was clinic clearinghouse around the country. Clinics meaning migrant clinics, those kinds of clinics, you know those things. So I got all sorts of offers, Mound Bayou, Mississippi, a couple in New Mexico, all sorts of offers.\n\nAnd then, my roommate from medical school calls me and he says, \"Why don't you come down to Miami, they're recruiting second-year residents down here?\" And I said, \"What's the deal?\" And he said, \"Well, I deliver my own babies. I take care of my own patients. I do it in the community and I work in a migrant labor camp. I do all this stuff.\" I said, \"Is that legal? What is that?\" He said, \"It's called family medicine.\" And I said, \"Really?\" And I'd never heard of it. I had no idea what he was talking about. You couldn't read things about it. And so, I flew down in March or early April.\n\nJohn Saultz:John, before we move on, I'd be really curious about what the main grievances the residents at Cook County had. What were the things you guys were so upset about that you were kind of in an uproar?\n\nJohn Frey:Well, it was interesting because... If I was home, I'd show you, I have on my wall the posters we put all over Chicago, I mean, at least the main areas of Chicago where our patients came from. It was a brilliant campaign. And what we were grieving about, not grieving but angry about and wanted to change were the living conditions for our patients, the fact that we had no support. Can you imagine a 1,200-bed hospital with no labs between six o'clock at night and eight o'clock in the morning? How could we practice medicine like that? The picture of an old man on the poster and it had above it, \"We're doing this for you, not us.\" And it wasn't about our salary because that wasn't the issue, it was working conditions, living conditions for our patients and that they would have privacy and that they would have decent food.\n\nAnd we went to the Cook County board, which was all run by machine politicians. I mean, the board was not physicians. And Cook County was run by the Cook County board and that was where I saw... What's the word I'm looking for, where you give jobs to everybody in your family? ... patronage in action. The dorm we had for internship was a 12-story dorm with automatic elevators and they had a guy sitting at the automatic elevator for three shifts a day, and he got paid more, we found out later on, more than the chief resident in surgery and on and on and on. So it was about working conditions, it was about living conditions, about the fact that we didn't have a clinic that functioned. So when you tried to discharge somebody from the hospital, you couldn't get appointments for months. These were people with serious conditions.\n\nSo it was the whole, and this, it was the '60s, and we were saying people have power to change things. I mean, whether you believe it or not, I mean, we didn't sit down and say that, but we acted on that. And there were protests going on all over the country. And we had been through Kent State and all the different things, the school had closed, we did all that stuff. And so we felt, I mean, the term is empowered, I guess. And so, we needed to do something about it. And I guess the reality is I think the administration thought, \"Oh, these are a bunch of people, they'll be here for a few years and they're going to go and we'll get some people that are much more manageable.\" But we didn't stop for that., And I could tell you more stories, I'm good at, John, but I've got county stories forever. But that's why.\n\nJohn Saultz:Part of the reason I'm asking you this question is, for me personally, there's a little bit of a paradox. I do not find the young people that I'm teaching today to be any less idealistic or altruistic, to be any less passionate. But it seems like the vocabulary has to do with the impact of life on them more than I remember it being how I thought about things. We were concerned about support services. We didn't talk about burnout much. There was a lot of depression among other residents I worked with and a lot of people had trouble keeping up and decided to leave the training program and whatnot. But I'm wondering what you think about the paradox because they are not less altruistic or less idealistic, but they seem to have a vocabulary that's more based on their own benefits now.\n\nJohn Frey:Yeah, I think it's this whole... Well, I'm not against wellness, believe me, but it kind of comes down to that whole sense about how can I help me? And they're not necessarily narcissists or whatever, but the language that's around them, I mean, medical schools  are saying, \"Oh, we're going to help you.\" There are studies that show that family doctors who work in clinics which are harder to work in because of the population they're taking care of have lower levels of burnout. They feel they have a mission, they feel they have something to do, empowered is a phony word in many ways, but they feel that they can do something, whether it's true or not. But they tend to be organized. They tend to do things.\n\nWe had was a collective sense of change as well. As one of the things that that whole period in history taught people is that if you get together, whether you're the farm workers or whether you're a bunch of people protesting a war, whether you're a bunch of interns and residents around a hospital, that if you get together and work together toward change, you can do it. You read history, that's the only thing that makes things change.\n\nJohn Saultz:Yeah. \n\nJohn Frey:And I think one of the problems is we've taught a group of people in our system-\n\nPART 1 OF 4 ENDS","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298#t=0.0,1684.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298/transcript/83660/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"John Saultz:I thought we lost you for a second, but you're back.\n\nJohn Frey:Oh, okay. We're treating people as if they're victims. They're not victims. These are the most empowered people in our society. Right?\n\nPhysicians should be because we have jobs, we have money, we have all sorts of things that we can use to the good of our communities and our patients, and ourselves. And if they can't make the connection, and maybe haven't done the connection, between doing something for other people which requires hard work, stress, and other things, and realize how much that gives back to you. The hard work we do makes us happy. Not necessarily ... I mean it's hard. God, I mean County was beyond imagining, being on every night, every third night, stuff like that with a wife and a baby and all these things. But it wasn't that. It was more the sense of working in conditions that were unbearable.\n\nSo I think one of the things is they haven't been exposed and don't believe in themselves. They don't believe that they have the power to change things. And what we have to do is get them to take that power and move it towards changing things in their lives that need to get changed, so they can feel better about their work and feel better about themselves. They will get better when their work gets better.\n\nAnd you and I have talked about this forever. It's this article which I've used from Julian Tudor-Hart forever, which he was never a teacher but he is somebody who changed society, was the idea of creating disciplined anger. \"And anger without discipline is mere shouting.\" That's the line. So we have to teach them to stop shouting and start using their anger to change things and it's not about them. It's about the people they work with. So we somehow had that experience and you obviously had it because you've been doing the same kinds of things all your life.\n\nJohn Saultz:So you were getting to the point where you were making a decision to go to Miami for a residency, and you were just hearing about family medicine. This was the very early days of the specialty, only a couple of years after the specialty had started-\n\nJohn Frey:Yeah, 1971.\n\nJohn Saultz:How much did you hear about it as a discipline focused on social change? And how did the discipline look to you as somebody who was a rotating intern in 1971?\n\nJohn Frey:Well, it's interesting. So two parts to that. One is me and one is the context. I like doing a lot of stuff. I really don't enjoy narrowness. I like breadth. I mean, as somebody told me, I'm a person who is an eclectic who managed to get tenure as an eclectic. I never had a thing I did. But I've always liked that, I like many things, and that's what makes me happy. And that's clearly what made me happy at County because I was a rotating four, which was six of medicine, six of pediatrics. I'd go over and deliver babies on my own, because I just wanted to do that, and God knows they could use the help.\n\nSo that's the kind of image I had of myself as a doctor. And I go down to Miami and here's Lynn Carmichael, who is all about social justice, who has the clinics in South Dade County with migrant laborers, and he has it with the Model Cities Program in North Dade County, and that's where I would work as an intern. But I said, \"This is like Brer Rabbit. It's like putting me in the briar patch.\" And the idea of being in that kind of environment and train there was something I couldn't imagine. I really kept asking Dave Rosenfield, my roommate, I said, \"How long has this been around?\" He said, \"A year or two.\" And David is a visionary, he went there and I didn't.\n\nSo Carmichael said, \"You want a job?\" And I said, \"Sure.\" Trouble is I had to get it past draft board.my board had to agree that the residency in Miami would qualify as my alternative service for two years. Fortunately, the board did approve. So clearly the social mission was there. I describe my internship to people these days as one I made up as I went along. I mean, my internship, my residency, you know that. I mean it was do whatever you want. And supervision, what's that? All those kinds of things. So it wasn't necessarily the kind of thing you want to let on, but we were so excited.\n\nAnd the cohort I was with were just like me. They came from everywhere. Ben Daitz  and Dick Herman came from interns in, what do you call it, Nova Scotia. And Bery Engebretsen came back from the service., Bill Shore came from the Indian Health Service. We were all that kind of cohort of people, and loved what we were doing, and it was interesting. But we also were people who continued to feel like we had some ability to control our lives. So one of the things we did when Carmichael left, and I don't want to get off on this one, but it was fun.\n\nHe went on a sabbatical for a month and a half to New Zealand and put us in charge, and so we created a governing council. We had a constitution, bylaws, we did everything. We had flyers. We had all sorts of things. In a month and a half, we did it all. Wrote the preamble, which I am still proudest. I wrote that and that was the best thing I've ever written about this is why we're doing what we're doing. This is why we're taking responsibility for it.\n\nJohn Saultz:Do they still use it, do you know?\n\nJohn Frey:I don't think so. I probably have a copy somewhere, but I should ask Crystal if she has a copy. But anyway, so we asked Carmichael to be on the governing council, but he only had one vote. So when he got back, he said, \"This won't work.\" And I said, \"Oh, well, you told us to run it and we did.\" And the other thing he said when he left, he says, \"When you run it, you should take notes and write it up.\" Seriously. Now, he was not a writer but we were. And so one of the first things I ever got published in Journal of Medical Education was Residents Control of A Residency Program, which I think is a magnificent piece of work about how residents should be part of a management system of whatever. Anyway, when I sat down there, I realized I was ... I was a pig in shit. It was exactly where I wanted to be except I'm not a hot weather guy.\n\nSo I had to talk to my, what do you call it, the draft board and say, \"Here are the options I have. I can work in these clinics out west, Mississippi and stuff, or I could be a second year resident.\" So they said, \"How much will you get paid?\" That's all they were interested in, that I wouldn't make money off of this. So, of course, you get paid nothing as a resident. So they said, \"You go be a resident.\" So the reason I'm a family doctor is my draft board made me do it.\n\nJohn Saultz:There you go.\n\nJohn Frey:So all these steps along the way, the things that happened, the things that I was exposed to ... I think the greatest definition of a career is a bunch of accidents and unexpected occurrences on which you stamp a retroactive label. So I can tell you up to now what I've been, but where I'm going to be, I can't tell you that. So I had all these accidents and all these things, and I got more and more committed to the idea of taking risks and trying stuff. And it was a new field and everybody was trying risks. So there's no guidelines and no this, no that.\n\nJohn Saultz:When I think about the stories we tell ourselves, looking back at what our lives were like, I think about these residency programs that were sort of paradigms for their time, the Rochester of the '70s, the South Carolina of the '80s, and for me, Miami in the time you were there has always been one of those historically significant training programs, as I look at it as somebody who's never been to Miami. To what extent do you think that's true? And to what extent do you think you knew it then?\n\nJohn Frey:Well, I didn't know it because I didn't know anything about family medicine. I really didn't. I joined the Academy because I was supposed to, and they had a meeting down in Miami because the Academy always loves to go to Miami. And I walked in there and I had a beard down to here, hair down to here, and a tie as wide as my shirt. And I walked in and I said, \"Oh my God.\" They were all in their leisure suits and golf outfits. And I thought, \"What in the hell? What have I done?\" It was this whole sense of believing that there was more to what I was taking a chance on than what I was seeing then. And Lynn was extraordinary. I mean it's hard to be ... I mean he had his quirks, God knows, but he basically said, \"Go do it. Go do it. Go do it. You want to work at the Dade County stockade taking care of prisoners? Go do it.\"\n\nAnd I got the sense of that's the way education should be.It's called adult learning, right, and you make your own decisions and they give you some guidance. I mean there wasn't complete randomness, but it was all about go try stuff, don't be limited by this or that. We had rotations, we had hospital stuff, we had all that, but it was an amazing experience.\n\nSo I knew that I was in something really special because I talked to residents who would come down to Miami occasionally too to go to some of these meetings and I'd say, \"What's your experience like?\" And it wasn't like ours. That's for sure. And they were much more traditional. They were much more like GP residencies that were expanded into three years, hospital specific and all that kind of stuff. So we were clearly doing something different. And like I said, my cohort, which that continued, John, until ... I left in '73 and it continued towards the end of the '70s, I think, getting these unusual people. And the RRC would always come in and slap Lynn's hands but you can't criticize George Washington. You can't put George Washington on a probation. So anyway, we were kind of protected by the fact that Lynn was known by everybody. So it was an unusual situation.\n\nJohn Saultz:Sometimes that freedom is really important. So, by the time you finished residency there, what do you think your idea of family medicine was? You said you didn't really know much about it, and you went to your first Academy meeting and you were in this residency that was pretty individually focused. Around the time you left, how would you have defined the discipline?\n\nJohn Frey:Well, it was full of a lot of people like me, like you, like other people of that cohort who were pretty committed. First of all, this idea of, \"Oh, you're too smart to be a family doctor\" was bogus. I mean nobody ever told me that because I wasn't that smart. But the whole idea is that we didn't believe that. There was this sense of we were not going to get convinced by some surgeon that I shouldn't do that because of this or that or the other thing. And we were absolutely determined to do medicine in communities. So my connection was and still is, because it's what I write about and I talk about and I do, is in communities where we belong. We belong outside of hospitals. We have affiliations and connections with hospitals and all that, but our job is to be in communities doing the work.\n\nAnd when you're around people like Gayle and you read what McWhinney wrote, and you read some of the things that people were writing about then and you meet some of these guys who basically left a very happy practice in a very successful community to go into something they had no clue about. Like Gene Farley shaped Rochester to be Rochester, and they shaped where you got these characters in South Carolina and who was a neurologist, I think.\n\nJohn Saultz:Hiram Curry , yeah.\n\nJohn Frey:Yeah, he was a neurologist who said, \"I don't like that. I want to do it this way.\" So you had these people who were doing stuff who were not afraid, who were not intimidated and I said, \"I want to be with those people.\" Those were the teachers. So part of it is the practicing community and I didn't get together for a long time. I mean it was not familiar, but the teaching community was something I felt completely comfortable with. And that's a decision I made that I want to be a teacher. I mean that was the compelling choice when I was finishing. I looked around to see, and actually I went to some great communities who were doing wonderful, progressive work with migrants and rural health and everything else. And I said, \"I want to do that, but I only want to do that as a teacher. I want to do that, but I want to have teaching be a part of my life and if it's not a part of my life, I can't do it.\"\n\nAnd they promised me things out in the state of Washington. They said, \"Oh, you can do that. We'll get there in a couple, three, four years.\" And I thought, \"No, if you don't do it from the beginning, you're not going to do it.\" And so I didn't go there. So I went to a lot of wonderful places, but I wanted to be a teacher. That was the thing that molded me. And I wanted to be a teacher like the people who were my teachers, thinkers and writers and characters and people with imagination and people who were not deterred by defeat or discouragement or anything like that.\n\nJohn Saultz:Was there much interest in teaching before medicine for you? Or did that come up as something that became part of how you thought of your medical career?\n\nJohn Frey:That's a good question. The answer is no, it wasn't there. I suppose going into English, I mean I only went into English as a default, but being a university professor felt kind of phony to me, kind of still feels phony to me. But no, I wasn't bound and determined to teach. But when I got into my internship experience, my residency experience, and when you're responsible for ... The only teaching award, well, it's not the only one, but the one that I still have is the University of Illinois, believe it or not, gave me a teaching award as an intern for being an excellent teacher of medical students.\n\nJohn Saultz:Cool.\n\nJohn Frey:That was my teaching. I thought, \"Whoa, I can do that.\" So I wanted to tell people what I saw. I wanted to tell people what I learned. I wanted to tell people what I wasn't able to do. I wanted to use my own experience and be able to work with other people and help them learn from me whatever it is. Not in an ego sense but just pass things on. And so that really got strong when I was a resident and in a couple of years it became fundamental actually.\n\nJohn Saultz:So you were looking for a position or a next step that was going to include teaching. Is that how you found your way to Massachusetts, to Worcester?\n\nJohn Frey:Yes. Yes. I mean I looked at a number of possible opportunities in some wonderful places to be a doc in really wonderful clinics. I look back now and think, \"Boy, my life would've been fun and interesting then,\" but I still wanted to teach to somebody. If I wasn't a student or a resident there, I wouldn't have been as happy. And so everything was getting started. There were no residency programs in New England per se. And this ad in The New England Journal of Medicine, if you can believe, that said starting a program with three different sites and they're looking for young faculty members. And so I called a guy, Dick Walton, who is legendary in my own life, but called him and said I'm interested. But I didn't call him. I wrote him and said I'm really interested. And then I went to Chapel Hill and met  Robert Smith, and I went to a couple of other places and I didn't like them that much.\n\nThey were clinics, were all in the hospital, not out in the community. And they offered me positions and lots of stories around that, and I just didn't ... So I thought, \"Oh boy, I'm not finding what I want.\" So then I made up another list of what can I do other than be a teacher. Finally, Walton writes me back two months after I wrote him a letter and said, \"Have you signed anything yet?\" I even took a job in Portland, Maine, but then turned it down. And I said, \"No, I haven't. I haven't signed a contract.\" But he said, \"When can you come up here?\" So I went up there two days later, visited UMass, met all these people. They were the same kind of people. They were the people I wanted to be with. You know that story, that feeling. I mean I wanted to be with them, none of the other places that I'd been.\n\nPlus I was going to be with a cohort of incredibly high energy people starting clinics in rural areas. I went to the rural clinic and it was a little too New Englandy Congregational Church thing for me. And so they took me downtown and they said, \"Here's a storefront clinic. You want to do that one?\" And I said, \"Sure, I'd like to do that one.\" So basically I just took this job in Worcester and Lucy Candib was there and Dick Walton and all these people. Lucy was my first resident for about 10 minutes. Then she became my teacher for the rest of my life and on and on and on and all these incredible people. And we were doing everything. You name it, we were doing it. And I said, \"This is great, and this is what teaching's supposed to be.\"\n\nAnd then it started becoming more like everybody else. It started becoming more structured. I mean it had to. It was a medical school. They couldn't let you run around like Brownian motion. But the seven years I was there was life changing and I also learned another culture. New England's an interesting place. So every time I've moved to a new place, I've learned a lot about myself, the world, the country and so on. And so I was there. I love New England. I love all those people. The answer about why did I leave? It's another long story, but it got to be more uncomfortable. And I was just wanting to be some place where two things were available. I wanted to have an affiliation with the university and UMass, they have a medical school in Worcester, and UMass itself is in Boston and Amherst.\n\nBut there's some great teachers in local institutions I met who changed my life, Roger Bibace and people like that. So I had teachers, but there was something about wanting to be, and it's weird to say, John, but I was wanting to go from being the outsider. And I only think about this way after the fact of why I did I things. Go from being an outsider, trying to pull people out to be more of an insider, trying to push people out. Because you need people inside institutions to say, \"Go do it. Go do it. Go do it.\" Or help construct experiences for people to go do it. So the move to Chapel Hill was to a much more traditional institution, which had a lot of money and a lot of activities around the state, the statewide network. And it turns out probably the most important professional experience of my life, which was the fellowship, which was meeting incredible people who were energized to do things I had never thought about, who had intelligence and gumption and on and on and on.\n\nI mean you know the classes. You were in them and it was thrilling. Plus I was auditing it as I went so I got smarter and learned some things about organizations and things like that. But the fellowship was what they ended up offering me as the job there. And I didn't have any experience, in fact. Well, we had some faculty development stuff going on in New England, but it was pretty loose. But to go into a structure like that and work with them was pretty amazing.\n\nJohn Saultz:So you may not remember this, but in my 1983 cohort of that fellowship, one of the other fellows was Dick Walton.\n\nJohn Frey:Oh, man.\n\nJohn Saultz:He was in my class with Jeanette South Paul and Sue Schooley, and it was a kind of surreal thing because it was pretty clear how much he meant to you. I think he was down at Asheville at the time.\n\nJohn Frey:Yeah. He was in Asheville.\n\nJohn Saultz:And he was in my fellowship cohort later in his career, \"I want to see what these guys are doing,\" which was a pretty amazing thing. I don't know if you remember that or not.\n\nJohn Frey:You know what? I do now but I didn't remember it then. Dick died last November, and I went down to Asheville to the ceremony and the meeting and stuff like that. I have so many Dick stories from Massachusetts, but I don't have a lot of Dick stories from North Carolina because he was over in Asheville, and when I was acting chair down there, I was his boss. It was weird. And then I guess I was his, not boss, but I was his director as fellowship director too. Wow. Wow, what a cohort. Holy mackerel.\n\nJohn Saultz:That's always been one of the more wonderful things  about my academic career, how teachers and learners change roles. And the best of us are really comfortable with that because it's true open-mindedness. Dick was an incredibly open-minded man to be a program director at his level of sophistication and to come back and say, \"Well, I think I've got a lot to learn and I've got a lot to contribute.\" It completely, as you might imagine, changed the fellowship experience because it made it  intergenerational than it would've otherwise been.\n\nI would also tell you that your decision to move to North Carolina reminds me a lot of my decision to go to a medical school when I got out of the Army, because it's kind of like why do you want to have anything to do with those guys? I didn't think too highly of medical schools, but it seemed like if none of us ever went there, we couldn't complain about them very much. And the medical students all are there, so somebody needs to go there. Otherwise, we're just sort of recruiting against orthodoxy but that was part of, I suspect, the challenge.\n\nJohn Frey:Yeah, it is.\n\nJohn Saultz:Residencies became more orthodox. How do you take an unorthodox discipline and have it standardized? Around that time, Gayle Stephens was giving that talk about counterculture, right?\n\nJohn Frey:That's right. That's right. That's really interesting. To put it in a nice light, which I think is true, is that also was about service, but it was service to a discipline. By that time, I realized I was part of something or, as Gayle would say, \"We're part of something bigger than we knew, but we are part of something.\" And being part of something brought an obligation with it. An obligation to do something. So I think going inside the medical school, so to speak, was a way of service as well, just as going into a community or going into a practice as a kind of service. This was a service to people that needed somebody to do that work, frankly, and it was great. And part of the thing is I would not have gone into a medical school which only had Chapel Hill as its location, so I went to Asheville and Fort Bragg, and I went all over the state all the time, and that gave me a sense of being part of something that's bigger and also it got me out of Chapel Hill, which was pretty smothering in many ways.\n\nIt still is and so having that network around the state was one of the biggest attractors to that job, because the other job I looked at at that point was New Mexico. And given my seemingly lifelong love of New Mexico, you'd say, \"Why didn't you?\" I didn't take a job there twice. I went to look at jobs twice and just said, \"This isn't\" ... The people, the place, everything was something I loved and part of my soul but not the work there right now. And it just didn't work out. The timing was just not right.\n\nJohn Saultz:How much did you interact with AHEC people in North Carolina? Because I know when we built the Oregon AHEC, there was an enormous influence from North Carolina about what we were trying to be like. \n\nJohn Frey:Every AHEC in the country probably used the North Carolina model as we'd like to be like them, because Gene Mayer, who was the director, a brilliant, brilliant politician, but principled, you never met anybody who was so principled. He was amazing. But he could talk the talk. He could walk the walk, and he really knew what was going on. So he would go to the legislature. I mean the dean would take Gene to the legislature for the annual budget talks because the dean knew that Gene could say, \"Oh, by the way, we have Dr. So-and-so. He's in your community and we trained him out in one of those things.\" So he was like the best politician I ever met in my life and got it fully funded and lots of money for Chapel Hill, lots of money for the other AHECs, for Duke.\n\nHe was Catholic with a small C. I mean he got money for everybody, Bowman Gray and everybody else. So he was a person who was ... what a model of how to do things right. So hanging around with the AHEC people was certainly more fun than hanging around with the other chairs when I was the acting chair. So I continued to do that. And the public health people were very helpful too. The  UNC School of Public Health, there was some really great people there as well. I mean you had some as teachers and stuff. So that was a big change for me.\n\nJohn Saultz:So we have been going about an hour, and you've been doing all the talking.\n\nJohn Frey:I'll shut up.\n\nJohn Saultz:No, no, no, no. It's your interview, John, but I'm wondering if you need a break or if we can keep going because I'm fine with keeping going, but you're the one that probably has the dryer mouth.\n\nJohn Frey:Yeah, I know. No, I'm fine actually. I'll wave a signal or something like that.\n\nJohn Saultz:Okay, good. \n\nJohn Frey:One thing I wanted to point out between leaving Worcester and going to Chapel Hill is that's the nine months I spent as a GP in the National Health Service working with Julian Tudor Hart which was truly-\n\nPART 2 OF 4 ENDS","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298#t=1684.0,3364.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298/transcript/83660/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"John Frey:which was truly the most important teacher of my life. I've had wonderful teachers all my life, Gayle and people like that, who I love and cherish. But Julian became a part of my life in 1979. Just to give you an idea, when Kathy and I got married, he and Mary went on our honeymoon with us. He is the most powerful writer I have ever known. He's the most fearless advocate for communities and for healthcare and for the right kind of healthcare for people I've ever known. He lived this incredible life of being a world-famous country doctor. He was known all over the world for The Inverse Care Law which he wrote in 1971, when he was a solo person in Glyncorrwg, Wales, ends up as the most highly referenced Lancet article almost in history.\n\nSo I thought, \"Who in the hell is this person? How can he do that?\" So I called and said, \"I want to take a sabbatical,\" and I was going to take a sabbatical at UMass. And I realized because of the politics that were going on at UMass, I didn't want to go back there. I wasn't going to do it. So I took my own sabbatical. I said, \"Julie,\" it was great. \"Would you be willing to go to Wales, to a coal mining town and spend nine months?\" And we said, \"Okay, we'll do that. We need a break.\" So we did that with Ben being eight years old. And here we go and I got exposed to all these extraordinary people in the National Health Service and extraordinary GPs, and Julian used all of his contacts and sent me around, and I would call Scotland or I'd call him Central London, or I'd call these places and say, \"Hi, this is John Frey, and I'm not the English John Fry.\" And I'd come for a week.\n\nJohn Saultz:Did you find Julian by reading one of his papers and calling him on the phone or at a meeting?\n\nJohn Frey:No.\n\nJohn Saultz:It was a contact from one of his papers, and when you were in Wales, were you actually practicing with him?\n\nJohn Frey:Yeah, I was the first American trained, board-certified GP to be a practitioner in the National Health Service. I just found my files. I was not paid, but they gave me a license. They gave me the credentials to be able to practice with Julian. So, I shared a practice with him for nine months and saw him practice, watched him practice, and he watched me. You couldn't find more contrasting in some ways to practice medicine. Learned a lot about general practice. But I was a real practicing doctor. I wasn't a tourist.\n\nJohn Saultz:Did he stay in that community and practice there? He had some academic things he did later in his life, right?\n\nJohn Frey:He only did that after he retired.\n\nJohn Saultz:I see. \n\nJohn Frey:So he retired and then they gave him appointments. And John, I'm sure that Julian would agree with this. He was not a good clinical teacher. He's a great doctor. He really knew what he was doing. But he couldn't stop talking. Someone kind of like me. He'd asked the student or the resident (there was a resident equivalent who was in our practice), \"Bob, what kinds of things would you think about using for this man's congestive heart failure?\" And if Bob took more than five seconds to answer it, Julian would answer it. And so he was the kind of teacher who tells everybody stuff. He couldn't bear having a dialogue and whatever you want to call it.\n\nAnd so I'd go back and I'd say, \"Julian, you got to let Bob talk. I don't know if Bob knows this stuff.\" \"Well, I know he knows it.\" So he was very not good. And he was so pleased because I said, \"I'm so glad that you ever became an academic because you are an academic. You're the highest level of academic there could possibly be, but you don't have to...\" He's like somebody working for Bell Labs or the Rockefeller Centers or Institute or something. He had all these great opportunities to do research and do his work, but he didn't have to spend his time doing teaching. And then he gave lectures. His lectures were his teaching, and they were brilliant, absolutely brilliant. And he researched them harder than anybody I've ever known and never gave the same one twice in 50 years or whatever it was.\n\nJohn Saultz:I have always known since I met you in the Fellowship, how important your experience with Juliet Tudor Hart was. How do you think, on a day-to-day basis, when you get to Chapel Hill, how do you feel like that changed you?\n\nJohn Frey:It reinforced something, I think I believe, but couldn't talk about instead, that to be successful in changing things, you have to have courage. You have to not be deterred. It's not like you have to be bullheaded, but if you see something that has to change, you have to keep at it. You got to have the courage to be wrong. You have to have courage. I mean, Julian was wrong as many times as he was, right? But he was always going and going and going. And the other thing it taught me was, if you can't answer the question, try and answer it yourself. So that's called research. And he was one of the great researchers of all time in communities.\n\nAnd he thought I was there to study research, and I said, I really didn’t know much about research. I had done some in Worcester and done some publishing. It's pretty menial. But he made research a part of what I wanted to know more about. So even though I have done certain kinds of research in my life, and I've been working with other people on that, I realized that quality and research go together. And that you had to have the courage to go out there and answer the question yourself and fail and all those kinds of things. He thought of himself as a GP who is a researcher. Community and policy was this kind of other stuff he wrote about. But his work was, what's the story on blood pressure in a community like this? Because he saw that the major big shot people in Hopkins, and you name it, were wrong. They were wrong about salt.\n\nAnd now they're finding it again. They keep finding it about every 15 years. You know what, you can't make somebody have hypertension by eating a lot of salt. Oh, they proved that back in 1980. But anyway, he just kept going and kept going. And he would not just blather about what he felt. He did a lot of that brilliantly, but he also studied stuff and he had the courage to do that.\n\nSo courage. And also that article, which I keep. We have to have pole stars in our lives. We have to have things that you go back to say, is this still true? In that article, which he told me, no one except me ever talked to him about, which I've talked about non-stop for the last 45 years about what you're supposed to be doing as an academic department, what you're supposed to be doing as a teacher.\n\nThat very simple outline has kept me going. Actually, that really characterizes Julian. The things he teaches are, you got to deal with uncertainty. You have to teach people how to do that. You have to teach them that takes courage. It takes courage to not do more and more and more and more studies hoping you're going to find the answer when you know that you won't. And secondly, you got to act on what you believe and what you think, and then be willing to say that whole uncertainty thing, which you've written a lot about. It's there. And it comes from a lot of things. Uncertainty comes from knowing who you're dealing with. And you can act on somebody because you know that person, and you know that person because you've been their doctor for a long time. It's all in a mix there.\n\nJohn Saultz:So over the course of the time that has transpired since you were in Wales with Julian, you've shared that paper about the role of undergraduate education in general practice and the concept of disciplined anger being at the core of what departments should do. When you got back to North Carolina and you shared that with other faculty members, and you started telling it to groups of fellows, and then you went to Wisconsin and you shared it with a whole different community of faculty, do you feel like it universally resonated, because it certainly did with me, and do you think that how it resonated changed over the course of that period of time between then and now?\n\nJohn Frey:Well, the reason that resonated with you, John, is because of who you are. And you're from a generation that understands that and has that same kind of sense of mission and sense of responsibility to make changes. It didn't resonate. I think the enemy of change is comfort. And when people get really comfortable, it's very hard to move them. And you know this. Gayle, what he said in counterculture, all the stuff he said about counterculture. But the thing that I take back from that article or that presentation was that the biggest struggle we're going to have in the future... And this was, I think, written in 1977 or something like that, late seventies. The biggest struggle in the future is going to be with ourselves, not the other people. It's not going to be medicine and surgery and dermatology and things like that. It's going to be with ourselves. And I just didn't hear that at that point in my life.\n\nJohn Saultz:I didn't either.\n\nJohn Frey:But you know it now.\n\nJohn Saultz:I know it now.\n\nJohn Frey:And so, that kind of hit me in the face. I used to call Gayle every once in a while, and I said, “I get out there and I put myself and what I want and what ideas, I put them out there and when I have a conversation and when get back is anxiety and silence”. Then what I realized is I got to go find people and recruit people who share that idea, because it is not going to happen. This thing we wrote, which you published on radical changes of residency training, anytime you get out there and say, we need to change things pretty radically in order to make a new discipline that's ready to go, you get pushback from the residency directors. Instead of saying, right, let's go, there's a lot of problems with that. They worry about how much work it would take, how much money it would take, how much other things it would take. They're wonderful people, and they're doing God's work here.\n\nJohn Saultz:I'm sitting here thinking the typical residency director group would reply to the idea of admitting 400 people to Cook County Hospital is, well, then we're going to have to discharge them.John Frey:I know. I know.\n\nJohn Saultz:Yeah.\n\nJohn Frey:So when I got to Madison, I enjoyed the experience immensely. I really respected the people who were there. There was a great line that Jack Caldwell, he'll probably deny it, but he just said it because I remember he was our external reviewer at one point. And he sits me down and we were talking about a bunch of different people who were doing really, really good things, but were a challenge, let's just say. And he says, \"You know, you got to ask yourself when you hire somebody, is this person worth the trouble they're going to cause me?\" And I thought, ooh, that's an interesting way to think about things. Now, he wasn't being negative, he was just saying people were... I'm sure that Carmichael felt having my class and all of us guys and Don Cauthen and all these people in the class was great and exciting. On the other hand, we were a pain in the ass, and we tried to steal his residency program and all these different things. So it's a ying and a yang, I guess.\n\nJohn Saultz:Bob Taylor used to tell me, \"The essence, John, is to be able to tell the difference between a sports car and a clunker. Both of them require a lot of maintenance, but the sports car's worth it.\"\n\nJohn Frey:You're absolutely right. So yeah, I think that the decision to go to Madison. I was the acting chair at UNC and said, I do not want to do this in Chapel Hill. And the reason I didn't want to, well, my wife Julie, died the year after I started doing that. And so that was another,” who in the hell am I, what am I doing, what do I do” period. My son went off to college. I was living alone for the first time in my life. And I had a great job with the Center for Documentary Studies at Duke. I had wonderful people over there. I had the cushiest job in America in some ways, and I was practicing and writing, and I was editing a journal and doing all these things I really liked, but I didn't feel fulfilled.\n\nAnd the other thing I didn't feel was I was not a part of the big conversation that needs to go on in every field. And I wanted to be in that conversation. And reality is, one of the ways you do that is to be chair of a department, because that gives you a voice in a particular group. That's where that conversation should be going on. Whether it does or not is a whole other thing. So I realized I wanted to be in that conversation. The only way was to think about leadership. I'd had this Kellogg leadership training, which was all wonderful. I learned a lot of things about leadership in that fellowship. Amazing. But I never was a leader in the sense of institutional leadership.\n\nSo Wisconsin came along. Gene I loved. Mike Fleming and Susan Skochelak called and said, \"You ought look at this job.\" I'm from Wisconsin. A lot of support for family medicine. I said, \"Well, okay, I'll go do that.\" And it wasn't a slam dunk for me or them really, but it was one of those things where there were a lot of doubts. Part of it is going back. As one of my patients said in the South, they said, \"Where you going?\" I said, \"Wisconsin.\" And they said, \"Oh, okay, Wisconsin. Why you going there?\" And I said, \"Well, I'm going because I have a really good job. I'm looking forward to doing stuff again.\"\n\n\"Okay, for work.\" And then I said, \"Oh, my mom and dad live there, and my brother and sisters live there and stuff like that.\"\n\n\"Oh, you're going to go be with your people.\" And I thought, oh, they can understand that, but they couldn't understand why would you go there for a job and leave North Carolina.\n\nI had the letter in my drawer that I wrote six months after I arrived, to Gayle. I have all the letters to Gayle, and I didn't finish this one and send it. I just said, \"I'm having trouble again. I don't what's going on. I'm not sure I made the right choice.\" It's kind of little buyer's remorse, a little this and that. And I couldn't talk about it with anybody. And that's one of the problems with being in a leadership role is you have nobody to talk with. You have to find trusted people. You call John Saultz, or you call people you knew from residency or people like that.\n\nSo I wrote this letter to Gayle trying to explain why I was having trouble. And I got about three quarters of the way through it, and then I put it back in my drawer and I never finished it. And then I talked to him and I said, \"I got a letter I wanted to send.\" He said, \"Is that the same letter?\" And I said, \"What do you mean? You sent me letters before about this.\" And he said, \"You got to take good notes.\" He said, \"You got to take good notes and you're going to go through it again.\" So I said okay, so it worked out all right.\n\nJohn Saultz:So you obviously became close enough friends with Gayle Stephens that you would confide and write letters back and forth with him, but you never worked in the same place. How did that friendship, how did that relationship develop?\n\nJohn Frey:I think it was one of the early meetings, and I don't know if it was the STFM meeting, probably was, where Gayle... And one of the things that changed me during my residency program is we learned about Michael Balint. Carmichael knew about Balint. We had a Balint group. It worked. And I read The Doctor, His Patient, and the Illness and said, \"Boy, this is the book. This is the one that makes sense. This explains what we're doing.\" But nobody else knew about Balint. And I went to this meeting, and Gayle got up and probably half of his speech or his presentation was on Michael Balint and learning him from Balint. And I was just literally jumping up and down on my seat saying, I got to go talk to this guy. I got to know about Balint too. And I went up to him afterwards and said thank you for doing that.\n\nI've known about Balint since residency and I'm trying to do it. We have a Balint group in Worcester still going on 40 years. And so anyway, he just was very kind. He said, \"Why don't we talk some more?\" And so he kind of spotted me in some way or the other. And I said, \"Oh boy, this guy wants to talk to me. It'd be nice.\" So I called him and we talked and we wrote back and forth, and he came. We invited him to Worcester. And one of my teachers there was Roger Bibace. I have one of the photos on my desk wall is of Roger and Gayle talking. The two great teachers of that era of my life, talking with each other with just animation and stuff. Well, great teachers know each other. That's one of the other things that life will teach you is that the most dangerous thing is to get in a room with two great teachers and try to get a word in edgewise.\n\nBut anyway, so Gayle got to know me, and then he sent me a letter that said, \"Would you come as a visiting professor?\" Which of course is ridiculous because I wasn't anything. I had barely done anything. And it came and I remember preparing presentations and stuff, and it was pretty clear he wanted to recruit me to Alabama. He was in Birmingham by that time as the chair. And what we both realized, John, and you know this, is that it's one thing having somebody as a great teacher and dear friend and a lifelong core of your life, and having him as a boss. And I realized, and he realized too I think, that both of us said no to take this any farther. We want to be friends. We want to be colleagues. We want to be in this together, but working for him was not going to happen.\n\nAnd I actually liked Birmingham. It was really fun and interesting. And you know the story. Gayle was a great scholar, leader, intellect, writer, but not a great chair. And so it crashed and burned shortly after that. There were a number of people from that era who were used to having a command of the world. At Wesley Hospital in Wichita, Gayle had the command of that place. Not in an arrogant way, but he was just... And then he went to this other job as a dean and the other job as a chair, and kind of acted a little bit the same way. And that doesn't go over so well when you're in an academic institution. And we hadn't really talked about that very much. He was just too embarrassed that it didn't last very well.\n\nJohn Saultz:That's a hard thing to avoid having happen, the more senior your leadership position becomes. And for me, that's why staying really clinically engaged was important for me, because the clinical practice keeps you humble and it keeps you part of a group that's interdependent. And at least for me, it played that role. But I think the idea of friendship versus work colleagues versus boss- subordinate relationship is really kind of key. But that relationship became really important, it sounds like, to both of you for the rest of his life.\n\nJohn Frey:Yeah. I would see him and EJ at least once every year. I'd drive through there coming out west. I'd go through and I'd spend a couple days and we'd talk, and then I'd call him on the phone, and then we'd visit. I've found letters. I don't know what to do. I was going to talk to Crystal about this. I actually talked to a lot of folks about things back and forth with Gayle that are very revealing of a lot of things that are important about who he was and how he ended up being who he was. But I'm not sure they're ready for... They probably ought to be ready for an archive between the two of us, and I did the same thing with him.\n\nBut one of the things that happens with mentors... I don't like the word mentor, actually. Mentor is okay for an organizational structure. But he was my friend and he was my teacher. Teacher is good enough for me. As they get older, and as you get older... I think as Gayle got older, he did a different thing at that period of his life than I've been doing. In many ways I'm doing what I'm doing because I don't want to become what Gayle became, which was somebody who was withdrawn, who had a huge amount of disappointment. He was the person who warned us about things not being what we think they're going to be. This whole question of the future is going to have challenges and difficulty. But I think he had a real belief that generalists and family medicine was going to be the important part of the US health system that would save a lot of people's lives and make folks happy.\n\nHe had a real image of what the world was going to look like that got more and more damaged as he got older, because he hated HMOs, he hated all sorts of stuff. I used to tell him, \"Don't talk like that with me because I got to work in that world still. I'm still there. You can't tell me how awful it is, because I have to work in that awful world. Do you want me to leave? Do you want me to get out or what?\" I had to figure out how to make it work. It's this old line we were talking about before is, if you're inside, your job is to make it work, not to complain about it.\n\nJohn Saultz:Well, that from my point of view, just looking at it in my own life is the challenge that our second generation had to deal with.\n\nJohn Frey:Yes.\n\nJohn Saultz:When do you admit 400 people to the hospital to teach them a lesson? And how, as you become a really influential department, you have a lot more to lose. And so there's cost involved with that, and you're trying to figure out how to be true to these notions. I've made a bit of a study of how people that I admire a lot have managed being retired. And I'm trying to take object lessons from all of them too, but it's very difficult for people not to be dissatisfied about the regrets that they had in their career, things not listened to. And partly, you can't celebrate accomplishments if you're overwhelmed with regrets all the time. But I'll tell you, if I were to list out all the things I did when I was the editor of the journal, the festschrift we did on Gayle, and bringing him back to the annual meeting with all those people sitting around him trying to figure out what to say to him, that really is high on the list of things I'm proud of.\n\nJohn Frey:It should be. Because again, we don't celebrate history. We don't acknowledge the effects that come down through history. We're not unique that way. But I have run into some places which honor people by just doing simple things like naming something after them. I always make fun of Kellogg because we'd sit down and we'd all say, \"Are we going to get the Kellogg prayer now?\" And the Kellogg prayer was W.K. Kellogg believed in people. And so he said, \"I am going to leave my money to people, not things.\" And that was the phrase. And as I thought about that, that was always there. So if you wanted to understand what Kellogg was up to, you would have to think about that.\n\nIf you have an idea, they're going to give it to the person. They're going to give it to somebody they believe in rather than a thing. So you had to frame whatever your idea was in the shape of a personal mission. I've been having a great time going through my old files and finding stuff. Ooh, there's stuff in there you wouldn't believe. I found all my conscientious objector literature, so I'm sending it to my son so he has that because I partly did it for him.\n\nBut all these things that are important to me, and I think they have some element of contribution to the discipline. And I think, hopefully, younger physicians, physicians coming along who have idealism, who have energy, who demand or want change, will find out that they too can demand change. They have to. It's not going to come to you from institutions, organizations. It's not going to come to you from oversight groups like ACGMEs and so on and so forth. It's going to come to you when you demand it and you show them that you're willing to make the sacrifices to make it happen. If you want to radically change, there are a couple people who are trying to do this new model. Go, go, go is all I can say and give it a chance, and they have to see how thrilling and exciting and satisfying that is. But let me just say one thing about regret, that I have this place in Northern New Mexico, that spacing of my sanctuary, and we were...\n\nPART 3 OF 4 ENDS","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298#t=3364.0,5044.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298/transcript/83660/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"John Frey:there a month, well, three weeks ago. Our next door neighbors are monks, right? There's an orthodox monastery next door to me, and I've known the oldest monk there for probably 32 or 33 years. Because our land was land and theirs was an old Adobe house that they remodeled and made into a little church and stuff. It's just him and one other guy. It's now a wonderful monastery, built a beautiful chapel. It's run by an extraordinary Abbott who's a young man of, he's 6'4 and 170 he looks like, and he has a tall hat and he has, he's just a remarkable human being and he's gotten to be a very good friend. And we talked, and probably right after I retired and actually stopped rather than just taper. And I've had some health problems and challenges over the years and things like that, which I think about, worry about.\n\nI wasn't sleeping very well. I was just tossing and turning and I'd think about stuff, go down and read, come back, try to sleep. It was a disaster. And I thought, this is not healthy. I can't. And so Father Silaoun and I were talking and they make beer over there. They make great beer, great beer with hops that are grown in our community, believe it or not. And so Fr. Silouan  said, \"I'll bring some beer over and we can talk,\" well, you know what Abbots need people to talk with too. So we have this lovely conversation.He talks about what's going on over there and what is he going to do. And we do a little back-and-forth therapy thing.\n\nAnd I said, \"I'm just not sleeping. I don't know why I'm so anxious about stuff, I don't know what I'm anxious about. And he just stopped. And he said, \"Well, you know,, \"One of my teachers, said that regret traps you in the past. Anxiety traps you in the future. And if you want to be in the present, you have to let them go.\"\n\nJohn Saultz:Wow. That's very profound.\n\nJohn Frey:Yeah, it is. It's incredible. And I just said, \"My God, why didn't I know that 20 years ago?\" And part of it, John, is that I realized I have more of the anxiety end of things in my psyche. And for some reason or the other, I think part in fact because of some of the things I told you about my life up you can't get back there and relive that stuff. It's just too hard. It's too hard. And you can't think about all of my accomplishments at Wisconsin, what I often do. And Cathy says, \"What did Father Silouan  tell you?\" And I said, \"You're right.\" But I started to think about, well, we didn't do that. We didn't do that. We didn't do that. We didn't do that. And boy, that was hard and boy, but look at the things we did do and look at the things that we were able to do and so on.\n\nSo letting regret go, which is why breathing and Zen meditation is very good for people.  The whole point is to let your thoughts go, not to hold onto them. And it's training to do that. Now, I'm not great at it, but I work every day. And that's an important factor that I think is going to make me be able to do the future without a tremendous amount of anxiety. And certainly the past, I have nothing except a lot of affection and a lot of things that could've would've should've is not part of my thinking. Well, most of the time.\n\nJohn Saultz:I'm sitting here thinking, John, that one of the most memorable STFM plenary talks that I ever heard was one you gave, and it was in the late eighties, and I don't remember what the title was, but the thesis of it was to really talk about the great teachers in your life. And I think that maybe one of the more profound lessons Gayle shared with you is this business of regret. Sometimes you learn from your teachers what not to do just as much as you learn what to do. And a good teacher is okay with the fact that I'm not a complete and all-worked-out human being here. And if you can learn from my mistakes and my flaws, then I feel that's the next level as a teacher. Gayle, you didn't have to agree with Gayle, but I think maybe you're taking as an object lesson. And I think that's the way it is been for me with a lot of my mentors. Some of them teach me the things I want to be like, and some of them teach me the things to avoid. And they're both really good lessons.\n\nJohn Frey:That's right. I think everybody's said it, but we learn a lot more from our failures than we learn from our successes. If we're good, if you sit down and say, \"Now why did that not work?\" I mean, that's this whole point behind a lot of the language around Silicon Valley and innovation and creativity is you learn from what didn't work and you try and fix it the next time. And one of my favorite questions, when I'm interviewing medical students or potential medical students, is this article from David Greer something that was in the Journal of Medical Education before it changed, which is called “Failure as a Criteria for Admission to Medical School”. And so I have a way of putting a question to them saying, what experience have you had with failure in your life and how have you dealt with that? Now for some, and I think it's probably the single most, that question differentiates between the students I want in our profession and the ones don't.\n\nThe ones who don't say, \"Oh, I remember when I got a B plus in organic chemistry and I was really feeling terrible.\" Crashed terrible. And I thought, but then the ones who will sit there and look at you and say, I mean, the one that I never forget was somebody saying, \"I always felt like my parents' divorce was my fault. And I had to learn to not think that way. And it's made a big difference.\" I thought, what are you 20 years old and you figured that out, how, please come to medical school? So I mean, this whole idea of failing with your ambitions, failing with your hopes and failing all that stuff, and you get up and you dust. I mean, that's what I guess we learned from the generation before us. Many of them, not all of them, but many of them is that just got up and kept going.\n\nGene Farley had wanted family charts as the core of every place he's ever worked and they never were. And so that one thing, which was brilliant, true, and it would change everything. It's still not there. When you see Mr. So-and-so, if you also had Mrs. So-and-So, and the two kids in that folder, and you could look and say, how's she doing? What's going on? What? It makes your connection so much more, but it's all one-on-one right now. So Gene had that for his whole life. He lived into 86 and it never accomplished it. And all I have to say is say, \"You were right. We were too lazy to make it work,\" on and on and on.\n\nBut he kept going. He was the happy warrior about a whole bunch of things. So he learn from that. But I think going forward, I don't know, John, I think finding what I should be doing in my profession, in my life is a real challenge. I mean, I'm writing and writing and writing and writing and getting rejected, rejected. That's okay. I mean, I'm writing essays and so essays are easy to reject, but I keep them and look, I like to write, so I do it. There's so many big things that need to get written about and studies that need to get done. And part of our job is to, the experience with the loneliness research was really life altering for me in a weird way because I did an SCFN which is an STFM shark tank, I got up and just for the hell of it, I had this idea about the fact that my patients are lonely, and nobody ever talks to them about it.\n\nAnd then I read a little bit and they said, \"Oh, this is a bigger risk factor than smoking and everything else you can think about and we never talk about it?\" And they presented it at the STFM meeting and Frank DeGruy and who else is there? A couple other folks in room came up and said, \"I want to work on that with you.\" And I've never done things with other people. I'm not that good doing it. And it ended up being a wonderful experience, and I learned a ton about doing research, how hard it was, but also how an important topic will find its way and still isn't in people's charts. We still don't ask people that question. It's funny, I did all the time with my men patients. But anyway, so you keep learning and I keep hoping that there'll be some way, but this idea of being helpful to younger faculty members is still first and foremost in my mind. Now I've been doing it since I stopped being chair, which is a long time ago.\n\nAnd it's the most satisfying thing I can do is to sit down and say, \"How's your life going?\" And I have no power. I have no role, I have nothing. It's just called John having breakfast or John having a coffee or John having this, and maybe you had that. But I didn't, I mean, as much as I love Gayle and other people in my life, there was not a process of just checking in on me to saying, \"How you doing? How's life going?\" And boy, do we need that all the time. And as you get older, you need it more actually. And so that for me is the service that I can provide and maybe a model that I can provide to younger physicians that when they get to be senior clinicians, then they take that as their responsibility. I did that as Chair because that was my responsibility, but I'm doing it now with selected people because I just want to talk with him and find out how they're doing. \n\nJohn Saultz:Well, my, I've been doing a fair amount of that, and I've been trying to broaden the denominator from people who are in medicine to people that I know in other ways.\n\nJohn Frey:Absolutely.\n\nJohn Saultz:And I find that the principle of just being interested in their lives and listening to what they have to say is incredibly good for people. And it's good for me because  I'm curious about how things are for them and particularly curious about how people are in the healthcare system right now. Very curious about what being ill and what being a patient is like, because now that I'm not practicing anymore, I'm really worried about how frightening it is for patients to be patients around people they mostly don't know, talking to them about things they mostly don't understand. And so that's how do we get that sense of advocacy back and sense of relationship with patients. On the one hand, we've got all these tools like video conferencing to stay in touch with people that should make it easier. Think back when we were residents, how much it easier it would've made things to have had a cell phone to call people back as opposed to go find a payphone someplace,\n\nJohn Frey:Right? I mean, we were lucky to have beepers,\n\nJohn Saultz:Yeah. And you get these pages and you didn't know what they were about, so you felt like you got to call back right away and you can't find a phone, which really made you landlocked. And I used to tell medical students, \"Well, cell phones were a really big important deal for me because they made me able to move around and still be available to patients.\" And yet we're less available to patients now. And so there's paradox in that, I think. But I agree with you. I think people need that sense of just caring connection, caring connection.\n\nJohn Frey:Yeah. And people, really great writers are writing about it all the time, and yet the world continues to disconnect in a way. And so I've got to find a way for myself. Part of the reason we lived for a decade in Santa Fe and loved Santa Fe. I mean, it's got a lot of things to offer. It's a wonderful city. But I didn't have a community. I didn't have neighbors. I had one neighbor who was there often enough. I mean, it's a bunch of part-time Texans, unfortunately, but a lot of them were in, a couple people lived there long enough so I could actually build a relationship with them. And then they moved to Chicago. And so when we were deciding where to go, we thought, oh, the one couple we get to know really well there are moving to Chicago, and if we go to this place we were looking at, we could just be a train ride away, which we are.\n\nAnd we see them a fair amount. So yeah, I mean it's fascinating to seeThe reason why writing about continuity and connection and keeping on that and pointing that out is so important as you've done is because that's the way you build trust, confidence, connections and so on and so forth. And then what you realize is that's what keeps you going every day. It's getting up in the morning and going in, if you're doing clinical work. It's saying, \"What am I going to find out about people I didn't know? What am I going to find out about me that I didn't know?\" It's this sense of curiosity about the world that is crucial. And so to go into your day without that just would, I mean, then it becomes a job. Yeah, so.\n\nJohn Saultz:Did I not ask you any questions that I should have asked you? \n\nJohn Frey:That's always the good question.\n\nJohn Saultz:Did we leave anything out?\n\nJohn Frey:No, I yakked. I didn't mean to, I didn't have this organized, believe it or not. But I think, no... There have been plenty of reasons. If we look at things now, compared to when I started 53 years ago as an intern, all of what medicine and family medicine and general practice offers in terms of personal and professional satisfaction is still there, but it feels so lost in some way or the other. And one of the things that has also kept me going, John, is this idea when I told you about North Carolina having this AHEC system, is I talked to practicing doctors. And when I stopped being the acting chair there, I became the director of the Chapel Hill clerkship for students, third-year clerkship.\n\nThey had clerkships in different AHECs and stuff. And so I travel out to other AHECs and talk to docs about their communities, and they'd talk about these, \"Oh, you got to go see John Saultz, he's an amazing, you got to talk with him.\" So there's this network of people that we know are really wonderful people, wonderful doctors are exemplars. And I just force myself, force myself. I just take the time and do it whenever I can to go talk to these people and say, people talk a lot about you. You're doing something really important. What's the story? I just want to do it for myself or call them up, or things like that. And I think what's important is there are exemplars out there outside of the academic bubble that we live in, who are doing wonderful things with great creativity and energy, and yeah they get discouraged.\n\nBut don't talk to me about burnout. Talk to me about how you pick yourself up, dust yourself off, and start all over again, that kind of stuff. And there are enough people, and I believe there will continue to be people who are out there in communities of all sorts doing wonderful things and enjoying themselves and really living an extraordinarily happy life. But they're stressed and challenged. And our job is to make sure that we build something whatever ways we can that's going to support them and keep them doing that. That's their choice. And it's the story. My favorite story is about Dave Loxterkamp and him coming to the fellowship in North Carolina, and we had the faculty development fellowship, and then we had a full-time fellowship that was there, which I have ambivalence about, but I think it serves a purpose for a lot of people.\n\nAnd so here comes Dave Loxterkamp, who had already written something that I was using to give to people, saying, \"This is who we are, this is what we do.\" So Dave comes in and I was the fellowship director, and he said, I'm looking at fellowships, and I was wondering what your thoughts are about fellowship. And I said, \"Don't come here. Go back to Maine. What you're doing is unique.\" I don't use that word ever. What you're doing is a service to all of us. And if you don't keep writing and learning and doing all those things. So I think one of my major accomplishments in life was to talk Dave Loxterkamp out of going into academics, because even it's funny, even his academic time after he retired from practice was not as enjoyable for all the reasons that we've been talking about.\n\nJohn Saultz:Yeah. Yeah. He's written about that.\n\nJohn Frey:I wanted to say, \"Boy, what a privilege for these residents to have Dave Loxterkamp as a teacher,\" and all they want are the top five drugs you use for something or other.\n\nJohn Saultz:Yeah.\n\nJohn Frey:And they don't want the stories. So anyway.\n\nJohn Saultz:Well, John, I would say that one of the reasons why I treasure and love you so much as a teacher is the degree to which you put together two things that have really, really been instrumental in how I think about myself as a teacher. The first is that you think deeply about things, and you're not scared to do that. You think, what does this mean? What are these people doing you? And you're curious when you read something that Julian Tudor Hart wrote, or you hear something that Gayle Stevens said, but the step that you go farther than that is that you hear a call to go learn about that, and you can't help yourself. You go and spend a year in Wales, or you go and visit somebody, or you just make a cold call to connect with the poetry work you did around your fellowship with Robert Coles and William Carlos Williams, which we didn't talk about here.\n\nI have been doing a lot of thinking within the context of my church about how one hears and responds to calls. You could say a call from God, or you can say a call from Destiny. I would say, when you read this paper and you can't help yourself but to figure out who this Julian Tudor Hart person is, you open up a whole new branch of your life that you didn't know was coming. And you have always been an exemplar of that for me. I think I've learned that from you, and it has made my life richer, and I think it's made me a better teacher and a better physician.\n\nSo I appreciate that. I really appreciate getting the chance to talk to you about it. And I think in this interview with you, that sense of intellectual journey is everywhere in this discussion we've had today. So I thank you for sharing that. It was my hope that people would get a sense of how you listen and then respond to calls that are in your world. And that's a blessing and your sharing that with me has been a blessing to me, has changed how I live. So there's something to be said for that. John,\n\nJohn Frey:Thank you, John. I really do appreciate that a lot because you're somebody who, I think the great experience of a teacher is to have people, you feel like you're doing a good job and showing them some things and opening some doors, but to watch students just zoom past you and when you're, as Carmichael used to say, \"I like to sit at the back tables to see if I can watch people I knew be at the front of the place.\" And so you have zoomed way past anything I was able to do, and I just think it's a joy for me to see something you did at the Keystone III. You did a summary that still to this day I've been asking people and say, \"Can I get that?\" Even a summary of some of the most incredibly difficult things that talk we talked about and we did in a way that was as clear as anything I've ever seen.\n\nI thought, \"Holy shit, how can somebody do that?\" You have the ability to integrate things in a way, that's a gift. And so part of it is we learn from each other and to see people have great careers and continue to have great careers inspire people and stuff. I'm really proud of what you've done, and I'm glad to see you enjoying yourself and you deserve it. But you also, you got to keep talking to people. You got to keep taking people to coffee and listen to them.\n\nJohn Saultz:I personally have decided that there's hardly any loyalty owed to organizations. No, no. The loyalty is to people. Absolutely. People ask, don't you care about what happens to the department here in Oregon? And the answer is, the department in Oregon is nothing but the collection of the people that are there. If you guys thrive, the department is fine, but I think organizations change over time and they don't always change for the better, but people need to be changing for the better if they can.\n\nAnd I do not know how, it's been a wonderful thing for me to get a window inside of how those career transitions and calls were for you from the inside of you. Because looking at it from the outside, they were all pretty inspirational to me. How did things work out, or to what extent was this a blessing that John didn't just decide that he didn't have the time to figure out about this Julian Tudor Hart guy? Because it's been an enriching thing for many, many people and it obviously changed you and through you changed us. And I just can't thank you enough for that.\n\nJohn Frey:Well, thank you, John. It's been lovely to do this. One of the things we will do, I promise, because I told Kathy we're going is, we've got so many friends in Portland now. It's unbelievable. It's like my roommate from medical school, a family doctor there who's one of my longtime friends from Notre Dame, you, Marco, a whole bunch of other people that are all living in Portland. So we got to take a trip to Portland and spend a week and just have a good time visiting.\n\nJohn Saultz:Well, you're welcome here anytime. I have to tell you now, now that Fox News is telling everybody there's violence all the time in Portland, it's amazing. I go back to the Midwest and people go, \"Well, aren't people rioting there all the time?\" No, but we didn't put up with Donald Trump very well. It is our equivalent of admitting 400 people to the hospital.\n\nJohn Frey:Yeah, exactly. Exactly.\n\nJohn Saultz:Anyway,\n\nJohn Frey:Thank you, John.\n\nJohn Saultz:You're welcome here. Anytime. Crystal, can you come back on, is there anything else we.\n\nPART 4 OF 4 ENDS","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298#t=5044.0,6582.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298/transcript/83660/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298#t=6582.0,6558.37733"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298/transcript/83661","type":"AnnotationPage","label":{"en":["Interview Summary [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298/transcript/83661/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interviewee: John Frey, MD\n\nInterviewer: John Saultz, MD\n\nDate: March 27, 2023\n\n“I’m an eclectic; I like breadth,” says 79-year-old John Frey, MD. And, breadth is what he was exposed to as a student at Marquette High School in Wauwatosa, Wisconsin, where he learned the importance of dedication to communities, to service, and to social justice. He was exposed to a prime example of this type of dedication after his first year at Northwestern Medical School in Chicago, Illinois. He traveled to a migrant camp in Waushara County, an area known as the Appalachia of Wisconsin. Here the local physician made him the “impetigo doctor” who went into the camps and homes to distribute the necessary medicine. After returning to Northwestern, he volunteered in Chicago’s West Side and the Mexican neighborhood around Pilsen. Then he became involved with the Cook County Hospital’s Internships and Residents Association which launched a successful campaign to improve working conditions and patient care.  \n\nDr. Frey spent his two years of “individually focused” residency at the Model Cities Program, a migrant camp, in North Dade County, Miami, Florida. It was here in the early 70s when he became convinced that a physician’s job was to be in the communities not necessarily in the hospitals. During this same period, he learned about the newly established medical specialty of family medicine. And, it was here that he made a decision to become a teacher which he did for the next seven years as a faculty member in Worcester, Massachusetts, helping to establish a program for rural clinics.\n\nNext, he worked nine months as the first American trained, board-certified, general practitioner in the National Health Service. Then he joined the staff of the University of North Carolina at Chapel Hill, which was the most professional experience of his life as he worked along-side intelligent people who had gumption.  His positions included Acting Chairman and Director of the Clerkship for third year medical students. A change of pace occurred when he went to work in the Center for Documentary Studies at Duke University where he practiced and wrote. Today, he is still busy writing because… “There are so many big things that need to get written about and studies that need to get done.”","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159336/file/290298#t=0.0,6558.37733"}]}]}]}