{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/4x54f1pb1d/manifest","type":"Manifest","label":{"en":["Dr. Donald Brown"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1989-05-09 (captured)"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","Dr. Donald Brown","family medicine","family physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Donald Brown, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["english (primary)"]}},{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eInterviewee: Donald Brown, M.D. \u003cbr\u003eInterviewer: John J. Frey, M.D. \u003cbr\u003eDate: May 9, 1989 \u003cbr\u003eDr. Donald Brown discusses his medical transitions from rural to urban aspects in Nova Scotia. His story is that of a white, Anglo-Saxon, Protestant Scot with a hard work ethic which was developed as he was raised on a farm in the rural atmosphere of Shubenacadie. Rural was where he wanted to stay even when he completed two internships: one in Munson, one in Newfoundland. Then he spent a year practicing with Dr. Austin Crayton in Tamabush which was only 90 miles from his hometown. It was here that he realized the importance of learning by doing while in the office, the local hospital or in home visits. The following year, he practiced alone at River Hebert, the poorest area in Nova Scotia, where two coal mines operated. His next practice was at Amerst where his family settled into its small community expecting to spend the rest of their lives there. But, after six years, their life changed from rural to urban when Dr. Brown accepted a position in Halifax. He says, “I saw it as a new challenge with more educational opportunities. And, I could come to the Sir Charles Tupper Medical Building and put my bag down.” It was here that he could train himself for yet another career in medicine. This time it would be in research. But, he would be the first person to tell you that he misses the sense of community life that can be found in a rural practice.  \u003c/p\u003e (summary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}}],"summary":{"en":["\u003cp\u003eInterviewee: Donald Brown, M.D.\u0026nbsp;\u003cbr /\u003eInterviewer: John J. Frey, M.D.\u0026nbsp;\u003cbr /\u003eDate: May 9, 1989\u0026nbsp;\u003cbr /\u003eDr. Donald Brown discusses his medical transitions from rural to urban aspects in Nova Scotia. His story is that of a white, Anglo-Saxon, Protestant Scot with a hard work ethic which was developed as he was raised on a farm in the rural atmosphere of Shubenacadie. Rural was where he wanted to stay even when he completed two internships: one in Munson, one in Newfoundland. Then he spent a year practicing with Dr. Austin Crayton in Tamabush which was only 90 miles from his hometown. It was here that he realized the importance of learning by doing while in the office, the local hospital or in home visits. The following year, he practiced alone at River Hebert, the poorest area in Nova Scotia, where two coal mines operated. His next practice was at Amerst where his family settled into its small community expecting to spend the rest of their lives there. But, after six years, their life changed from rural to urban when Dr. Brown accepted a position in Halifax. He says, \u0026ldquo;I saw it as a new challenge with more educational opportunities. And, I could come to the Sir Charles Tupper Medical Building and put my bag down.\u0026rdquo; It was here that he could train himself for yet another career in medicine. This time it would be in research. But, he would be the first person to tell you that he misses the sense of community life that can be found in a rural practice. \u0026nbsp;\u003c/p\u003e"]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150630/file/277800","type":"Canvas","label":{"en":["Media File 1 of 2 - Brown_Donald_1989.05.09_-_Side_1.mp3"]},"duration":3771.056,"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/3180/collection_resources/150630/file/277800/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150630/file/277800/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/277/800/original/Brown_Donald_1989.05.09_-_Side_1.mp3?1750272920","type":"Audio","format":"audio/mpeg","duration":3771.056,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150630/file/277800","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150630/file/277800/transcript/81249","type":"AnnotationPage","label":{"en":["Dr. Donald Brown Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150630/file/277800/transcript/81249/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1: …I graduated in a rural area in a small town in Missouri and she always wanted to practice [      ]. In other words, in her hometown, in the rural area.\n\nWhat’s your story about how you ended up in a small town?\n\nWell, that’s my story too. I grew up in a rural village.\n\nIn Nova Scotia?\n\nYeah, in a place called Shubenacadie.\n\nShubenacadie?\n\n \n\nShubenacadie. That’s Micmac Indian, means a place where brown nuts grow. And there is not similar [        ] former President Carter on TV. I think of peanuts when I think of him. But they’re a bit like peanuts and they grow along the Shubenacadie River. The Shubenacadie River is one of the three rivers in the world that starts with one side of the [        ] country or whatever and goes [        ] you can see on the other side. The Shubenacadie River starts on one side, to Lake Halifax, and goes back to the Province and goes into the Bay of Cobequid?. One of the highest tides in the world there. And Shubenacadie is right in the middle. So there’s a different, of course, to be told by the tourists about Shubenacadie. (Inaudible.) But I grew up on a farm. I was a 4H member. I judged cattle and heifers at the local agriculture expo sort of thing each year. And I was comfortable in a rural area. And, of course, I went to practice in three small, rural communities in Nova Scotia.\n\nWhen you grew up, was there anyone in your family that was in medicine?\n\nNo, not anywhere except now there’s a cousin (I have about 40 first cousins) that’s a physician in one of the branches of the tree…\n\nBut these are more contemporaries, not…\n\nMore of a contemporary. No one beforehand. But, of course, there was a local community family doc. Just an outstanding family physician. And after I became a doctor, every time I went to refresher courses, Dr. McGinnis was always there keeping up.\n\nSo he really was a kind of an inspiration?\n\nI suppose so. Yeah, I think so. And, of course, he didn’t actually encourage me because I was never sick. I only had to see him once in my life.\n\nOh, really?\n\nAnd that was an accident where we were playing around in the barn and I was sliding down the chain and the hook caught me in the crotch sort of thing and they thought maybe I needed stitches or something. That’s the only time I saw him as a patient. I was about five. And, again, I was a home birth, born at home. So I went to rural practice, the same thing. I went to one community where acting as an internship, I had agreed to take over…I went to [        ] first and practiced there. (Inaudible) is the only medical school in Munson (?), before Maritime Provinces. That’s including Newfoundland, which is Atlantic Canada. Maritime Province is [        ], Nova Scotia. So I wanted to get all of my internships outside of Halifax as much as I could. So I had two months in Munson (?) for pediatrics, Munson family medicine, and two months in Newfoundland. And that was the maximum I could get out of Halifax.\n\nYou wanted to get out because you wanted to see what else …\n\nDr. Brown: I wanted to see what people did and another way of doing it. And I wanted an emphasis on the smaller community, rural sort of thing. So I could do that in both places. Just like practicing ambulatory medicine back in the ‘50s. So in Munson (?) I was covering this family doctor who lived 15 miles outside. And he was very busy and I looked after his patients as an intern on the service. And he liked me. I had agreed to take over his practice, he was going to move to another community in [        ] in Nova Scotia because his wife, again, was from Wallock (?), ten miles away from [        ]. \n\nWhere did you get married?\n\nI got married a week after graduation. I had about five classmates there.\n\nSo you knew your wife and you were planning on getting married, so she was…\n\nWell, I met her when I was in Munson. She’s a nurse and I met her in the hospital in Munson.\n\nSo you met her in a small town?\n\nWell, it was 40,000 at that time. It was a city pretty much. So we got married after I finished my internship. Now in Dalhousie you got your MD after the internship in those days. In 1974 (?) they had two graduating classes with MD. One before the internship and one after. Because Dalhousie internship was part of the training of a doctor. And it was one program and the internship included these hospitals all around the Maritimes, where they went through their training. So in order to take part in the Canadian Intern and Resident Service, we had to get our MDs before internship so they had a choice before then. So we weren’t mobile for our internship. So in ’74…that’s why. So that’s part of it too. But I was in Tamabush for a year. And the reason I went there was because the doctor decided to go take his residency in internal medicine, so he wasn’t going to go to Tamabush. So he had agreed with [        ] to go there. So I said, well, I’d be quite happy to go to Tamabush, you know. So I went there.\n\nHow far away was that from home?\n\nThat was 90 miles straight north. It was on the opposite shore, the north shore, (Inaudible). And a small community. He was the only doctor there. But he was too busy, so he wanted another doctor so he wouldn’t be so busy.\n\nSo you went there and he left?\n\nNo, he stayed, you see. This other Dr. Crayton. And we were in partnership. He built a new clinic for two doctors and so on. But what happened, we gave so much better service, people came from 30, 40 miles. And we were going on house calls 30, 40 miles away. And I didn’t have any more time. In the meanwhile, Lake [        ] is a coal mining area 17 miles from [        ], no hospital. In Tamabush we had our own hospital. And we did surgery and I would do anesthesia while he did things. You know, that sort of stuff.\n\nThis is when you did the internship, then you went up (Inaudible)…\n\nYeah, that’s when I went to [        ] France. And it was like an apprenticeship because this guy was really up on…he would send patients to Halifax to the tertiary care hospital. I would get a resident – well, what do you expect me to do? You know, he had done everything. He was in [  ] and all that kind of stuff. And he did a four-year training in obstetrics too. So we were doing everything in terms of obstetrics. We weren’t doing Cesarean sections – shipped those 30 miles away. \n\nI remember asking you – because when we talked about this before, the feeling I had is how in the world do you learn how to do those things given the fact that, you know, how residents are so conservative.\n\nYou see, in the ‘50s there was one way then. We didn’t have a choice of a residency, you went out and you learned by doing. And I still think that’s the best way to learn. And so that’s why the residency program was marvelous with the rural and the urban and learning to do by doing the types of things, the types of patient problems you’re going to have a practice in. And so when I was in Tamabush, I was learning with Austin, that sort of thing. And he told me, when we were there a few weeks before, you’re going to have to pull teeth. Well, I had no training in exodontia. So he told me so many things, I had forgotten in the first afternoon. I was in the office alone and this farmer come in with a loose tooth in the front. I was fiddling around in the drawer getting a local because I didn’t have enough time to learn exactly how to do it. And he looked over my shoulder and said, no doc, no needles. So I breathed a sigh of relief and dug in the drawer to see which one of these instruments should I have. And, well, this one looks like it will fit. So I put it up around and just rotated and the tooth come right out. And he was quite happy. He paid me the $3 and went out, and no needle.\n\nAnd you breathed an enormous sigh of relief?\n\nYeah. But I was reading my Hamilton Bay that night about locals and all. So you learn to do by doing. And then a year there…the size of the community wasn’t big enough to support two doctors but it was too big for one. So he guaranteed me a minimum and I was getting over my minimum after about six months. But, again, he wasn’t getting any more time off. And meanwhile River Hebert always had two doctors and the doctors would do all their obstetrics at home, home deliveries. And one would be in the office and one would go around house calls, around the [        ]. And it was a [        ], which was a practice. A coal mining area. Two coal mines, one in River Hebert and [        ], three miles away, had a coal mine too. And the former doctor was a member of Parliament, had a big farm, who owned the coal mine and was doing all these other things. And he couldn’t practice any longer because he had [        ] disease and he couldn’t remember. He would go out on house calls and he couldn’t remember how to get back. That’s how bad this disease had progressed. So I went there, where there were no doctors, when there always were two. So I was there alone covering 5,000 population. Two coal mining [        ], with for $1 a week taken off their pay…\n\nIt was a prepaid cap payment?\n\nYeah. In fact, I gave a farmer and a miner and his family total healthcare, including triple [        ]\n\npain pills. But I had a contract and I wrote into the contract – again, talking about educating, I had written into the contract I would see them in the office during office hours and I would see them on house calls that were necessary. And, of course, I decided what was necessary. \n\nWho was the contract with?\n\nThe individual patient.\n\nSo essentially you had a contract with the patient?\n\nReally with the miners, you see. But that accounted for a third of my practice. Two-thirds was not. And this was the poorest area of Nova Scotia, so I was collecting about two-thirds of what I made and the other two-thirds of my…\n\nWhat was the name of that community?\n\nRiver Hebert, Joggins – and River Hubert.\n\nSo you were in Tamabush for a year?\n\nA year. Then I was on my own with this [        ] for two years. And I got a resident in psychiatry, a fellow a year ahead of me, to cover my practice. Because I had a contract, you see, so I needed a vacation and some…I agreed, when I went into practice, that I should have at least four weeks’ vacation and two weeks CME, continuing medical education. So this was the only coverage I could get. So I had four weeks off. And that guy, the first week he was there he had five OBs and a major traffic crash. And, of course, we were…\n\nThis is the psychiatrist?\n\nYeah. And we were 17 miles from the hospital in Amherst. So he had a baptism of fire. But he had a good month. He got through alright. But there’s no obstetrician in Amherst, you see. A general surgeon. So when we needed a consult, we’d get another family doc and we would decide between us whether a [c-]section was indicated. And we would call the general surgeon in and we’d assist on the patient sort of thing. So it was that sort of thing. You were doing a total of…but I refused to deliver at home because there were always two doctors before. And that was part of my contract. And I would deliver them in the hospital. \n\nYou had a hospital in River Hebert?\n\nNo, Amherst, 17 miles away. So I put 30,000 miles on my car the first year there. And after two years there, I couldn’t get anyone to cover the practice the second year for vacation or continuing education. So where I was going into the hospital in Amherst, they wanted me to go in there. And, again, we had two children at this time. And River Hebert was a rural area and it was the first regional high school in Nova Scotia. In other words, the doctor was responsible for that. So he was into education as an MLA too. \n\nThe old doctor that was there…\n\nBeforehand, yeah. And very pillar of the community. And the other thing about educating…you know, after six months I figured it was time to hand out some bills. And you should have heard, Dr. Brown sent us a bill. Dr. Cofferan (?) never sent a bill in 37 years, you know. So, anyway, that was part of the practice too. But I was getting a check from each mine every two weeks, which was one-third of my practice and $1 per…but, again, it was a median educational learning thing. I learned a lot in practice and I’m still learning, of course, as we always do from our patients. But, again, that was my background. And I was really enjoying it. And that was the point in my life, as a physician, when I decided what I was going to do the rest of my practice life. And I decided…I only considered three residencies. One was OB/Gyne, but I knew my back couldn’t take the surgery for the gyne component, so I said no to that. And then pediatrics was another one. Then when I really thought about it, pediatrics is just too simple. They only have one disease and it’s pretty straightforward. And you relate to patients and the whole family and so on, but it wasn’t a challenge enough. And the third one was psychiatry. And you really get to know people that way, but in family practice you get to know them too, but then you lose your stethoscope and all the things that go with that and you turn to diagnostic challenges and so on. So I decided I’m going to be a family doc the rest of my life. So we moved into Amherst. That was our final move. We planted a hedge and we were there for the duration until they asked me, [        ], they come up and recruited me to go back and start the residency program. So we were going to stay in Amherst the rest of our lives.\n\nHow long did you end up living in Amherst?\n\nSix years. So I in rural practice over nine years, almost ten. So the post-test, in terms of rural practice, I was still really in a rural…because half of my practice from River Hebert still kept coming in the 17 miles.\n\nWere you with another doctor at River Hebert?\n\nYeah, I was able to recruit one to cover. But, again, he was just there for awhile. And now the physician who lived three miles from Amherst, between Amherst and his office near River Hebert, he’s been there now for the last 24 years, so it’s worked out well. They’ve had a doctor all the time since then, but it was difficult recruiting some. But it was 17 miles from the hospital. But I guess the component there was that they asked me to start the residency program. And it took me two weeks to decide that I would leave my practice to do that.\n\nCan you tell me a little bit about what was going through your mind at that point?\n\nLet’s see, I would be about 33, I guess. No, I would be 35.\n\nAnd you had been in Amherst about six years?\n\nYeah. When we were in River Hebert, we decided to leave there. One of my main reasons was we didn’t particularly want to educate our children there – and it was an education, at least for the kids who went to Amherst. And, of course, the physicians in Amherst were working on having me come to the community. But it was really our decision based around our family and so on. Because, as you know, small mining towns have a particular approach to life, you know. You live today and let tomorrow take care of itself. That sort of thing.\n\nIt’s a real different cultural kind of thing?\n\nOh, quite different. I wish I had written down so many things about the patients and things that happened in the community. I could write a book on that. There’s tremendous material that I…I still recall them, but there are a lot of things you don’t write down but should have. Some of the things that are sad and so on. And a third of our practice was [        ] French and [        ] and all those people. And very colorful, you know, fun-loving people. It was really a very colorful… and, again, I know growing up on a farm, I could communicate very well with anybody in that background and miners. Being a rural person, I think that was an advantage in terms of how you relate to people.\n\nYou felt comfortable even though they were different?\n\nYeah.\n\nTheir ethnic background was, in some cases, quite different than yours?\n\nYeah. But, again, they had been part of the fabric of rural Nova Scotia and it’s primarily Scots and [        ]and blacks. When I moved to Amherst, it’s either…at that point in time, over three-quarters of the blacks in Canada were Nova Scotians. So in Amherst, I would guess a third of my practice was black. And I hired a black for my third person. I was running a business then and I delegated and hired good people. And I asked for three people to be sent out from the local training for receptionists. They sent one black and two whites and there’s no question. And I asked E.J., my chief person who was working with me. She was my receptionist and a former lab tech and that sort of thing. And I made my decision – well, E.J., which one do you think? She was way ahead of the other two and we hired her. And it was quite interesting to see patients come in because, again, you know your patients in family practice. One lady who was a spinster diabetic came in and she said, oh, don’t you worry, Dr. Brown, I won’t need you. And I said, well, what do you mean? She said, you know, those black people, you know how they talk…in other words, it was her attitude about confidentiality.\n\nOh, I see…interesting.\n\nAnd at that point in time, I was booked out about two weeks ahead, so I couldn’t care. But that was just her talking, her attitude coming out. But as far as I was concerned, she was excellent. And I gained a whole ethos. The black/white thing is different in Nova Scotia than it is, say, when I was in River Hebert. I didn’t mention, but when I was in Hebert, the months we took off, part of our trip we went to Dothan, Alabama where one of my classmates was with his uncle, practicing in Dothan, Alabama.\n\nWhat a difference!\n\nAnd we got a fair earful and talked a lot about the black/white Deep South and their black waiting rooms, their white waiting rooms. The white waiting rooms with color TV, you know. That sort of thing going on. And this is the way they had to practice. And if they went out on a house call, if they didn’t demand the money before they left, those black people would never call them again. You know, they would lose patients. So there were a lot of things going on. \n\nWhat were the black/white issues in Nova Scotia in those years? What was that?\n\nIt was very much underground. You know, they weren’t getting the jobs sort of thing. But why weren’t they? Well, there wasn’t anything you could put your finger on. It was just there, but it wasn’t in the open. And there was mixing and intermarriage and things like that. But it was just a different sort of thing. And with five children we often had someone come in once a week. And when we were in Amherst, it was a black lady and she wouldn’t eat with…she would eat with Eleanor and the kids but she wouldn’t eat when I was there, you know. Working with the patients and so on and a tremendous mother and worker and so on. But she just wouldn’t eat with the doctor, you know – that sort of thing. So it was both sides to the white/black. But it was just a different sort of thing. It’s difficult to explain in a clear, verbal way. It was just something that was there.\n\nSo it was pretty… \n\nIt was discrimination…\n\nFor you to hire a black receptionist was a fairly progressive move in those days?\n\nNo doctor had ever done that in Amherst before.\n\nThat’s interesting.\n\nAnd, to me, it just wasn’t [        ]. We picked the best one. And, of course, I always ask other people, because they have to work with the new person. And that was my approach. I always delegated responsibility and made sure there was a communication process going on. So I delegated this lady, my chief, E.J., had a high [   ]. And it was really tremendous. Any of my patients that required an ostomy, they had known E.J. for years and they had no idea that she had an ileostomy. And she would visit them in the hospital after their surgery and she could just give them total education. Diet, you name it, and [        ]. I would write down the diet and she’d do it all. So there was a phone call backwards always to E.J.\n\nIs that a characteristic, do you think, of a small community practice where all of the employees have to be kind of multi-potential?\n\nWell, that’s part of the practice, no matter where you are. You see, I think another thing, we could talk about process again of the practice. I was eight years in the Navy and I learned, you look around communities, ex-Navy, ex-Army, these people, when they retire from service, get the administrative jobs all around. For instance, they just retired this past month, our executive director of the Nova Scotia Medical Society who was an ex-Navy officer. And they’re all over the place.\n\nI noticed that. I saw them…\n\nAnd I learned my administration, as a confidential books officer and top secret stuff and all that, eight years in the Navy as an executive officer.\n\nBefore you went to medical school?\n\nNo, during. So I was there all summer. You get officer’s pay. And one night a week during your academic year. And that’s how I funded myself, too. Because, again, we didn’t have the bucks, you know. So you do what you have to, to get through. But it was a great experience in terms, again, of traveling around the world. So those are things related to being in a family practice. And my wife, you talked about the spouse – she would be covering the phone before we got a TAS in Amherst.\n\nTAS is?\n\nTelephone Answering Service. But we had the phone hooked up to the house, the office phone, when we weren’t there. And she would be answering and making appointments. And every year, every spring a patient would phone my wife and ask about when you put the kids into different types of clothes and things like. Details like that, you know. So she would get involved. But, again, being a nurse it wasn’t a major problem.\n\nWas she a part of the practice? \n\nNo, I always had staff. We had five children to bring up, so that was a full-time job.\n\nBut that was never in your original plans? The two of you never talked about it?\n\nNo, not really. [        ], again, we were there. Now, you see, in rural practice, in River Hebert there was an operator because it was all [        ]. And so that was the best telephone answerer because she knew everybody in the community. And when I would go to Eleanor’s parents’ place, which is 40 miles away in Munson, from River Hebert…the gal, I would tell her where I would be and she would phone me. She told me the total story of Mrs. So-and-So. And I had a phone call once when I was in Munson. And based on what this gal, who was a patient, too, told me about the patient, I said, well, that’s acute cholecystitis. So I came home and admitted the patient to the hospital and we had her gall bladder out the next day.\n\nSo the telephone operator was essentially part of your practice?\n\nYeah, a very important part. And she’d know whether you were halfway between the office and the hospital – you know, 17 miles away.\n\nThat brings up one of the issues. There is an article, I keep saying I will send it to you – and I will do it today. An article on the ethics of rural practice, which I thought was very…it was a survey of Nebraska and rural GPs. And one of the issues, of course, that they bring up is confidentiality.\n\nVery much so. Everybody knows everybody else’s business.\n\nWell, how did that help? And, obviously, in this situation where the telephone operator knew about the patient and that…\n\nNo, we just talked about the office. And she was a patient who was in her 40s then and who was not married. And this was her life, just being that part of the community.\n\nShe was the network?\n\nYeah, she was the network.\n\nDid you ever have any concerns about her? Did you ever have conversations with her about confidentiality?\n\nYeah. And she knew. Because, again, the former doctor, I’m sure they covered it. But she was just a sensible person. And sometimes when she was in the office, she would say, I’m not supposed to know about this but…and she’d give me the key point about a patient’s health that I should know as a doctor that she had heard from so-and-so and that sort of stuff. And, of course, you learn all about your patients from the neighbors and that sort of thing in a rural practice. But in Amherst, when we started the Telephone Answering Service, the group of doctors got together and one of the nurses of one of the physician’s husband drowned. So she didn’t have a job, so she did her TAS in her home. \n\nPeople would call her?\n\nYeah, she had a switchboard in her home. And the burner salesman come in to make a pay. Furnace burner people sort of thing. But, again, part of the communication in rural practice, we talked the hospital switchboard into, we had CB, citizens band radio, in all our cars. Because, again, all the doctors but one had a cottage out on the shore, 17 miles away, and all summer we were up there. So we had a citizens band radio and it came in very handy. Like we would be sending a patient to the hospital, we would just telephone and talk to the nurse on the floor and have things ready, an emergency sort of thing. I was on call the night we had a train wreck eight miles from Amherst. And Maccan, I always went through there, between River Hebert and Amherst. And it was in the woods, about a mile, so I had to walk along the track by all these cars that were burning. And I went up where the train, the two engines had run into one another, and the engineer, his brain was all over the train sort of thing. He was crushed between them. But, anyway, I had to report. And I just went back to my vehicle and radioed in what we needed in the way of transport and so on. And the surgeons were already there when the patients arrived, when necessary. You know, that sort of stuff. And it went very well. And the citizens band in the car was, again, an important part of the care.\n\nSo the communications in a small community has to do with a variety of informal networks – formal and informal. You had the formal answering service to help but also had lots of information from patients about each other, I would suspect.\n\nAnd the other part of why these were so necessary…there weren’t phones in some of the cottages. And you’d take your radio out, take it in and plug it in the cottage for the night. You would turn on the end coder or decoder, turn it off. And the only person who could turn your radio on was the switchboard at the hospital. So if it was turned on and was making squawking noise, you knew the hospital switchboard was trying to reach you. So then you’d go up to the phone at the neighbor’s and phone in. And that’s part of rural practice, communication, and having your time off is part of it too.\n\nWas it Tamabush that you couldn’t get someone to cover your practice?\n\nRiver Hebert was the only assistance. But I had the contract, too, and that was a unique situation. But in family practice, we’re unique in that we have an unwritten contract where we’re covering our practice, whether it’s written or not.\n\nDo you think that made it apparent to you and your family that probably staying there was not going to work in the sense of not having the flexibility?\n\nThat was less of a factor. I think it was really, if I remember accurately, I think it was the education of the kids. And the other thing, I enjoyed it and she enjoyed the community. Like in Amherst, we weren’t going to leave there. It was a 10,000 population and rural and small town and so organized. We counted them, there were 129 social organizations that you could belong to in Amherst.\n\nOne hundred twenty-nine?\n\nOne hundred twenty-nine. And, for instance, I was a member of the [        ] Club. And, of course, the church and things going on like that. And YMCA. And [        ] was a senior and into a whole lot of things. But you have to choose, you know, and you don’t have so much time. But the other thing I should bring up with rural practice that’s crucial…some people have, and by some people we’re talking about training doctors, okay…trouble with, your patients are also your social contacts. And how do you look after your friends? And no matter where you are, as a physician you’re going to see them as patients too. And that in itself. And, also, if you practice in a medical school area, you’re going to have deans as your patients, too, and those sorts of things.\n\nCan you tell me some things you remember about the whole idea of having patients as friends, friends as patients?\n\nAnd also your family.\n\nAnd your family…\n\nYou’re the only doctor. You know, you have to look after your family at times. And it gets into a whole thing of…well, money and so on, if you’re looking after certain members of your family. But I talked about that with Austin Crayton in Tamabush because he had to look after his brother who was critically ill – and I don’t think I’ve had a problem with that at all and I’m not sure why. You know, it’s said that you lose your objectivity and so on. I’ve had to do what I had to do, I guess, and I just did it. And if you’re stuck and you have to look after your wife or someone else in an emergency, you do it. But I’ve been able to…say, for instance, we would be going out with about eight couples playing bridge and maybe a third of them would be my patients and the communication goes through all sorts of things, you know, and you have to be careful what you say. And Eleanor has often said, and, of course, with her nurse training it helped a lot…she would be talking to a neighbor who said, well, do you know so-and-so and they’re asking about what’s wrong them, you know, and she knows. But then she has to think, now how do I know that? Do I know that from Don or do I know that from Mrs. Smith across the road? And that’s\n\nthe way she dealt with it. If she heard it from Mrs. Smith, then she could talk about it to so-and-so knowing [        ] the local gossip or what. But that comes into it, the confidentiality to the spouse of the physician.\n\nIs there something that you remember you and Eleanor talking about?\n\nOh, yeah, quite frequently because…\n\nWhat was some of the context that came up, for example?\n\nWell, for instance, someone’s got cancer – and that’s always a big one, depending on what type of cancer and so on. And she doesn’t know. Well, what’s wrong with Joe? I don’t know, you know. Hasn’t Don told you? No, that’s at the office sort of thing. You know, that type of stuff. And you have to have an answer for the person that’s appropriate and also so that they don’t know that you know or they don’t know…or you can be right straight out and say, well, that’s none of your business. Well, that’s hardly acceptable depending on your relationship with the person. But that’s one context. I guess another context is say when you know…for instance, we know, not a patient of mine, but Eleanor knows what the real diagnosis is because I’ve told her about [        ], a relative of a neighbor, you see. And that relative asks and that relative doesn’t want other people to know she’s got MS because it would be the whole thing of pity and that sort of stuff. And so she’s told them that it’s arthritis. So it doesn’t quite fit, see. And when she has her relapses and so on. But Eleanor knows this but she still can’t level with the neighbor because the patient doesn’t want her to know.\n\nThat’s one of the things that comes up all the time in particularly small communities where you’re the bearer of secrets. And my sense is that one of the anxieties that younger physicians have about choosing one of the small communities in some ways is what you alluded to, because of personal and professional…has that burden been something that weighed on you or your and Eleanor in ways that were really difficult for you?\n\nI have trouble with that because it’s never been a burden to me and it hasn’t been a burden to her. Because I’ve dealt with in what I think is a straightforward, logical way. But if you get caught up in the emotion of it, it’s going to clog your processes and it’s going to clog your ability to deal with it appropriately. And I think maybe that’s it. I think the crux of it in doctors going to a community, I try and turn it around. You know, that’s not a problem, it’s a challenge. It’s a challenge to deal with that. It’s a challenge to be able to communicate in such a way. It’s a challenge to be able to think in such a way. It’s a challenge to be able to separate the emotion from the verbiage, the words, and to be direct with the person but in a kind, gentler way, but to be firm. And you can be kind and firm. It’s just a matter of, I guess, wanting to be able to do it in a positive way. And it’s possible to do negative things in a positive way and it’s possible to state things not as they really are but as they appropriately are in the situation, within the context. And you don’t have to become emotionally involved in the situation. The thing that’s important is the confidentiality and the trust your patient has in you. And that comes first. And if everything else comes after that, I don’t have a problem with it. So I’m out with Mr. and Mrs. Smith and they’re both patients and one has a problem that, for some reason, you’ve tried to talk them out of keeping from their spouse and you’re talking around it and something’s come up in a sentence and you’re the obvious next respondent and you can respond to five different things and down a whole line of exposure of the problem, you know…\n\nIt’s a challenge.\n\nIt’s a challenge. But I don’t have a problem with that. I get one or two over here rather than the four or five exposure level and I don’t have a problem with that.\n\nWould you say that there’s a kind of code, in a sense, that you use in situations like that?\n\nYeah, there’s one word, truth. Now, you know, that’s easy to say. But there’s things that are true and things that are really true, you see. And what’s the teenage phrase they used to have? \n\nTell it like it is?\n\nYeah, that’s one of them. But again, the problem is when you’re telling it like it is, you’re telling it like it is appropriate to tell in a confidential way and the physician talking in a situation. And that’s the way I look at that, you see. I’m not saying that so-and-so has MS because it’s really not their business. But if they’re a relative, it is partially. But with the attitude and the construct of the heart, if they chose to deal with it this way, you go along with that.\n\nMy sense is that you, as a physician in that situation, have to be more aware of conversations and interactions with people wherever they happen than, say, the average person who’s not a physician. So there’s a strict sense of paying attention to what you say in a different way than you might…\n\nI guess maybe another thing is I’ve been practicing hypnosis for 26 years. And we’re talking about communication. And when you’re into hypnosis, you’re communicating at an entirely different level. You’re communicating with the subconscious. And each word and each type of word and each way you express a word has meaning. So a half day a week of hypnosis, I find I’m using a different language because it’s language of the subconscious. And so it makes it easier for me to communicate in a conscious way, whether it’s socially conscious or just one-on-one or triple – you know, a husband, wife and you.\n\nSo the hypnosis has really helped you be attuned to that kind of language to much better say something than if you hadn’t had that experience with it?\n\nAnd that might be part of the reason why I don’t find this a problem. But, again, just what I had to go through in terms of my process of a physician out in the rural area where you had to do all this. And the buck stops here, you know, sort of thing.\n\nAnother thing that’s come up when I’ve talked to people has been the issue of mistakes in the sense that as you perceive them. Maybe patients don’t perceive them. Do you remember that as being something that…\n\nYes. And they can be very detrimental and very catastrophic to decisions. But I guess it gets back partially to what you’ve been taught and what you’ve learned and what your philosophy of life is and what your belief system is. And these are all part of that. And I’m a white Anglo-Saxon Protestant Scot, okay. Scottish, some people call it. And it gets right to the crux of efficiency, time is money, a hard work ethic and rural. Where I grew up, your whole attitude and philosophy of death – and on a farm, life, death, birth, sex, it’s all matter-of-fact stuff. In rural Nova Scotia, it depends whether you’re in the mainland or [        ] or in Cape Breton in terms of death. You know, Cape Breton is known for its big, party wakes, you know. Wakes that are the party of the year, you know. That sort of thing because that’s the way Joe would want it. And the beer and the wine and everything’s flowing and everybody’s dancing, having a great time at Joe’s wake. But, again, it gets to the very fabric of the society of life that it’s life and death basically, is the main thing of what you bring up. And that’s a major, major mistake. And, for instance, when I was in [        ], I was the only doctor there. I would get called out to [        ], which is three miles away, and to a patient of mine whose brother was up to the States with his wife and he’s got pain in the chest. So I’m out there within four minutes and diagnosed MI. Now, this was ’61 before Medicare and he was in his late 40s, overweight, he had plethoric facies, you know, a very risk guy. And no question, I knew he had an MI [        ]. And the treatment was go in the hospital. He wasn’t going to go in the hospital. And I said, well, I think it’s really important that you…I’d treated MIs before at home, but this wasn’t the type. So he wouldn’t go.\n\nDo you think it was financial, was the reason?\n\nYes, I think primarily because he didn’t have Blue Cross or anything like that. And, of course, not many people had it in those days, in my experience. So I treated him at home but I told and his wife it’s a risk. And we talked about all the things, about the commode. And, again, over the phone, I had a patient who was the local pharmacist’s wife who knew where all these things were and they were to get one in and that sort of stuff. We covered all the bases. Anyway, to make a long story short, the second night he went out to the toilet, outdoor plumbing out in back, and died up there. He was just too proud – and his pride and that’s why he died. And I did all I could have done. You know, I could have really twisted their arm and insisted, you know. But, again, I informed them of the risks. And he might have died anyway in the hospital, but that’s the way I would look at that. They made their decision. They had the information. I did all I could and we covered all the bases. But you don’t call the ambulance, bring it out and force him in because then he could die in the ambulance on the way in. And he didn’t tell me. I’m sure that’s why he didn’t. I’m sure it was the financial reason. But, again, did I make a mistake? Should I have really insisted? But I don’t ruminate on that. I made my decision and I went out and discussed the whole thing with, again, my patient. And he was the patient. But I knew the brother very well, and his wife, that were living in Jargonson (?) and they were interpreting too. You see, the three of us would be talking, the wife of the dead brother and so on. So, again, we talked about it. And her last comment was, you know, it was his pride that killed him sort of thing.\n\nBut do you think that, as you were saying before, the cultural context of that community and their attitudes about life and death and choice and so on…because you were part of that culture and knew about that, you think there was not a…\n\nThat makes it easier. And that’s just one part of your question. That’s one component. Another part would be if I made a wrong decision after…I’m just trying to think of another patient type of problem. For instance, one thing, I was in the same area making a house call. I was in Amherst and I was called out, I made a house call. And when I got there, I found I didn’t have my stethoscope. And it was an 18-month-old child. And I listened with my ear on the chest and so on and percussed more and did all the other things more and I diagnosed pneumonia and treated him at home as pneumonia without a stethoscope. But, of course, when I came back the next time, I had it. But I made a decision without your basic tool. But it didn’t bother me because I was able to…now, they knew I was there without a stethoscope and began litigation and things like that.  [     ] in that situation in Nova Scotia. But it wasn’t the same sort of thing but it was a different approach. You made a mistake, you didn’t have your stethoscope, you should have gone back and gotten it and that sort of stuff. I guess diagnostic problems where you missed something and it’s crucial – I can’t think of a specific to that to make a point.\n\nWell, I think there’s probably all…we second-guess ourselves all the time and say, well, if I maybe had done this or maybe had done that. But more I think the atmosphere that we’re practicing in now is so intimidating. I think the thing that makes me saddest about the practice of medicine now, even in my lifetime, is that there’s a sense of adversarial relationship that’s there all the time. And you pick that up from residents, I’m sure, here. I’m not sure how it is in Nova Scotia, but my sense, at least, is that there’s less adversarial kinds of relationships between you and patients in a small community partly because you got what you got and you have them and they have you and you’ve got to work it out somehow. I mean I suppose they could go find a doctor someplace else, but that’s often not a choice. So you probably know more about where you failed, if you will, maybe that’s too harsh a word…but where you disappointed yourself or someone and we all feel that. Two issues that come up: One is living by yourself in that community where it’s just you and the patients and how that might affect your behavior towards them. The other part of it is, who do you talk about that with?\n\nExactly. Yeah, you need somebody to talk about it with – and most people do.\n\nWho did you talk about with or who could you talk about that with?\n\nWell, Eleanor, for one thing. And the nurse, certain aspects of it. I was into the hospital everyday with various physicians there. And, of course, the surgeon’s lounge, the doctor’s lounge is a key place for discussing these things. \n\nI also have the sense that the physician’s lounge is often a kind of…well, in certain ways they’re kind of a confessional.\n\nYeah, they can be. And the other thing is, everyone is different. And, you know, we could get into the whole thing of three camps in a community, such-and-such size, and people are…you know, the whole thing of competition. But there’s not enough docs…the discussion is different if you’ve got too many docs. And nobody wants to lose, quotes, their patients, quotes, their income. But, again, the attitudes vary. But I guess I don’t need to talk about things as much as some do. Again, it gets back to your philosophy of life and where you’re at. Whether things are predestined or not and all that sort of thing. Well, that’s just the way life is, you know. C’est la vie. I guess I’ve been very good at rationalizing a lot of things – and all you can do is your best. And if you have really tried in a situation to do your best and you have done your best…or if you haven’t quite done your best, why didn’t you? And if that answer to that question is satisfactory, well, then I don’t go any further with it. I’ve never lost a day of practice, you know, to sickness out of the 20…in those rural areas. And I lost one, I should say, when I was in River Hebert and I was the only doctor there. And there was a flu epidemic and I caught their bug. And I was in the hospital seeing my patients and the senior physician there said, you’re coming in as a patient. So he just admitted me overnight so I could get a good night’s sleep so I could go back the next day. And I was vomiting and apologizing to the nurse for vomiting on the bed, that sort of stuff. But that’s the only time I lost in practice, as a teacher for 20 years in practice, except when I was in and had surgery once. So, again, I think I’ve been fortunate to have been able to do that.\n\nSo people called it stoicism?\n\nYeah. Again, that’s part of being a Scot partially. And my mother was a teacher before she got married. And, of course, [        ] one of my boys. I’m sort of next to the youngest, so that gives a flavor to it, again, in a rural community. And my father was a sawyer, a millwright sawyer, a carpenter-type person. Then when he got older for that and his arthritis was bothering him, the Brown family had been in the lumber business for eons…so then he was working in the Gypsum area in the maintenance of heavy machinery. And he used to box a bit. He loved sports. So self-defense, I think, and tumbling the poor boys. \n\nAs you said, nobody sits and writes down how you conduct your life. But you learn from just being in a community, being in a culture, being in a family. And obviously those kinds of things affect how you…and it’s nice when your particular values and attitudes coincide with those of the community you’re practicing in because I think it makes it easier. I mean it’s a kind of understanding that doesn’t exist often when there’s a cultural difference. But I really feel in some way…I’ve been here nine years now and there are still some points I don’t understand. And I was up in the Midwest over the weekend, last week, and it’s funny, it felt…it’s like if I was there, I wouldn’t know how to conduct myself. Like I wouldn’t have to conduct myself any differently but it would be continent with what goes on up there.\n\nIt’s difficult to talk in detail about it’s something that you feel and something that you’ve learned too.\n\nDo you think that some of the reasons why people who go to rural practices, it doesn’t work out, it has to do with that kind of…\n\nI think for some people. But I think some people just seem to have a way with people and some don’t. And I think that’s partially it too. But if we, as family physicians, if you’re the type of person who’s got to have square problems in square holes and can’t put a round peg in a, you know, that sort of stuff, you really shouldn’t be in family practice, if you can’t live with uncertainty. And I guess that’s one of the key things. And if you can’t live with uncertainty in a community, in a country where the legal threat is up there, always there, permeates the whole thing and is responsible for 30% of the healthcare expense, you know, that really puts you in a bind for rural family practice. It really does. So when I left River Hebert – and, again, some of your patients you know extremely well and what they say stands out. For instance, one of my patients who was a nurse who lived in Joggins, whose husband was the former…\n\nSide 2: …went to [      ] and she made a comment towards the end of her visit about well, I wish we were able to have, I wish we could have done more to help you stay in Amherst or stay in River Hebert. And we really let you down by the fact that she felt guilty that there’s more maybe that we, the community could have done to retain me in that community. And what she was expressing was the ability of the community to retain a physician. And she was referring then to the social context because we could have made you and your wife feel more at home and that sort of thing. That was her perception but that wasn’t our perception and had nothing to do with why we left. Because we had very close friends. But that was her perception of why, one of the reasons why we left. But she was close because it was the education of the kids and that‘s nothing they could have changed. I guess that’s something that is kind of important. Communities, and it relates to what you were saying a moment ago about the litigation problem. But there’s always going to be a rotten apple there who will litigate the doctor, you know. And no matter what all the rest of the community might have heard, they can’t prevent that. So that’s something that makes it difficult for rural communities to attract and retain physicians. And a lot of them will try that, too, and it’s sad. But I think it’s the old thing we talk about gigio, guy gets in, guy gets out with the computer. It’s the type of individual the medical schools recruit as med 1 that really…and you are in a much better position in North Carolina than we are in Nova Scotia, I realized this past three weeks. The percentage of your populace in this state that’s rural, it’s more than half. It’s over 50%. Nova Scotia, the percentage rural – in other words, we’re talking about recruits for medical school, you have over half your recruits. You can get half your recruits from the rural because that’s where the population is. We only have 10% population in Nova Scotia. 90% of our population is urban.\n\nI had no idea.\n\nAnd I thought we were very rural. We’re a very rural province. The Maritimes are rural, too, but I guess it’s rural in a different way. For instance, our generation is a unique generation and it’s urban. With respect to when I was a baby, 90% of Canadians were rural dwellers. Now 90% are urban dwellers. No other generation has that happened to. And the whole thing politics, you know, how do you get votes – what about the 10% vote? Who cares about the 10% vote? Let’s go for the 90%, you see. And the same thing with doctors. But here you’re over half rural that you have a great pool to recruit med 1 students from.\n\nI’m not sure we’re doing it very well. We have a pool but…\n\nThat’s where, in seven or eight years, you could have a major impact of doctors going out in the community by recruiting them in this year, in med 1. I think that’s where you really have to work at. And that’s what we’ve been trying to do. Certainly in our residency program, that’s the criteria. We have a structured way of recruiting and rural, where they come from and where they intend to practice, these are important parts of the numbers, of how we get the numbers.\n\nHave you been happy with your…\n\nYeah, reasonably. A higher percentage off our residency grads go and remain in rural practice than the, quotes, rotating grads do, rotating internship grads. Dr. Stewart (?) formerly did a study, oh, 15 years ago, looking at how graduates practice, and where they came from was crucial and where they went. But, also, too, where they were trained was important too. And the whole thing of money pay base for residency program, I looked at this as residency director, too, back in the ‘70s. And we recruit in a maxi (?) for residency…in other words, how many Maritimers and how many outsiders do we bring? And we can look at those people. And we have recruited quite a few Maritime physicians from other medical school programs in some states who came and did their residency program in the Maritimes because, quotes, the residency program in Maritimes is out there in the closed community hospitals. So we recruited them into and they stayed, you see. So, again, the map is there. And, of course, I guess you would have it, too, as you have your pins on the wall and the map. \n\nBut as you see, that cluster is right here. I mean the national data…I haven’t looked at it for a while, but it used to be 70% of graduates of any residency program practice within 100 miles of that residency. So I tell medical students, when they go off to their residencies around the country, your intent is to come back to North Carolina but the reality is that that intent will be followed up maybe 25% of the time.\n\nYeah, the administration…and I had my share. I don’t really want to get into…aAgain, keep on with the practice and more of the research – which, again, looking at what we do.\n\nOne of the things I was actually playing around with in all these discussions with physicians is this…I mean it’s in my reading and in my understanding of adult development, there are different periods in your life.\n\nUh-huh, the seven stages of man, Shakespeare.\n\nExactly. There’s a sense of expected transition. You get to a certain point. I don’t if for each person the transitions are similar, but I expect they are because I’ve tested out what I’ve been going through at different times with other people who are kind of farther beyond me. I’ll say, do you have this? Yeah, I have that. And one of the transitions I think has to do with getting things up and running. You know, it’s kind of the six years in Amherst, kind of getting confidence, feeling comfortable with what you’re doing. Kind of getting over the initial jitters, although you always have that uncertainly, as you were saying, about things. But there’s a certain stage you get to. And then often people will make changes at that point. And you obviously made a change. What I want to do is get you back to the point where you were at in transition, whether that transition you talked about was going from River Hebert to Amherst that had to do with family and kids. What were the changes, as you can remember, that were going on with you about the time that you were leaving Amherst? Did that come out of the blue?\n\nIn effect, again, I was in Amherst, I was going through the committee structure I had been through and I was president of the local county society and I was chairman of the medical education committee and Amherst and Cumberland County. So I was heading up the CME, the community CME where they send the teachers out to the community. So I was the family doc organizing that. And also includes [        ], New Brunswick, [        ], all the provincial boundaries, as we had patients back-and-forth too. So I was there doing that. And, of course, when I went into practice I promised myself…this was all subconscious now, but I can bring it out of the subconscious. That at least four weeks off, quotes, vacation not just for me but for the wife and family and so on. And at least two weeks CME. So that’s six weeks a year. River Hebert, couldn’t do it the first year. So I was only there two years. And that was part of the decision, too, not being up-to-date. I wanted to give my patients the best, I wanted to be up-to-date and I could see myself very quickly getting out-of-date if I stayed in River Hebert. So it clarified the issues. But in Amherst, we had made a decision. We planted the hedge, we were there until I retired. So Lee Steves (?), of course, he was the CME guy. Dr. Steves would come out. And, of course, I would be with him on the phone checking up the refresher courses based on patients and things in the hospital and that sort of thing. So he wanted to meet with me, so we had lunch together and he made this offer. He wanted me to come to Dell (?) and set up the residency program.\n\nWere you at that point before he had that lunch with you? Was there anything going through your mind at all?\n\nNo, we were in Amherst, we weren’t moving. And, again, that was eight, nine miles from where I went to my undergraduate, [        ]. You know, talk about background and that sort of stuff. And the [        ] and all that sort of stuff. But I was there and this came. And like I said, it took me two weeks to decide that I would leave all this, this mess that we had. I could go hunting. We had a pheasant preserve. I could hunt pheasants, I could hunt deer. And with the car radio, we could pull onto the farm where we were hunting birds and bringing geese by stuff we planted, that sort of stuff. They could phone if someone went into labor and my son would come out and say, hey, somebody’s in labor – so I’m off. But I’m still hunting, see. All of that was built in. So we were there. So this came. And the main reason that I remember why I decided to take it was, it was a challenge. And I felt Dalhousie was behind. Like we had three pilot programs in Canada. The first was in Calvary in ’66. And then ’67 McMaster and London started theirs. And they were all three-year programs. I was, again, on national committees in the medical society and the College of Physicians. And I felt we were behind and that we should be ahead because, again, Dalhousie was training general practitioners. Seventy-five percent were going out. And there was only one other school that was producing more and that was UBC. Again, the two seas, Atlantic and Pacific.\n\nWhat kind of discussions did you have with your wife at that point? Do you remember the kinds of conversations around that?\n\nYeah. Very surprised that I was approached. I was sort of, too, and she was. And Halifax, what’s it like, that sort of thing. And education and that sort of stuff. Again, a better place, maybe Halifax, maybe not. And what was going on in the community. I can’t remember clearly, but we talked about those sorts of things. I mean the friends and the community. But when we went to Halifax, they had just finished, the year before, the Topper (?) Building, which is a 15-story structure when then was the highest building. And we went down and Lee Steves took us into this office of my classmate’s, who was Paul Kenmore (?), was away having a year of educational training with George Miller and this would be the office I would share. Well, there we were, looking it over, and I told Eleanor, on top of the world looking at sort of thing, not be a temporary location sort of thing. That I could come and put my bag down, so-to-speak. But, again, the Sir Charles Tupper Medical Building, named after a physician in Amherst who was the only physician in Canada who became Prime Minister. And of the 36 fathers of the confederation at the time of the charter in Canada, four of them were born in Amherst. That’s a little history. And, you know, a small town. So that’s part of the background. But here we were in Sir Charles Tupper Building. And, of course, the local drugstore where he practiced from had all the story of him as a teenager and all that sort of stuff. But this was part of it, I guess the education and the building. But, for me, she could see that it was a major challenge because those city slickers don’t want a [        ] out here. You know, that sort of stuff. But anyway, you look at things differently but it’s the perspective. It’s hard to, yeah…\n\nHow old were your kids at that point?\n\nWell, there were four boys and the youngest would be about eighteen months.\n\nSo they were at the stage in the sense that they were more movable than they might be if they were a bit older.\n\nYeah.\n\nDo you remember what it was like breaking the news to the folks in town?\n\nYes, very much so. And, of course, the major folks in town, from my perspective, were the other physicians and what was going on in the community at the time. And like five family docs who had just gone through the process of going through the whole thing and going through the contractors and architects and building a clinic and that sort of thing. And now they’re just, in effect, faded because we went to Tinder (?) and the lowest one was twice what the architect [      ]. But that’s going to be a new clinic just across the road from the hospital. And the physicians all had individual offices and two had homes. So that sort of thing was going on. So that had kind of fizzled because of the finances. So the whole thing, the TS (?) had just started four years ago and I was the mover in that, insisting that one of the family docs…the busiest one before I came to town, had never been away on vacation. And I had been working on him. And finally this year he had taken four weeks off and went to York with his wife. And, money, you know – I think you’ll make more money. But January had just gone by and he came and we got our things ready for taxes. And he smiled from ear to ear. This was the first year he had taken off for vacation and had growth. I said, you’re twice as busy the two weeks before you go and you’re twice as busy the two weeks after. So, again, that was education, behavior mod. So that was the key person. And, of course, we had two general surgeons and one, it was really difficult, he was shocked, that I would be going, sort of thing, and leaving us, sort of stuff. So that was traumatic for some of them. And one local community psychiatric with the mental health center. But I guess there was a positive and a negative. Difficult to leave but, again, you’re going on to newer things.\n\nI’m sure it was a hard thing for you. But in some ways, how sad for us.\n\nAnd I guess a major problem was leaving the patients. It was an uneven practice again for a year or two before I got the thing going. So I did a day a week in student health and that sort of stuff, doing clinical. But that was difficult. But I recruited new graduates to go to Amherst. And the one female, I really was responsible for her getting there because I really twisted her. And she went there, she married there and we just recruited her as a faculty this past year. And she always tells me about the family patients that she inherited from me and they still talk about it, 22 years later. And I could relate to that because some people in the community of Amherst were talking about a Dr. McIntosh who practiced in Amherst before he went to Dalhousie. And this was back in the Depression, you know. Because people remember certain physicians. So that was difficult. But, again, it gets back to you make decisions…I guess what makes it easier for me, when I make a decision, I really believe that if I have made the decision based on all the database that was available at that time, I’m not going to go over it again, you know, two months later, two years later, ten years later. Because it was made at that point in time with the database. And the same thing applies when I’m going to make a decision on diagnosis of a patient. And it gets back to what we were talking about, you made it based on the decision, on the total thing. On the patient’s perception and the patient needs and the community needs and so on. And the details of diagnosis, what are the physical and all that sort of stuff. So it’s done. And the same thing with the decision…I made it based on, and it took me two weeks to make the decision. But, again, I didn’t talk to any physicians, just to answer your question. I didn’t talk to any physicians. It was my decision, talking with Eleanor. Didn’t talk with the kids about it. They were eight years and younger, so they were not conceptualizing yet. So, again, I made it with the necessary and what I felt important database. And it was my decision, so that’s the way I did it. But it was difficult.\n\nSo you’re not plagued with, you know, there’s this saying, if I knew then what I know now type thing?\n\nI think that’s ridiculous. It’s not logical.\n\nI agree.\n\nAnd I took my course in logic. And the main reason I took my course in logic was so I could understand what the damn philosopher was saying in Philosophy I. And so I took a six month… but that’s the way it goes. And I guess if you talk about philosophy, I’m a Platonic realist. That’s the way I see it. But in terms of…I think rationalism and logic and how you come to a decision, it’s important to have the emotional component in there. But it should be in context in terms of how it will affect you and your life and so on. But the basic things are still basic. And as far as I’m concerned, the challenge is important. And when you’ve been out in rural practice doing it all, and I do mean doing it all with respect to the breadth of medicine, and your decisions are really important in terms of the patient perspective and the family perspective and so on…that you’ve gone through that and the challenge, it isn’t that things are rusty and you’re not being challenged and so on basic every new patient, you get challenged, depending on what your criteria are. But I think (Inaudible), the second career, put it very well, that any professional should, and, again, that’s a judgmental term, change the direction of their life every decade. Well, I’ve changed the direction of my life in a major way every eight years or so. And now I’m training myself for my sixth career, you know, with the research.\n\nWhat happens to doctoring (?) in the communities that don’t physically change what they’re doing? Do you think they go through some of those kinds of internal changes?      \n\nWell, you see, it’s like Li’l Abner used to say, things aren’t as bad as they appear, they’re worse. And it depends upon your perspective. And as one of our teaching fellows used to say, it depends upon your impact with them. So what’s the context? And if you talk about the Joe Blow or the Jane Brown who’s out there practicing, he or she can go through a metamorphosis in a different area of life.\n\nWithout actually physically…\n\nWithout physically change in the community or change in the nature. You know, how does a left eyeball surgeon get kicks out of life? Okay? It’s no difference between a left eyeball surgeon and turning the nuts on the left, front end of a car. You know, they’re putting on a [        ] on there. Of course, robots are doing this now. But it’s the same monotonous thing. And, again, my background is coming out [        ]. But, again, it’s the same sort of thing. It gets back to the basic question of life, where you get your kicks. And people, that’s why I went into family practice as opposed to…when I was in medical school, the only thing I knew about where, quotes, I was going to practice, it was not going to be in Halifax, you see. And it was going to be out there you could do the whole thing with the whole patient and look after patients in hospitals and all that sort of stuff. That same decision-making process is what all students go through now. But, again, where do you get your kicks. And some people need a challenge mentally, some people need a challenge and stimulations by people as persons, as parents, as kids, as families. Some people get their kicks from really making a rare diagnosis. You know, they’re just waiting for that rarity to come along (Inaudible) fifteen years [        ], if they’re a family doc. But, again, it’s the everyday things that are crucial.\n\nDo you have any examples, can you think of any people who have gone through this kind of internal metamorphosis that you were talking about in that the change is really a substantial change but haven’t physically moved or … You’ve made some changes – now you’re doing, in a sense, more right now where you’re re-emphasizing or emphasize something in your career that you haven’t emphasized. But what about people in practice? What kinds of things have you seen them be able to do that’s kept them happy?\n\nWell, I guess everyone’s different, everyone’s unique. And, you see, it gets to the whole point of we all have our internal maps of switch gears now. And we are made up of a background, an experience, consciously and subconsciously. And it’s a whole thing in relating to a patient, a physician, he or she, it’s a total of her background and experience. And each new day, when you wake up, how you look upon that day, is your experience. And life is made up of one day after the other and one night after the other. And so our whole meaning of life is how we live each day and what we get out of it and what we put into it and what we put into our practice, what we put into whatever we do, whether it’s a game of tennis with so-and-so every Tuesday morning at 8:00, you know. And that’s something to look forward to, if that’s how you go. Now, if you’re a routinist, and we’re all routinists, and it depends upon how you look at the word routine, but we develop habits. And we develop habits in our training that we’re going to be doing when we get out there in our practices. And the types of habits, whether it’s going to a certain emotional or a certain thinking process of problem-solving, you know, in terms of what do we do when we get up and we go to the hospital to see patients, we go to the office, we go back to the hospital to see a very sick person. Or, again, if you’re in a city, you don’t have to do that because someone else is looking after the urgent stuff. You’re just going back to the office and seeing patients morning, \n\nnight, evening maybe. And so it depends upon your background. It depends upon where you really get fulfilled. And whether family life is important or not in your life. Whether having a spouse, whether you’re male or female. And just being whether you’re male or female is crucial to that. Because female, you know, their relationships are more important to them in terms of relating to other females. The group process is more important. Whereas men can tend to get locked in their work and they can easily get, as many of us do, lost in their practices. Getting married to our practice, so that their families go [        ]. But you have a really good marriage, you have to work on it. \n\nA couple of things I want to ask you about what you just said. One is, do you think, therefore, that women have a more difficult time being small town doctors than men do?\n\nThey do in certain ways, yeah. And it’s more difficult for a female physician to be a physician, to be a mother in our society. Now, it’s become easier over the last ten, fifteen years because the whole changing of our societies, and I look upon Canada as different from the United States when we’re into the family sort of thing…that has changed so that the male in our society now is really lost. A certain type of male who can’t look at how it has changed. And there are a high percentage of males that can’t cope with women taking control and being everything in terms of having it all. And there are other types of males that just enjoy that. They think it’s great that she can be stimulated to be a physician and work in somewhere there to have a baby or two. And he will back her up and be the, quotes, mother and the home person, the home body, and take a much more chunk of rearing the kids responsibility – by that meaning time with the kids, so that she can be stimulated. For instance, Joe, here, who is in every Friday morning. His wife has gone through another MPh and so on. And he’s just very happy that she’s been able to do that because the kids have gone through a process. And, again, a rural practitioner but actually a city boy. But, again, if you look at what makes Joe tick, where does he get his enjoyment from, that’s part of it, too, in terms of recruiting physicians in a rural area. But part of the reason he’s there is because his wife needs work. So it comes in. I think I’ve strayed from your question.\n\nI think you’re getting it. I mean the men and women…One of the things you brought up was this need for affiliation. What you were saying, women have stronger needs for collaboration, affiliation with each other and maybe with others whereas men tend to be more comfortable being solo and independent. Those are maybe not my best choice of words, but you know what I’m saying. So that in a small town, I mean this is my interpretation: In a small town it seems that you can go either way. In a sense keeping kind of solitary…no, that’s not the right word. But keeping more independent. I mean not mixing it up quite as much with the community. Maybe preserve yourself a little bit. On the other hand, it may isolate you.\n\nIt might be easier to recruit female physicians to rural practices by recruiting their husbands as the bank manager to the one little bank in the rural community who’s going to be there for four years. And the wife, while the bank manager is there, acts as the local physician. You know, that sort of stuff. And the other physician can sign out to each other. I think just by switching gears and putting more emphasis on the male spouse and recruiting them as much…\n\nSo you’ve got to recruit them.\n\nBecause you’re recruiting the couple, no matter how you look at it. In those communities who have done that openly and aggressively, who have recruited the couples, the husband and the wife, have been more successful, if you look at them. \n\nThe other part of what you were saying before, I wanted to get at a little bit, is family. Again, not only your own experience with your own family, but as you’ve seen doctors over the years and there have been families that have worked as far as, as you say, you marry your job and ignore your family or you can work it out…what is it about, in your perception, the differences between the families that are comfortable or that work in a community in a small town in contrast to those that haven’t? And what it is that works and what is it that doesn’t?\n\nWell, again, the ones that seem to work better and stay there better are the ones whose total interest almost, or a higher percent of…their really interests in life, they intermingle and become part of the community. Like, for instance, in Canada, and you don’t have to go back far, up until 1970, each year, in the ‘50s and ‘60s and the ‘40s, over half of the new doctors that got a license to practice in Nova Scotia were non-Canadian, were Britishers mostly. And when we closed the doors for outsiders, including Commonwealth or British Empire types, that changed. So the Britishers that have come over, I used the term British meaning the term [        ] as well, and the Irish…you see, there’s three different types of people there. But they’re all the same, they’re all WASPS, okay? See what I mean? So it depends on how to find your compass. Well, the British in Amherst, the second surge. The first surge was in Nova Scotia. And who grew up in [        ] County where one of the family doctors were neighbors and all that sort of stuff. And the new Britisher had just come over with his wife, a family doc. And he was the second general surgeon in Amherst. But they’re still there. Why are they still there? Part of the reason they’re still there is because he was the general surgeon and part of their British background is horses. They bought a place five miles outside of Amherst, a farm with horses and so on and the kids were riding ponies and all that. She was involved in that, but she was a family doc. So they came and bought their horse rearing place five miles…and you can get in and out of there quicker than you can go three blocks in the city, sort of thing. So they became part of the community. They bought a border collie. It’s all part of the fabric. And they’re still there. And, of course, their son had just gone through medicine. And that’s a Freudian slip, because it’s their daughter. So it’s the people who come to a community and fit in at all the various levels, the working level, the social level, both male and female, at the physician level with the other physicians in the community, the spouse level, whether he or she is working level, and the social level with respect to what they belong to in terms of organized social activity, whether it’s the bridge every whatever night. You know. And, again, I think that and the kids. And where they are in their cycle as a family. Are they newlyweds, do they have three or four kids just entering school or whether they’re arriving with their teenagers and the drug problem and how much is it a problem or not. \n\nSo the fit of the family and you say the fabric. That’s a good word, the fabric, whether they fit into the fabric of the community. \n\nI foresee that. Now, I had a class of 52 physicians and this was in ’59. So we all went out there and there wasn’t one that went directly into a residency of another…there weren’t any residencies then to mention. Some of them went into general practice. Just went there and they couldn’t control the practice. And if you don’t control your practice, it very quickly controls you. And so they got duodenal ulcers, had to leave because of recurrent GI hemorrhage. They just couldn’t cope, so went into a narrow discipline of consultant practice. Three of those 52 became neurologists, five of them because psychiatrists, two became internists, two became orthopods. But they got there by various routes. And some of them got into rural areas and couldn’t organize. And, of course, they weren’t trained. I wasn’t trained either. But, again, we all had different backgrounds. Now, I think, when I look at the percentage…I’m just trying to think of the percentage. The ones that were in the Navy, the UNPD’s (?) or ROTP, is it called, or COTC, they were getting, quotes, administrative training, whether they knew it or not, because the services are administratively, it’s in the power structure. The whole thing with the ship that went aground, you know, oil companies trying to…they don’t know how to manage seamanship, in any sense. So it’s making decisions based on administrative decisions. There are certain decisions that have to be made, taking all the facts, the administrative facts, and running one’s practice and organizing – or are you drifter just in the corners or gets backed into corners? \n\nWhen you talk about physicians who are able to control their practice, the implication is that if you kind of set some rules to guide you and those rules are compatible with a reasonable life, then you’ll be alright. But if you get kind of pushed along by whatever streams and whatever, if you’re not in charge, not in control, then there’s a sense that that will, in the end, destroy you in some way?\n\nYeah, it can. The risks are greater.\n\nOne of the things, as you were talking, that I was thinking about, that I want to talk about was privacy. You know, as you were talking about all the different levels that the family and the physician are involved in, how do you cope with the issue of privacy?\n\nWell, there’s two types of people when it comes to privacy – those that tend to need it and those that tend to not. And a lot depends upon the family they grew up in. And we all have needs but our needs are all different. Some people need their privacy, some people can’t get along with it. Some people can’t exist without it. And some people can turn everything off and be in a room with ten other people and they’re in their private self. And privacy is relative like everything else. And whether you have to be four-walled around you to be private or whether you can be private out in a concert hall and be ready to [        ] around with everyone else there. But, again, you see, everyone’s focused on the music and you can talk about the symphony, you know. And it’s mostly auditory. It’s a lot more than auditory. It’s visual and all of that. So it gets very quickly into…I talk about British. We, and North Americans, our sense of privacy is quite different than anyone from UK or from Paris or Hong Kong. Privacy is a thing, it’s not just a spatial thing. It’s primarily an ability to be within one’s self.\n\nAnd do you think we’re worse at that than the British or…\n\nWe haven’t had to do it. British people – now, again, you see, in my North American, Northeastern, from your perspective…British people are growing up in British Isles. The people per square mile is quite different. The spatial relationships are different. People born in London, who die in London and haven’t been out of London consider a big thing of vacation is to go 15 miles out that way and be out there, and that’s a tremendous trip. But, again, we talked about community and privacy quite different and we noticed, Bill and I and a lot of other people in Nova Scotia, when British doctors come over, they really need their privacy because they haven’t had it. They’ve been [        ] over there with millions of people. And we had our privacy. I grew up in rural Nova Scotia, always had my privacy. Quotes, is it two cubic yards you’re talking about or is it twenty cubic yards, you know.\n\nSo projecting…you’re more comfortable, the kind of privacy that you’re…is different from what is the kind that, in a sense, you can be by yourself even in the midst of a variety of…\n\nI can turn…in fact, if you talk about privacy with respect to one sense, the noise, there’s silence. Okay, that’s the extreme privacy. But if you talk privacy in the sense of visual sense and just the ability to take a nap or a shower without eyeballs watching you, that’s privacy. But you take an Indian where they have a communal bathroom and there’s ten people in the same room. You know, why don’t they wash their genitals? Because they don’t want to be seen playing with themselves. You know, that’s privacy. But, again, it relates to (Inaudible). But, you see, it depends upon your perspective. So we talked about having a big hedge up there that no one can see through in the backyard. If you’ve got your backyard, that’s privacy, you see. But North Americans, Nova Scotians don’t need that kind of privacy because we’ve had the big space up there. And you folks don’t need it here so much. But why are so many of the houses here in the woods? Well, that’s the thing to do. Whereas in Nova Scotia, you couldn’t sell a house in the woods. One of the British doctors, husband and wife family doctors in [        ], they built a house in the woods. No Nova Scotian worth their salt is going to buy a house in the woods. And they moved to Troy, to a house in the woods. Geez, who would build a house in the woods? Anyway, privacy is quite…there’s a lot of ways to look at it. But I’m just answering your question this way because what’s the difference between a duck? You know, one of our local drunks in [        ] used to ask, what’s the difference between a duck? And the answer is, one leg’s both the same (?). So what’s privacy? So I know the intent of your question, but what I’m trying to do is put it in perspective. And everybody’s different and your privacy is not the same as my privacy.\n\nI remember you and Joe talking in the room that day we were talking about…I forget the specific examples, but there were some places you would be with groups of people…There were some places that it was alright for patients to bring up kind of patient questions and there were other places that it wasn’t. And Joe had the same kind of experience. And I remember, he stopped going to church because he was kind of intruded on. But no one ever came to the house. It’s one of those things where I’m not necessarily talking about literally spatial kinds of situations but places, even in the midst of people, where you could have…you would be looked at as a citizen and not as a citizen physician.\n\nRight. Joe and I would handle the same thing entirely different. You and I would be more liable to handle things similarly, but not Sully. See, what I’m doing, I’m taking your context, as I know it, and your context, as I know it, and Joe’s context. Now, Joe is very different from the two of us. We’re all the same sex but he’s very different. He’s got a major relating thing visually with people. So that is one of the main reasons, if you want to call it reason, why he solves problems like that, different than I would and take it that you would. But that’s not the main reason. But that’s the main reason. It’s that context of from what we represent. And we all represent the summation of our backgrounds, you know, in terms of genetic pool. Your genetic pool is quite similar to mine in a lot of ways and different than Joe’s. But it’s obvious that he’s got a major genetic pool that’s different. But, you see, you can really tease this thing apart and look at the detail. But you can look at it in a bunch of clumps too. It really gets down to communication, privacy. And if a patient asks me something when we’re sitting at a table or the four of us are standing around, two couples, say two doctors and two wives, or another Freudian slip, one of the doctors might be the wife…but, again, it’s going to take a long time to modify when I respond from whence I come because from whence I came is not where I’m at. And so to answer your question, a little bit different in terms of privacy…if a patient asks me something, the main reason, the main way I answer that is what the patient is and what they represent and what the problem represents. It’s not me. I’m answering their question from their…if they would be hurt by me saying, well, take off your shirt and I’ll examine you, well, I wouldn’t do that. But if they could perceive, and a lot of my approach in terms of behavior modification, again, my background has been very heavy in the behavioral model, in the psyche more so than in the soul model in terms of relating with people and families, is to use humor. Now if I could see that they could perceive the humor in that and not be hurt by it, I might do it.\n\nBut it comes down to in the context, your term, you know that patient, you know that individual. You know them very well and you know how to react to them. It would be different than, say, you were talking to someone … The same question from somebody would cause a very different answer. So knowing somebody and knowing their context and knowing a lot about them and their gene pool and background …\n\nThat’s crucial. And some people can take a joke and some people can’t. And some people can perceive the tremendous therapy in humor, appropriately applied, and they never forget it and you don’t have to keep reminding them year after year after year, you know.\n\nIf people say, Joe, you and I are somewhere differing in all sorts of ways and I’m a small town in a lot of ways, which is kind of what got me going on this project in the first place, which is that I literally take care of everybody up and down the street. It was a new experience for me, having been in a much bigger city. But what do you say are the characteristics of the people who are successful small town doctors? I mean what do they share, men and women, and what are the characteristics they seem to have that make them successful?\n\nWell, it gets down to privacy, in a way. They want to get away or they’re comfortable away from the hustle and bustle. Their use of time may be different.\n\nIn what way?\n\nAgain, you see, it depends on the context in terms of time. When you bring up time and the answer to any question is how people use time. And some people don’t use their time very effectively or efficiently. Some people need their time and some people don’t. But some people, if you enjoy what you’re doing and if what you do is a major part of your life, quotes, your job, well, then, being in a rural area where your whole capacity or need to be needed, if that’s strong…if you’re one of these people that needs to be needed, that may be all you need, to be out there and be needed by all those rural people because there’s no one else. They don’t have anybody else, so…\n\nSo it sounds like it’s clearer in a rural area that you’re needed than it might be in an urban area.\n\nYeah, it’s black-and-white. You’re there or you’re not there. And there’s no gray to it at all. Or yellow, you see. So, again, brought in the [        ] situation. But if you’re talking numbers and you talk about rural and you talk about people density…you know, you have as many people in this state as Toronto does. Six million. There’s six million people here. But you have half of them are rural. But the density of the rural here isn’t strung out.\n\nIt’s not like Wyoming.\n\nNo. So, again, everything is relative. So in effect it’s quite easy to practice in North Carolina and if the sound, the music, the symphony is an important part of this couple’s life, okay, they have to be close enough so that they can come in to wherever or whatever. And if education, university and so on is important – well, again, they’re not that far from it. But where they’re going to practice might make a difference. I guess the thing is, how far away or how close do you need other physicians to sign off to or OB and that sort of stuff. It gets down to details. But I don’t know, it depends upon what’s important to them in terms of…\n\nBut in some ways you may not even understand until you start. It’s one of those things where I think if you asked me what’s important to me, I probably only now know what’s important to me, having been in a situation for long enough to say I guess that is and that’s not. In some ways people don’t…it may be clear to you, a small community, a rural community is where you’re happiest because it’s constant with your background and your history. Other people may have to try it to find out.\n\nRight. And how well you know yourself is kind of important.\n\nWhat do you miss most about not being in a rural practice now? It’s been a long time, but as you think back on that?\n\nI suppose the community life, I would think. Yeah, sense of community life.\n\nI think that’s a real difference between an urban area. And no matter how much you feel involved with an urban area, it’s just different.\n\nJust going to the drugstore…I mean all three drugstores in Amherst, I knew all the people by name and all that sort of stuff. And Halifax, you know, 120 drugstores or whatever. And that’s part of the community. But, again, it’s the sense. And going downtown. Now, again, going downtown and just walking along or being in the shopping center…and there was nowhere I could go in Amherst that I wouldn’t bump into a patient, you see. Now, from my perspective, that’s fine because I know my patients, well, most patients. But some physicians don’t want to be approached by their patients with questions. But I don’t mind that. You know, a ten-year-old kid [        ]“Hi, Dr. Brown.” You know, no matter where they are. Or a five-year-old kid even. And what they do and so on. But, again, that’s part of a…\n\nBut it sounds like you get this idea that people who are comfortable…well, people who are comfortable with a kind of boundary list existence, maybe that’s a way of putting it, in life, frequently, they’re kind of building [        ], this is this and this is that. Whereas when you’re a small town doctor in a rural community, the boundaries really aren’t there. I mean what you were saying about the symphony and sitting and listening to it, the boundaries may be in your mind, inside yourself, more than they are out in the interactions with people. And the comfort with that kind of boundary for your existence in something is probably crucial to someone being happier than someone who needs boundaries, who needs divisions and so on. I mean is that an overstatement, do you think?\n\nNo, I think that’s part of it. And everyone’s different. And there’s two types of thinkers, you know. There’s the sequential thinkers and there’s the compact Gestalt. And a small percentage of people can think both ways. You know, like Brian can think both ways. And you’ve spent time with him one-on-one, so you can appreciate that. We can both think of people that are sequential and that’s it and it takes them a long time to learn. But once they’ve got it, they’ve got it, you know. And there’s two kinds of learners. But, again, there’s also two kinds of people when it comes to math. So young people have to separate the…they’ve really got to have their practice separated from their life. But they still enjoy their practice, you see. And there’s other people that aren’t like that at all.\n\nIs your sense that the people who need that separation have a harder time in a rural practice than people who don’t?\n\nYeah, they would, I’m quite sure. I would have to think of a few individuals to…oh, yeah.\n\nAre there things that we haven’t touched on that you think are important to talk about – because I’m just using ideas that have come up when I’ve talked to people.\n\nWell, it gets right down to the individual and then it gets right down to the individual family. And families usually consist of two but now they consist of four…\n\nOr seven.\n\nYeah, so… \n\n(Inaudible.)\n\nThat’s right, the family has gone down and it’s less than…what is the average family, 1.4 or .5?\n\nI don’t know actually. It’s over 2 somewhere but …\n\nIt was 2.3 some years ago and I’m not sure what it is now. Aren’t the majority of the babies born in the US first-born now?\n\nI don’t know that data. All I know is there are extreme differences between different kinds of ethnic groups. There always have been some differences, but it’s more pronounced now. Particularly in the Asian and the Latin American immigrants, were much larger families. So there’s a dis…\n\nThat’s right. It depends where you’re at. I know in Halifax, the one obstetrical hospital, for two years more than half the babies are mixed.\n\nYou were saying, what it comes down to is families. What is it that you feel about that? 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