{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/542j67bm2b/manifest","type":"Manifest","label":{"en":["Dr. Tom Leaman"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1991-05-06 (created)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","Dr. Tom Leaman","family medicine","family physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Dr. Tom Leaman (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["english (primary)"]}},{"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"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277832","type":"Canvas","label":{"en":["Media File 1 of 4 - Leaman_Tom_1991.05.06_-_Side_1.mp3"]},"duration":1911.40569,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277832/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277832/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/277/832/original/Leaman_Tom_1991.05.06_-_Side_1.mp3?1750279469","type":"Audio","format":"audio/mpeg","duration":1911.40569,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277832","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277832/transcript/81267","type":"AnnotationPage","label":{"en":["Dr. Tom Leaman interview transcript 1 [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277832/transcript/81267/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview with Tom Leaman by John Frey\n\nMay 6, 1991 (Part 1)\n\nQ. - John Frey\n\nA. - Tom Leaman\n\n_______________________________\n\nQ.  Tom, tell me the story of how you got to Hershey.\n\nA.  I interned in Lancaster and was looking around for a place to practice after one year internship, and one of the senior surgeons there told me about the town of Hershey, which is about 35 miles away, and said they needed a doctor, and the one thing I wanted was, I wanted a small town, the second thing I wanted was I wanted a place where I was needed.  About that time it wasn't too hard to find such places.  And I went to Hershey and there was an older doctor there who was in the process of retiring, and he agreed to turn over his practice to me, and he was delighted that I would come.  And so I just finished my internship, got my license and opened practice up there.  And that was the extent of it.  There wasn't anything, there (??) no advertising or anything.\n\nQ.  Did you, had you looked around at any other (??)?\n\nA.  I looked at my home town--\n\nQ.  Which was--\n\nA.  Lititz, Pennsylvania, it was a little Moravian town near Lancaster.\n\nQ.  Is that your background, Moravian?\n\nA.  No, but the town was Moravian.  So--my background is Lutheran, actually, before that it was Mennonite.  Not mine, but my folks.  And decided I didn't want to practice in the home town, and Hershey looked very good to my wife and I, and so we went there, rented the office, a house, and just opened the doors.\n\nQ.  Was the office in your house?\n\nA.  Office was in--no, it was separate at first until the, it was separate for about a year because the doctor was still in his house and was (??) practice, so we had a small office, and then a house about oh, a mile away which was right next to the hospital, it was a small local hospital which I had privileges in.  And so then after a year or two we moved into the doctor's office, my predecessor--\n\nQ.  So you literally took over his office, then.\n\nA.  Right.  And inherited all his medications.  Poured 75 gallons of some kind of a morphine-containing cough syrup down the drain 'cause I was afraid to use it.  I didn't know what else to do.  But--and he had passed the word around that I was a wonderful doctor and so forth, and--in fact his favorite expression to his patients was, 'He's so good he ought to be in medical school.'  \n\nQ.  That's what made that headline--\n\nA.  Yeah, so anyway, that, and then I practiced in the hospital and--\n\nQ.  How big was the hospital?\n\nA.  The hospital had about 50 beds, except it was kind of in ill repute because my predecessor was kind of directing it and not doing a very good job.  It was shrunk down to about 35 beds.  But we did about 600 deliveries a year there.  I didn't, I did deliveries, but not that many, and some medicine and surgery, surgeries came up from Harrisburg or Lancaster.\n\nQ.  You know, when they talk about people choosing small communities, they always talk about spouses being a crucial part of that decision.  When you guys talked about it, did you both agree in medical school that you were going to look for a small town?\n\nA.  Oh, yeah.  Yeah, I think--we both came from small towns and it's where we wanted to live and where we wanted to raise our kids, and so we definitely wanted a small town.  \n\nQ.  So you weren't, now you say you weren't uncomfortable with the notion of what complexities small towns could offer potentially.\n\nA.  Yeah, this was definitely a preference.\n\nQ.  So you took over the doctor's office, the hospital kind of downsized some--\n\nA.  Yeah, downsized some, and at this point we had accumulated a lot of debts and we were, I had one jacket that I wore and two pairs of pants, and when the jacket went to the cleaner's I didn't wear a jacket.  But the practice built up fairly rapidly.  I worked at the, got a part-time work at the emergency room of the chocolate factory, and that helped out.  And [interruption] but then (before we had been working long) I got called back into the service, and so I went off to, actually to Texas for 2 years.  And then came back and had to restart the practice.\n\nQ.  What happened to Hershey and the practice during the 2 years?\n\nA.  The patients went off with other physicians.  When I came back, some of them came back and some did not, so I again worked at the emergency room at the chocolate factory for a while until the practice built up, and then in a couple of years it did build up, and then got too large.\n\nQ.  What--so did you have children in that (??)?\n\nA.  Yeah, we had one before we got to Hershey, had one in medical school, actually, and one--three more after we got to Hershey.\n\nQ.  When, you know, as you think of that first period of your time in Hershey, well that was a kind of broken up period, because you were building it up and then (??) had to go back and build it up again.  Once you got back and things settled into a kind of pattern, as you think back on it, what were the, what were the biggest challenges at that point of your life?\n\nA.  I think the biggest challenge by then was trying to keep up with a pretty difficult schedule.  By then my wife had successfully talked me out of having Saturday night hours.  I used to have--\n\nQ.  Geez.\n\nA.  Yeah, I took Wednesday and Sunday off, and Saturday I had Saturday morning hours and Saturday evening hours but took Saturday afternoon off.  Then she talked me out of that, so I was down to office hours maybe just four nights a week.  And yet to see everybody I would start at 8 o'clock and work through until about 11, and then I could usually make four house calls until lunch.  Because to make house calls at the rate of one every 15 to 20 minutes depending how far out they were, and the average number of house calls I guess per day was about four or five.  And so did that, then came back to the office at 1 o'clock and then worked till 5, and then back in the office at 7.  So it was tight, and the challenge was trying to keep up with the schedule.\n\nQ.  When did you know that you were managing the challenge?\n\nA.  Well, I loved it, you know, I felt good.  And I think that--I felt like I was managing the challenge.  I think in retrospect, Jean would say that--and we talked about that--that (I) really did not have as much family time.  We had, we've always had, except for the first year, had the office and the house together for that reason (to be?) more part of the family.  But there were too many days off when I would have a delivery and that would get messed up, and too many family times that got interrupted by some kind of emergency.  So that--\n\nQ.  You were in solo practice--\n\nA.  Solo practice all the time.\n\nQ.  What kind of coverages did you have?\n\nA.  We got, the other three or four doctors in town agreed to an on-call system so that if I were away, if I were out of town, they would cover for me.\n\nQ.  But nighttimes and your off days were all--\n\nA.  That's right, right.  But off days, if I were in town at night--\n\nQ.  So being out of town was the only way to get away.\n\nA.  That's right.  Or lie.  And neither one of us could do that.  Some of the doctors could do that, but I just couldn't do that, and if we were in town we would say so, and see patients, and so on a day off you knew you were going to see maybe on average a half a dozen patients.  But the goal would be to try to pool it.  People would call in the morning and say, 'We'll come in at 3 o'clock,' so you'd try to pool everybody to that time.  And so the trick was just trying to keep up with things.\n\nQ.  So you were in a rhythm that was busy and hectic but loving it.\n\nA.  Yeah, yeah.\n\nQ.  You really felt that you--and once you got into that (??) after you hit a stride in some ways that it was--\n\nA.  Yeah, I enjoyed it thoroughly.  The only problem would be when I would run into a delivery that wasn't progressing well, this sort of thing, was difficult. But otherwise I thrived on it.\n\nQ.  Do you--can you think of, as you think back, was there a point at which, you know, you started to make some changes either in--I guess I'm interested in nodal points, you know, kind of points in transition in one way or another, and they don't have to be major changes necessarily, but I'm curious when, if you could think about when you thought about adding something on, changing something, doing something different.\n\nA.  I think we (were) at the point of getting interested in what I then called the psychological aspects of people, beginning with Michael Balint's book.  I guess probably that was a nodal point for me, although I can't identify that in time or even a visual image of it, but I became fascinated with that.\n\nQ.  How did you get Balint’s book?\n\nA.  I don't know.  But I know that when I--I have no idea where--as a matter of fact I don't know where my copy is, which bothers me even more.  But when I went overseas, you know, something (??), one of the things I wanted to do was meet Michael Balint, and I did.  My daughter went with me on that trip (??), so we went to see Michael Balint at his home.  I called him up, and had tea with he and his wife, you know, and I asked him to allow me to come to one of his sessions.  And he was very reluctant because it interfered with the dynamics of the session, and you know, I had no idea about there was a strict limit of 16 in the groups and so forth, but then seems how (??) and I attended a couple of his sessions.  The understanding was that I would stay outside of the circle and not say anything.  And so he introduced me and I stayed outside of the circle and afterwards I went to the pub with a couple of the doctors and discussed it.\n\nQ.  One of the great experiences of my life was, I found Balint in the library when I was a resident, and I was having a little crisis at that point, I mean I was just, couldn't find anything that really made sense to me, and I found that book and it was, you know, really changed things.  And years later when I was with the National Health Service, I was in London visiting one of their health centers and watching how they train people and watching their care, and went out to lunch to a pub with a group of people, and (??) there was a doctor there who had, he was from Liverpool, and for 6 years he had taken the training every Wednesday or whatever day of the week--\n\nA.  I almost mentioned him to you, because I was so impressed, it was what, 200 months?  (??) \n\nQ.  That's right.  Every week.\n\nA.  Yeah, he did that.\n\nQ.  And I just was dumbfounded, because I said, what was that like?  And he said it was really important and it was getting away, it was time to think, and so it fulfilled a lot of--I just, Nick, I'll remember it, he's still practicing--\n\nA.  I never remembered his name, but it was--\n\nQ.  I'll find it.  But anyway, that, for me to meet someone from the original Balint group was like meeting one of the 12 apostles.\n\nA.  Yeah, I was so impressed with this particular man from Liverpool for that reason, and he was at the pub with us.  Yeah.\n\nQ.  Same person.  So that you're--is there, was there a period that, you know, kind of getting your practice up and going and getting it going well, that you realized that, you know, this kind of start-up energy and then you hit a cruising point?  Did you make--you were always in solo practice.\n\nA.  Always in solo practice, yes.\n\nQ.  Why was that?  I'm curious.\n\nA.  I guess I like to be in charge, and I had the feeling that of the other doctors I knew, which were just those I'd gone to school with or internship with, I didn't like the way they did some things.  And I kind of visualized that there was nobody I was going to see really eye to eye with, and that I'd rather do it myself.  I would never do that again.  I mean it's not a decent way to live.  But it may have been the height of egotism, I don't know, but I just wanted to do it myself.\n\nQ.  One person I talked to said, he said 'I had more guts than brains.'\n\nA.  Yeah, it may be that.  But I, you know, I kind of thrived on the busy-ness of it, the fact that I would see a half-dozen patients on a day off didn't really bother me.  It would bother me if it interfered with something we were going to do with the family, but if it didn't interfere with the family business, if it could be put off till later, then that wouldn't bother me.  And I didn't really mind getting up at night to do things.  That never bothered me.\n\nQ.  What would happen at night?  What was it about getting up at night that wasn't a problem?\n\nA.  The feeling that it was important, that somebody who called me at night really needed to have some, something important, it was important to them.  And that made it worth doing.  And I guess the fear that even if it didn't sound important, that I could be wrong.  Early on, I had one patient, family called and said Mom was sick and I should come make a house call.  This was 2 o'clock or something.  And I asked what the trouble was, 'Well, she has a cold.'  I said, 'Well, I'll give her the first appointment in the morning, have her come in at 8 o'clock.  So okay.  The original request was for a house call.  Then they called back not 15 minutes later.  And I asked again, 'Well, what is the trouble?'  'Well, she has this cold.'  I said, 'Well, I don't see any reason to come now, I'll come by, though, first thing in the morning, before office hours.'  Third call, another 15 minutes later.  And, 'Come see Mom.'  And by then I was getting angry, which is not easy for me.  And I said, 'All right, I'll be there.'  So I thought I'll go there and I'll just tell these people, [Constantino rossi??--something in Latin?]' and I went in there and the whole family was all gathered around the bedside.  And I thought whoa, something's wrong here, and the woman was in pulmonary edema.  And all they could tell me was that she had a cold.  Well, she had this cough and to them that's all they needed to describe, and I was too dumb to ask the right questions.  And so we hauled her off to the hospital and she died.  But you know, I thought, had I been a little smarter the first time or asked the right questions or not even argued, it would have been, wouldn't have made much difference, but I would have felt better about it.  \n\nQ.  Since you bring that up, one of the things I'm curious about and, is the whole issue of mistakes and particularly how that works itself out in a small town.  \n\nA.  It works itself out, even--when the doctor makes a mistake--\n\nQ.  Whether you do or you feel that you have.\n\nA.  Yeah, it works itself out in the sense that your overall aura carries it.  And the overall aura is not based on what you know, it's based on how much people think you care.  We had a doctor in town who was on drugs, and another guy and I kept getting, either one of us would get calls when he would pass out, (??) for a call, and so forth, I don't know what the drugs were, but we would take--decided when either of us got called we'd both go, 'cause it was a kind of dangerous situation, he had a gun one time, and it was just a weird thing.  So we would go together.  And we would give him intravenous cortamine(??), supposed to be a respiratory stimulant, I don't know what--and stay a while and then he would get better.  We knew what we were doing and (??), eventually he moved away.  But anyway, with all this going on and people in the town knowing about all this, it didn't cut his practice at all.  Because people liked him and they thought that he liked them.  So mistakes like that didn't really bother them much.  The kind of mistakes that I think are damaging are refusing to see people, be unavailable, being drunk on the job, this sort of thing.  But all you have to do is care.\n\nQ.  All of us have times where, you know, there's something that either you did that you wish that you hadn't, or something you didn't do that you wish you had, like, you know, (??)?\n\nA.  Yeah. \n\nQ.  When you saw that family again, or similar, different situations, I mean--was it difficult to live in the community?\n\nA.  I remained their physician.\n\nQ.  How'd you feel?  Was it, did it create some turmoil in you at all?\n\nA.  No, I justified that on that the--at the time, I said, you know, they should--I realized later I should have, but at the time I blamed it (??) on them.  But another mistake for which I could have been sued, a family who were pretty near poverty level and had a bunch of kids, most of whom I delivered, but the father brought a little boy in one time with a gash on his head, and I checked it out and cleaned it and sutured it, and he said, 'Do you think we should have an X-ray?'  Well, I knew the X-ray was going to cost him money out of his own pocket, and he'd just been hit on the head with a bone, another kid picked up and threw it, and so I said, 'No, I don't think so.'  And he came in, then the wound got infected.  So I treated the infection with penicillin.  Then he came in later with all kinds of neurological signs.  And so we got him off to the hospital, he had a fracture and a brain abscess, frontal lobe.  And so we got that cleared up and he recovered.  But the father was right, yeah, he should have had an X-ray, and--but he never accused me of that, and they continued to be my patients and--\n\nQ.  Isn't it--as those episodes became clear to you, how did you talk about them and who did you talk about them with?\n\nA.  Well, my wife but no one else.  I don't think I ever discussed it with (??).\n\nQ.  So Jean was always, was she the person that--\n\nA.  Yeah.\n\nQ.  --when things were troubling you about--Now was she in any way connected to the practice?\n\nA.  No, no, she was not.  She, early on she kept the books, but that was just in the very beginning.\n\nQ.  And one of the other things that that leads to in some ways is this whole sense of confidentiality, it's said that in small towns everybody knows everything about everything, but, you know, there's a special kind of role that we play I think in this (??).\n\nA.  Confidentiality is, well, in the household we would never mention a patient's name in front of the kids.  But as far as I was concerned, what patients told me they told to Jean and I, 'cause I felt she needed to be part of that.  And--with the exception of maybe a close personal friend (??) I would not, but ordinarily, that was, you and I considered part of the reason, reasonable.\n\nQ.  Do you ever remember sitting down, the two of you sitting down and saying, in some kind of direct way that this was, you know, something that you had so that she--or was it just an understanding?\n\nA.  No, we talked about that, yeah.  And Jean never mentioned a patient's name.\n\nQ.  Were there times when that would be difficult for her?\n\nA.  No, no, it was just a way of life.  And I never had any qualms about it slipping out, because it was just a way of life.\n\nQ.  How about in situations where, you know, in a town that size you were bound to be in multiple roles with people, you made--\n\nA.  Yeah.\n\nQ.  --did you have, for example, you took care of your own friends.\n\nA.  Yeah.\n\nQ.  Was that, is that true or is that--?\n\nA.  Did I take care of my--oh, yeah.  Sure, sure.  And I had no problems with that.\n\nQ.  How did you keep all that sorted out?\n\nA.  I'm not sure what you mean, John.\n\nQ.  Well, in the--a concern that's expressed by a lot of younger physicians about going and practicing in small towns is that, that they want--I mean I've heard it verbalized, and I think it's because they're young and because of a lot of other things, that they want their personal and professional lives to be somehow distinct.\n\nA.  Yeah, I've heard that, and this is not my way.  I've become deeply involved with my patients, and this is my choice.  But I've--one woman, a widow remarried and asked me to come give her away and I did that.  Later she and her new husband died and they asked me to be the executor of their estate, which they wanted to turn over to the Lutheran Church, and I did that.  Another woman who (??) country were very simple person, and she was my early interest in psychological medicine, but she had all kinds of complaints, and she would call day and night and she could talk to Jean and that would be fine or talk to me, but she had to talk to somebody.  And so one time she was (??) talking about what is behind all this, trying to figure it out.  Turns out she was living in sin.  Her husband had died and she had a little child, and she was living with a man named McCurty.  But they weren't married.  And that bothered her.  She felt guilty about it.  And I said, 'Well, then, why don't you marry him?'  'Can't do that, 'cause then we won't get the Social Security.'  And so we talked about this over a period of time, and I said, 'You know, you've got to marry.'  So finally one day she said, 'All right, I'll get married.  You write the arrangements.'  '(??) you live out there in Grantville, go to the justice of the peace.'  'Oh, no, it's too important, it has to be in a church.'  And she didn't have a church.  And she says, 'You have a church.'  I said, 'Well, yeah, okay.'  So I said, 'Okay, I'll make the arrangements.'  So I called my Episcopal priest and he agreed to marry them, and so we went, we were the witnesses, Jean and I and our daughter played the organ, and we married them.  So yeah, but I believe in getting involved with them.  I had another woman with amyotrophic(?) (?) sclerosis who lived for 17 years.  And the husband, who was very simple, not simple--probably fairly intelligent, but never learned to read or write, and, but he took care of her and did her, everything for her all these years.  You know, every bowel movement and everything else.  And she died, rather he died first.  And she asked me to have the funeral.  I did.\n\nQ.  So you married people, buried people, execute their wills, deliver their children.\n\nA.  Yeah, yeah.\n\nQ.  (??) a full-service operation.\n\nA.  I used to, I had a couple of kids I arranged adoptions for.  Don't do that any more, but yeah--I do, am willing to become involved with the patients.  I don't always, but I am willing.\n\nQ.  Why do you think that, I mean why do you think you would have that--that feels natural to you or something like that.\n\nA.  I think my commitment is service to people.  To me it's a Christian commitment, and medicine is one of the ways I do that.  But it doesn't have to be exclusively medicine.  You know, I feel myself as a serving person first and a physician second.  And so this is how it plays out.  It's made a very interesting life.\n\nQ.  The thing that I, this whole idea got started when I started taking care of all of my neighbors, who were in their 80s and I was their--they had no kids and I was their surrogate son and I was their--it was all very complicated, and I thought, 'This is very complicated,' and somehow even at that point in my life, I thought that, not that life was going to be simple but that somehow I could keep it all clean.  And when it started getting what I thought of as messy, but I realized it's that, another way to look at that, is that that was starting to really make the challenge of being a doctor in a community much richer and much more--the complexity scared me at first, but then it drew me in after a while.  And I think it, you know, you talk about having, sense having some kind of inner sense that it's the right thing to do, you've got to rely a lot on that, and there have been many times where I really anguish over that, particularly the more I'm in Chapel Hill, where I'm in these complicated relationships with people, and again it's, you know, it's the certain sense of, as you said, why would people give me all of those, why would they be comfortable with all those roles?  'Cause it was my discomfort that made me start talking to people about how they manage it.  It wasn't the patients' discomfort.  But I think it's part of the--receiving into the community as a member and a citizen, and there was a lot more--I guess the other, kind of out of that, do you sense that, when that relationship exists, this complexity in your--that they're more, also more forgiving--\n\nA.  Oh, yeah, very forgiving, absolutely, absolutely.  It also raises many opportunities.  You know, when you hear family squabbles from two different sides you can help to do some reconciling.  And it becomes remarkably simple at times to, a few words here and there.  Just opens people's eyes.  When you're in that kind of a trust relationship.\n\nQ.  How does that come about, I mean I suppose it's, how does a trust relationship come about--mutually?\n\nA.  Well, I think, I think people basically want to trust the physician.  And what they want is somebody who cares for them.  And if you really do care they accept that and trust is based on it.  And well, you've experienced it, you know.  And to me it's the most joyous part of having a practice is interacting with people on a trusting basis.  Not trusting in God but trusting that I care.  \n\nQ.  And I think a lot of what, again I suppose it comes with time that as I, that sense of being directed, what do you call it, being directed (??) people, when you know them well and they know you well, when there's mutual trust it is not seen as an invasion of their own autonomy, it's more of a sense of trying to help them see that what's good for them themselves, I mean it's, some things are hard to explain in today's ethics, you know--\n\nA.  That is true, and there is a time when people want direction, and when people that--one woman I can think of who had her uncle with her, and he became a problem she couldn't handle--\n\n[tape side ends]\n\nA.  She felt it was her duty to take care of it.  And when I told her point-blank, '(??), you may no longer do that, you're not physically able to do it, you have to put him--'  'Oh, thank you, doctor.'  You know?  She just needed to have an expiation for guilt. So it's a priestly function sometimes.\n\nQ.  Can you talk more about that, 'cause one of the things I realized in a lot of ways, I mean I've needed it in my own life in some way from the health system, and also I find myself doing more and more, being aware of (??) before, is this whole priestly function and forgiveness.  A lot of what we do is to absolve people in a variety of ways.\n\nA.  Oh, yeah.  This is the burden of my anxiety (??), in the, telling people it ain't their fault.\n\nQ.  And even if sometimes it is their fault, they need somebody to be able to, you know, let them be able to move on in some way.\n\nA.  Oh, sure, yeah, exactly.\n\nQ.  What about the kind of, the darker side of what exists in small communities.  Since you're a possessor of knowledge that no one else has.\n\nA.  This is true, of what goes on with, inside family squabbles and so forth.  Yeah, people are real and you do get to know that side of people as well.  And I think, like I said earlier, there was a time when I used to dislike people who did things that I thought were far less than honorable.  And yet when I got to know them well enough and understood that I could help them in spite of that.\n\nQ.  That's what somebody called grace, unconditional power over (??).\n\nA.  It sounds like Carl Rogers.\n\nQ.  Yeah, I guess that's where it came from, but it's--\n\nA.  Which was, that was a nodal point for me, attending a couple of the human (??) in medical education sessions, very important.\n\nQ.  What was important about them?\n\nA.  I never really came to grips I guess before with myself or sensitivity to my own feelings as much as I did with those sessions.\n\nQ.  How did that affect your ability to work, meaning, to do your work?\n\nA.  Uh--\n\nQ.  Or to live your life, I suppose.\n\nA.  Yeah, I guess it made me, at this point I was already chair of the department when I went out there, and I think I was more at peace with myself for things that didn't go right in the department.  They didn't necessarily have to be all my fault.  If they were, that was okay.\n\nQ.  Was that a different kind of experience than the things that didn't go right when you were in a practice setting?\n\nA.  Oh, yeah.  The beauty of the practice setting was when you made a decision, then somebody did it, you know?  (??) and here, you know, you make a decision and first you must get the approval of the committee, and there are many layers.  And there's great advantage to that, you avoid a lot of mistakes, but it also is very frustrating.\n\nQ.  Another thing that I'm curious about is how you took care of yourself, you know, how you took care of your family, how you took care of yourself, in the process of being a caretaker for the community?\n\nA.  I guess as far as the family is concerned I tried, when I wasn't seeing patients, to be there, I didn't do any golf or anything else that would take me away from family, I did just things that we would do together, whether it was mowing the grass or go on a picnic or whatever.  And so that was good.  As far as taking care of myself, I didn't do very much of that.  I generally thrived on being extremely busy, needed very little sleep, and I seem to get a big charge out of being busy.  If there was a quiet day I might get disturbed, unless I had some paperwork to catch up with, but I sort of (??).\n\nQ.  Were there places in your life physically, anywhere in the community that were kind of free of medicine?  For you?\n\nA.  Yeah, my church.  Church was very important, I felt this, but this was, it wasn't free of medicine in the sense that most of the people in the parish were my patients, but it was a place that I could go and feel great nourishment.\n\nQ.  How did that happen?  I mean, that's a way of taking care of yourself.\n\nA.  Yeah.  It happened because I was nominally, only nominally interested in the church when I moved to Hershey, and joined an Episcopal mission that was there, just a few families, and they got a young rector, vicar, and we got to know each other because my office at that time was right next to the building in which he stayed.  And he didn't have many parishioners and I didn't have many patients, I'd just come back from the Korean War.  So we got to know each other and he had a real old car, an old Hudson, a Studebaker, which made a lot of noise whenever it came in the parking lot.  So when we'd hear him come in at night we'd invite him in, and we'd play, the three of us would play Scrabble together.  And in the process, why, he got us both very interested in the work of the church and theology, what it's all about.  And it just was, became a very powerful point in my life.  But it was that kind of introduction.\n\nQ.  So that was a, the church continued to play a role for you, as you said that it's a place of getting, of nourishment for you, which is (??).\n\nA.  Yeah.\n\nQ.  How does it do that?\n\nA.  Because it, not the formal church, but the spiritual belief behind it provided me with a sense of direction.  And the form doesn't matter too much to me, but it, to me it gives a sense of purpose to life, and a sense of the direction I want my life to go.  And that, the presence of being in church renews that to me.  Partly even at the church, but partly the community of people that come to love in that group.\n\nQ.  That feels like home to you?\n\nA.  Yeah, it does.  As I watch people go up for communion, I know what their inner problems are, and then I feel comfortable. \n\nQ.  You and that minister had a sense of--is he still there, that priest?\n\nA.  No, he's since gone on to many other things.  But--\n\nQ.  In a sense--\n\nA.  --we still get together, but yeah.\n\nQ.  But you were, you both had some knowledge of people that was really very--\n\nA.  Yeah, yeah.  And we supported each other a great deal in a sense.\n\nQ.  Did you, along the line--obviously the department and all of the things that you did around that was a, that was a big change and so on, but the other thing I've found is that there is a role that physicians play in communities, it seems, of being someone who has some kind of responsibility to the community, more than just their practice, but you're being called on to do, or you feel compelled to do more.  Is that your experience also?\n\nA.  Oh, yeah, yeah.\n\nQ.  Do you get heard?\n\nA.  You get heard.  You get invited to speak at the schools and that sort of thing, but for example in Hershey, I noticed that a number of my people have hearing loss, and a lot of these people seem to work in the molding room of the chocolate factory.  The molding room is where chocolate comes out in trays and people stand there, take these big pans and bang them and knock the chocolate out.  And it's, the machinery itself is so noisy that you cannot talk in there.  The only way you can be heard is to cup your hands and yell in someone's ear.  It's that intense.  So I bought an audio, audiometer, little--I started doing hearing tests, and I found I think seven or eight people with the characteristic acoustic dip of an acoustic loss pattern, and so I took these to the head of the corporation, (Choc-Hood??) Corporation, they told me that they had just had the commonwealth in and they had checked everything and everything was fine and so forth.  Nevertheless, they'd take another look.  And so they wouldn't probably have said anything else.  But shortly thereafter they did hire a plant physician, they did put in an audiometer testing apparatus and then they did automate the molding room so that people got out of there.  But it took 5 years.  And I don't know how much my doing had to do with it, but maybe so.  But you know, as a doctor in a small town you will always be heard, they'll always listen, not always agree or do what you want, but they'll always listen.  \n\nQ.  What other kinds of things, I mean what other arenas were you heard, or did you feel compelled to act?\n\nA.  You mean--\n\nQ.  In the community.\n\nA.  Well, in, within the hospital itself, this was a community of 14 doctors and hospitals and doing poorly, and we had to, actually I originally petitioned one time to get things signed to do something different about the hospital, in fact to get rid of the administrator, my predecessor.  Things had gotten so bad that it was just pathetic.  There weren't enough diapers to go around, for example.  One wing had no stethoscope.  You know, it was just--this sort of thing.  And there was no EKG machine, those basic things.  So that was an area in which I, a group of us operated.  A group of us got together to do polio vaccines.  It didn't work out because about that time the, we had the Cutter disaster out in California.\n\nQ.  What was that?\n\nA.  Well, the Salk vaccine was on the market, and being used and then a group of some 14 people, I think, in California, got the disease from the vaccine or there was some major thing and so all of a sudden the town didn't want to do that, and they did it individually.  But that was an arena.\n\nQ.  Was there any time ever you and Jean ever thought of leaving?\n\nA.  Leaving the town?\n\nQ.  Hershey?\n\nA.  Not really, no.  There was, when we went to the medical center I said we didn't recognize the risk, or really believe it was a risk, but nevertheless we did say to each other, you know, if this fails we might just have to go off someplace else.  And we both recognized that that was a possibility.  And there a couple of times during the early course of things when we had (witnessed) some danger that politically we would be wiped out.  And so we recognized that that could happen, in which case we might need to leave and go someplace else.  But we never seriously considered it.\n\nQ.  So it was a really a place that you knew was going to be your home for--\n\nA.  Yeah.\n\nQ.  I don't find that surprising from the way that you talk about it, because--\n\nA.  Well, now with retirement, the question came up again, you know, we could live anyplace we wanted to, and we decided there were some things about there we don't like, but basically we do like the area, we like--but our roots are there, and there are a couple of thousand people there that I feel close to, and Jean does to, so you know, we don't want to leave those people.  During the TMI crisis we thought we might have to leave, and that was a painful thought, but otherwise we didn't.\n\nQ.  What's been the hardest thing about doing what you've done, with your practice and your patients?  What's been the biggest--\n\nA.  With the practice and the patients?\n\nQ.  Your life with your patients.  What's been the hardest part of that--\n\nA.  Oh, I think losing people.  From, particularly losing people from things that are preventable.  That bothers me.  The last year I was in practice, three of my old patients developed lung cancer.  And with, you know, all three of them I think, maybe if I'd have tried that, they would have quit.  You know, we tried a bunch of things.  But you know, they didn't quit and they did get the cancer and they did die.  That's hard.  That's hard.\n\nQ.  As far as the practice, the life with the patients and--as you said, dealing with people who you thought you didn't like--\n\nA.  Yeah.\n\nQ.  But you didn't, sounds like you didn't shut out the people that you didn't like.\n\nA.  No, I didn't, and I think Jean was a help to me in that.  But, 'cause she would always remind me of a few other people I didn't used to like, and became very fond of.  But no, so that, I don't think there was anybody I shut out in that sense.  I never threw anyone out of the practice.\n\nQ.  What was Jean doing all the years that you were in practice?  What kinds of work was she doing?  Raising the kids?\n\nA.  Raising the kids with the--active in church, but raising the kids was a major thing, and looking after me.  \n\nQ.  'Cause that's, you know, it's not a role, it's like the minister's wife has a role in the church, but the doctor's wife doesn't.\n\nA.  Well, yes and no, because people like, like Mrs. McCurty, would call and talk to the doctor's wife.  And--or even get nasty with the doctor's wife, not even with the doctor, but with the doctor's wife.  So it was a role, she was known in the community and looked up to.  \n\nQ.  Were there ever stresses by being in, you know, the doctor in that small community and you or Jean or your family that were--\n\nA.  Related to the (families) in the community?\n\nQ.  Or, you know, in a sense related to the people or, like you said, I mean someone once described his wife going to the local supermarket and you know, somebody coming up the aisle and saying, 'You know, I saw your husband today and that medicine he gave me didn't do any good.'\n\nA.  Oh, yeah, there's that, but there's much more of the other sort of thing.  'Most wonderful doctor' and all these glowing things.  The complaints are much more--there are some, but that's never been a big thing, and Jean's always been able to handle it very well.  \n\nQ.  Where do you think she got her satisfaction?\n\nA.  I think she got her satisfaction from the kids mostly, and the fact that I was thoroughly happy in what I was doing.  I don't think either one of us would do it that way again, because in retrospect she feels that she could have used a lot more help with the kids than I was, and I think that's true.  But she she doesn't (??) about that, so (??).  But also she feels like the whole world of women has changed, 'cause we both grew up at a time when this was the expected role of women, and it was much less a shared parentage.\n\nQ.  I think that may be the one of the, if not the principal factor, one of the main principal factors in how the kind of life that you lived with that community has been changed, because it's going to require a different kind of doctoring, a doctor's partner, whether it's a man or a woman, and because the partner's doing to be different, at least that's the impression I get.\n\nA.  Well, you know, and I think this is all a very good and needed kind of change.  But I can remember when we first started practice, one private patient called Jean one time and wanted to see me on Sunday, and Jean said, 'The doctor doesn't have regular office hours on Sunday, this is not an emergency.'  And the patient said, 'Well, Dr. Horn always did.'  And Jean said, 'Where's Dr. Horn?'  You know?\n\nQ.  Yeah, I'm curious about that physician that you mentioned that the two of you went out to kind of give the (??) to?\n\nA.  Yeah, yeah.\n\nQ.  What do you think went wrong with him?  That broke down?\n\nA.  He was, you mean that he started taking drugs?\n\nQ.  Yeah, that in some ways he was not, his life with that community was not as successful by some measures.  I don't mean financially successful, but it took a toll on him in a way that--\n\nA.  He had a, he had a bad leg, I don't know from what reason, and had said that because of pain involved with that hip, whatever it was happened, he had to use Demerol.  And that got him onto it.  And that every once in a while he was (??)--\n\nQ.  But he just, but you don't know what happened to him?  He left?\n\nA.  No, he left and went someplace else and I lost track of him.\n\nQ.  You know that William Carlos Williams story, Old Doc Rivers?\n\nA.  No.\n\nQ.  What I--if you would do me a favor, it's a little book called Doctor Stories that, a William Carlos Williams collection that (??) Coles put together, and there's a story called Old Doc Rivers, or I'll send it to you--\n\nA.  All right, yeah.\n\nQ.  --and I'm just thinking to myself, what's really pretty stunning in some ways is that, you know, it's a story of a physician, it's almost the story you're telling about him, is this is a doctor who was using all sorts of substances, and he was very capricious, not capricious, unpredictable kind of--he would either be incredibly good or incredibly bad or lying on the floor or out taking care of everybody and so on.  And the story in some ways is about why, why did the community keep going to him and why did he stay with that community.  And it was a, you know, working class, rural poverty community in New Jersey, and in a sense there was this mutual dependency that they had.  And it says that no matter, Doc Rivers, good or bad, he always came.  It's this pact about, it's a kind of, you know, pact with the Devil in some ways, not that the doctor was the Devil, but the community and the doctor were in this incredible role of needing each other and being hurt by each other and needing each other.  And it brings up this, to me what is the most, the first thing you said about why you went to Hershey, which is that--you talked about being needed.  And what I'm impressed with is how there is this line or this sense that if you go someplace what sustains you is that you are needed and you feel that you're doing something important, as you said.  And the other side of that line, you know, is maybe this man, maybe other people, maybe the people who burn out or whatever term, I don't like that term, but you know, that can't get into a relationship that works and it has to be broken up.  And I'm just curious, what--how did you do it?  I mean how did you, I mean as you think back on it, how did you manage to not, as I think what is really the story of this old Doc Rivers is that he became addicted to his community.\n\nA.  And why did I not become addicted to it?\n\nQ.  You were in a mutually--\n\nA.  Yeah, it was mutually rewarding, and (??) I think the patients loved me, I certainly loved the patients.  I don't really know how to answer that.  I never really was sure that I was going to be able to terminate that relationship.  Now it changed a lot as the department grew and I shrunk down the amount of time I saw the patients, but I still saw some of the original patients up till I retired.  I took a 6-month sabbatical a few years before I retired, and was surprised how free I felt.  You know?  I was free of being concerned about what would happen.  I still cared about what happened to Mrs. what's-her-name, but I wasn't responsible for that, and it was a difference.  And that was when I realized, yeah, I could eventually retire.  And when I did, it didn't actually bother me, not seeing patients.  I think it would have bothered me if I weren't around.  \n\nQ.  Yeah, I was going to say if you were living in Florida it might be different.\n\nA.  Yeah.  Now one of the patients goes to the hospital I go see them.  And socially.\n\nQ.  But now you go as their friend.\n\nA.  Yeah.  And they call me up as a friend and, 'What shall I do?'  And I do a fair amount of that.  And I don't mind doing that, offering my services for that (??), 'I'll be glad to meet with you and talk about this and suggest who you ought to see, what you ought to do.'  It's nice to be able to do that and not to have to charge people for it.\n\nQ.  I know, it's you know, when I was in Wales all the GP's I talked to would say, 'How can you charge patients for what you do?'  And I thought, 'Not easily, and not happily.'  I never did buy into this idea that people who pay for it somehow are going to be more grateful.  I think it's, it's not a fiduciary responsibility, it's one of loyalty and perseverance, trust.  Other things that you can think of that just cross your mind?\n\nA.  One of the great rewards of being in a small town in practice this length of time, is that I now have two family doctors on my staff whom I delivered.\n\nQ.  Oh, my goodness.  Geez.\n\nA.  Actually, two of my senior people.\n\nQ.  That's wonderful.  You should frame their birth certificates in your office.\n\nA.  Yes.\n\nQ.  Thank you very much.\n\nA.  You're very welcome.  I think the, what I was going to say is that the joy of that kind of practice to me has been real ongoing relationships and that some of them have taken a long time to ripen.  But also because of the fascination of what can go on within one family within one span of my lifetime that I can be part of, and points in that where as I look back I may have made some significant difference in.  Also some points where I should have made significant differences and didn't.  But it's what makes it to me a fascinating way to live and much different from much more technical kinds of work, practice.\n\nQ.  Yeah, I think that's what keeps us all going.\n\nA.  Yeah.\n\n[interview ends]","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277832#t=0.0,1911.40569"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277832/transcript/81268","type":"AnnotationPage","label":{"en":["Dr. Tom Leaman interview transcript 2 [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277832/transcript/81268/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Tom Leaman\n\nMay 6, 1991 (Part 2)\n\nPhiladelphia\n\nQ. - John Frey, M.D.\n\nA. - Tom Leaman\n\n_____________________________\n\nQ.  Well, we had talked about you thinking back on, if you can, kind of reconstruct for me what, what was going on in your mind at the time when you started to think about making a change to becoming a teacher of family medicine from being a clinician.\n\nA.  Actually, I--my training was a general practitioner.  I did a one-year internship, I went into practice and I practiced like a general practitioner, but after, oh, I don't know, 10 years or so, I began to think a little bit differently and get interested in looking at people differently, and I went down to Temple and took a course every Wednesday which was meant to look at the whole person.  And to do that they had half the course taught by psychiatrists and half by internists, and the idea was to put it all together.  And it was very useful, but I realized that neither side knew what the other was doing.  But they both recognized that somehow it ought to be put together, but they weren't doing it and we as students were trying to do that.  But it was useful.  So I sort of evolved toward family practice in a sense, although they didn't call it that, but that was my interest in practice.\n\nQ.  How did, I'm just curious what was, where did that interest come from, I mean what about practice created that interest in you?\n\nA.  I think I saw so many people with things that they could have prevented, and a lot of these were related to how they lived their lives, and I'm very interested, I've always been very interested in prevention, and I felt that some of this had to do with what I saw as stress in their lives and I didn't know what to do about it, and then found this book by Michael Ballant(??), I guess it was his first one, The Doctor, The Patient, and The Illness, and that impressed me very much.  And I guess that's just how I got interested in it.  So that was kind of background, and I wasn't doing anything more with that than trying to do a better practice with what I had, but it was in a small town.  Hershey's just got fewer than 5,000 people, but there were three or four other docs in there and we were just overrun with patients.  We took turns being on call, but if you were in town you were on call, and it was just overwhelming with patients.  That was the situation till one day, one summer, we took our kids west, the United States, and I took a month off, and on the way back we passed a newsstand and there was this big headline, \"Medical Center To Be Built in Hershey.\"  Which just boggled my mind and I got all excited about this, and it turned out that the Hershey interests had told Penn State it would build a medical center in Hershey, or at least give $50 million toward that.  Which at the time was a huge amount of money.  It isn't now, but--and actually we thought you could build it for $30 million and have $20 million left for endowment.  Anyway, so that intrigued me.\n\nQ.  What year was that?\n\nA.  That was in about '65, and so the Pennsylvania Academy appointed Ed Kowalewski and I as liaisons to go meet with the new dean.  The new dean was George Harrell.  And he was parked in a farmhouse out--which is still behind the medical center.  And we went out there and made an appointment, went out and met with him.  And the, it was a memorable ride, actually, 'cause we drove out across these, it was in spring, we drove out across the meadows, the farm, and he was a, they'd just manured the area, and Ed Kobalesky said, 'Tom, remember this, I think this may be significant.'  So anyway, we met with George Howe, and he listened to us, complaining about there aren't any family doctors and the reason there aren't any family doctors is because you guys in medical school don't teach it, etc., etc.  He sat there and he listened to the whole thing, he said, 'well, now, if you're really serious, I plan to start the first department of family medicine.  And you could apply to me to join it.'  And sounds great, and he said 'there are three conditions.  One, you have to work at an academic salary.'  Which sounded wonderful.  Certainly better than we're (??).  'And two, you have to bring your practice along with you.'  Well, that ruled out Ed Kobalesky 'cause he was off in another county.  'And three is, you ought to get a year's experience working with medical students and residents before you come on board.'  That's wonderful.  So I went home and thought about that, and I, the more I thought the more excited I got.  And my wife supported this.  But I couldn't leave my practice, there was no one else to take care of the patients.  I couldn't support my kids with, so I went back to see the dean again and he said, 'well, it's very simple, all you do is find another person who wants to do that also.  And then one of you stays and takes care of the practice, and the other goes off for 3 months, and then you flip-flop.  And you do that until you've had your year's training.'  Great idea.  But I couldn't find anyone else in the town who wanted to consider it, and this went on for some months, and then a man who I had known in internship who was in practice, Hiram Wiest, got interested, and we talked, and finally one day he called up and said, 'Damn you, Tom Leaman,' he says, 'we gotta do this.'  So he sold his house and office in East Petersburg and moved to Hershey with his five kids, and we formed a legal partnership.  We were both in solo practice, formed a partnership, and then we practiced together for one day, the 28th of February, I think, and then the following day then I went down to George Washington, which was my alma mater, and signed on as a first-year medical resident.\n\nQ.  Oh, my God.\n\nA.  And scared the heck out of me.  And--'cause I found out I didn't know the language, they used all kinds of abbreviations I didn't know, and they put me in charge of the emergency room.  That turned out all right, because there were enough people in the emergency room who knew what to do about the comas(??), they had problems when they had someone with chicken pox.  And that was fine on that.  Anyway I did that for 3 months, and Hiram supported both families.  Ran the practice.  Then I came back and he went to Penn for 3 months, and I went to St. Christopher's Hospital for Children, and then I spent 3 months going around to places like Miami and Harvard and McGill and so forth.  And then the dean had said one block of time should be overseas.  So I went to England for 3 months, and there were seven or eight schools over there that were beginning to do things, but no one had really done much out there and were mostly talking.  Hiram went to Europe and did that.  And this was at our own expense, because even the dean wasn't paying for this.  We found out, the academic, gotta tell you, that the academic salary which I thought sounded so great, it turned out to be, the first offer was $25,000, which was--I was currently netting $54,000.  And I just couldn't, I couldn't swing it.  And so Vee(??) and I struggled with this, and struggled, I really wanted to do it, and finally decided we could get by for $28,000.  So I went back to see the dean and told him I couldn't do it, and before I made my offer, he offered me $30,000.  I never told him that.  So anyway, that worked, and then we got an additional year's experience that way.  And medical school started in '68, and we started the first year.  I guess the school, it was '67, the first year we practiced out of my office and had students in our office, and then the following year the building was completed enough that we could move into that and went on from there.  But that was really how I got interested in it.\n\nQ.  What was it, what I'm always curious about, what was it inside of you that, I mean those, if you laid those series of circumstances out for people nowadays, they'd say that is an enormous risk and a risk to your practice, risk to your family, I mean not jeopardizing, but that's a big change.  What was it that was really driving you to do that, do you think?\n\nA.  You know, it's an awfully good question, John, and I'm not sure I fully know the answer.  But there was, I never really thought of it as a risk.  Everyone else talked about the risk, my friends all talked about the risk, and I was so sure that it had to work that I didn't think it was a risk.  And I was sure that the way to practice was family practice, and I was sure that a lot of people wanted to do this.  And I thought it would probably be easy to teach, just by doing it.  Didn't turn out all that easy, but I don't, I didn't see it then as risky as I guess it was.\n\nQ.  Which is, I mean that's almost a definition of something that's not a risk.  I mean you were--there was a sense of surety that this was going to work and so it wasn't risky and I think that's--\n\nA.  Yes.  I guess the other thing would be that I was able to continue my same practice.  (Part of this) was taking my practice with me, and part of what I enjoy doing is taking care of patients, and I didn't need to start over.  Hiram had to start with a new group of patients, and that would be a lot of harder.\n\nQ.  But you said that town was so busy at that point that there wasn't too much of a worry about being able to build a practice.\n\nA.  No, there was never a worry about that, the worry was always how are you going to take care of everybody and do a decent job.  And that was the main concern.\n\nQ.  Where did you find kind of moral and intellectual support for what you were doing?\n\nA.  The dean was very supportive, in that sense.  Visiting these other places, like Lynn Carmichael and Gene Farley, who was at that process just laying out his residency in Rochester, he was marking out with blue chalk where the rooms would go.  But he and maybe a dozen other people around the country who were interested in this, and I think that--and people in England who saw this as a way of doing things.  And of course this was shortly after the Millis and the (??) Willard reports that came out and this was obvious intellectual backing for what we were going to do.\n\nQ.  So you, did the department actually start, or the program actually start before the society was founded?\n\nA.  Yeah.  Yeah, we started I guess in September '67.\n\nQ.  So were you the first, was that the first department?\n\nA.  Yeah, I think it was.\n\nQ.  What do you think got the dean to do that?\n\nA.  Well, the dean had founded a medical school in Florida before, and he was a very intellectual guy who had a very broad picture and had a sense of, that medicine ought to be people-focused.  And to do this, when he started the second school he wanted a Department of Family and Community Medicine, he wanted a Department of Humanities, and a Department of Behavioral Science.  And all three of those were new.  That was not the first department in behavioral science, it might have been in humanities, I'm not sure.  But he saw this as being people-centered, and we had a basic role in this.  When he designed the school he liked to translate philosophy into architectural concept.  And so he put family medicine on the first floor, between the medical school and the hospital, right across from the library in the front of the building.  You know it was kind of a focal point.  The limitation, however, was that he started this in a very small space, it was purely clinical, we had eight small examining rooms and some offices and a little waiting room.  I mean that was all the space we had.  And he told me later than he recognized that was a mistake, but he never thought we were going to get board certification.  He thought this was going to be a demonstration project--a very important demonstration project, but never board certification.  He was an internist and he just couldn't quite conceive of that.\n\nQ.  And once that came along, was he resistant to that?\n\nA.  No, no, he was delighted with the way the thing--and he responded by giving us more space, but a little reluctantly.\n\nQ.  What was, I'm curious what your family was, what were the family dinner table conversations when all this started to stir around?\n\nA.  Excitement.  When my wife really realized what this was all about and what I wanted to do, she was 100 percent in favor of it, and the kids were very supportive, that that was a big help.\n\nQ.  You'd been how many years in practice?\n\nA.  Seventeen, before that.\n\nQ.  So how old would that have made you, just out of curiosity?\n\nA.  I was mid-40s.\n\nQ.  I find it fascinating to, if you go back and calculate, most of the people who were leading this discipline at that time were in a sense at some predictable transition, at least possible transition in their own lives.  You know, looking backward and looking forward, and I think it seemed to coincide in a lot of ways with some timing in individual lives that was pretty important.\n\nA.  It did with me, in a sense, because it was just, oh, couldn't have been more than a year or two before that, that I was feeling that, you know, here I am in practice, things are going well, and I've finally paid off my debts, and I began to feel a little guilty, that maybe I really ought to be in Africa or in some undeveloped country doing something bigger, or where it was more need, and I went on a retreat one time and asked for time to meet with my bishop.  And I did, I told him this whole thing, and he said, in effect, that if God wants you to be someplace he'd have let you know.\n\nQ.  I'll check the mail every day.\n\nA.  Right.  But when I saw that headline, I thought, ah-ha!  there's something else here.\n\nQ.  Really.  It must have been quite a moment.\n\nA.  It was, it really was, really exciting.\n\nQ.  Well I know that when I was, I was an undergraduate out in the great Midwest at that point and thinking about medicine and I remember, I didn't know how long Hershey had been around, but the two places that, at least for, somehow that however anybody talked about them they seemed attractive, but you know, Hershey seemed like such a far ways away, it was Hershey and Case, 'cause Case had a family project and stuff.  There was something about that really hit me early, that I couldn't understand till much farther down the road.  What's, I mean I'm always curious about what, this sense of caring and the sense of serving people comes from, how do you explain your vocation, in a sense?\n\nA.  I don't know as I've ever thought about that, John.  I care deeply about people, and I think that I've learned about myself that there are patients that I really literally don't like.  And they're unusual.  And I've also learned that even the people I dislike most, if I get to know them well enough I can learn to love them too.  And some wonderful characters that I've become very fond of.  But I started out by just, could hardly stand the sight of them.  And I think it's, so I think I've learned from that that I like to get to know people better, and family practice is a wonderful way to do that, 'cause you can ask people anything, and you can be with them in all kinds of moments.\n\nQ.  Is that something that you had some personal experiences of earlier in your life, in some way or the other?\n\nA.  No, I had a family doctor, but I rarely saw him.  I only saw him for crises.  And I don't know that there's anything in particular that I can attribute that to.\n\nQ.  'Cause you certainly went through the, you know, the explosion of science, you know, time and medical education where all things were possible, and you were swimming against a very rapidly moving stream to be able to do that.\n\nA.  Well, I didn't really, a lot of people decide they want to go into medicine and they have that direction.  I didn't, I backed into it.  You know, I went off to college to study business administration 'cause my dad was a grocer.  I got interested in psychology because I read a book on abnormal psychology, and all these weird cretins and morons and things, that interested me.  So I decided I wanted to be a psychiatrist.  And then I talked to a psychiatrist and found out you had to be an M.D.  And at that point I had taken the first college chemistry course and I got a C.  And I had never gotten a C in anything in my life before, so I thought, that's my worst subject, I can't be a doctor, so I'll be a psychologist.  About then I got drafted or forced to volunteer, and in the service I took some tests and they pulled me out and sent me to an army specialized training program, and asked me what I wanted to study, and I said personnel psychology.  So they said fine, and sent me to Baylor in Waco, and it turned out to be a pre-engineering course.  But it was pretty much liberal arts, so I finished that, and they said, okay, now you can stay on in premed if you'd like to, or you can go back to the troops.  And premed sounded awful good then, so I--by then we had chemistry, well, organic stuff that was really no trouble at all and I did very well in that, and then went on to medical school.  Lost all interest in psychiatry as a field.\n\nQ.  Although you know, as you started talking, you were talking about this, at the point just before getting into family medicine, this curiosity about what was happening between you and patients, was still something that--\n\nA.  Yeah.\n\nQ.  I mean it's interesting to see that that--I'm convinced that people's early interest is broadly defined, often sway on the (??) back in in some way or the other at later times in your life.\n\nA.  It's interesting, yeah.\n\nQ.  I was an English major in college and I was not really convinced that medicine was what I wanted to do for a long time, because I really enjoyed writing and reading, and many years later ended up editing the journal, which has made me happier than anything in my profession.  So it's an interesting kind of--I'm convinced that there's some kind of connections there somewhere for most of us.\n\nA.  Maybe.  My current new career, after I finish being interchair, is in writing, and I've written a book on anxiety disease written for lay people, and sold it, it won't be out till spring.  And another one under way on malpractice (??).  But writing is something I want to do, and--\n\nQ.  Well, what were the--along the line, and once you've--so you've started the first department and in a sense you were way ahead of everybody else organizationally, and you were into a medical school a lot sooner than other people did, and then this--when was it that you started to become part of this network of people and programs around the country?\n\nA.  Through the traveling route I knew a lot of people, such as (??) and others, but when I guess Lee Blanchard and Lynn got together the first group of STFM, and I think Hiram went to that, I didn't, one of us did, I think it was Hiram, we had--I'm not sure we got to the first meeting, may not have been till the second, because the dues were $15 and it was in New York City and we didn't know how to get the money together to do that.  But anyway, so by the second or third meeting, then we started being part of it, and by then we found out how to get money out of the system.  I was totally green, I had no idea.  Had no idea about curriculum, about anything.  And we had a meeting up at the farmhouse one time, early on, and we were the only basic science chair, we had no hospital, that hadn't been built, so it was just basic science people and me.  And so this was a curriculum committee.  And they said, 'how many curriculum hours do you need?'  You know?  I didn't know what a curriculum hour was, and somehow I didn't want to look totally stupid, and I said, 'Seventeen.'  And they said, oh, that sounds reasonable, and so they put that down and they went home, (??) discussion.  And I thought afterwards, I don't know if that's 17 a week or a month or a term.  I didn't know what I was going to do with it.  But I was just totally, totally green.  The, I'd been there a couple of years and we were trying to find a way to get somebody else recruited.  The biggest problem was trying to recruit people for family, because there was not much to offer them except the possibility.  And not much money, but we got the idea with the behavioral science people that we could maybe work out a joint fellowship and attract somebody by having a joint fellowship.\n\nQ.  Attract an M.D.?\n\nA.  An M.D., yeah.  And so we wrote up a proposal, and I went out to Denver and met with the board of the AAFP.  And told about this idea, and [interruption].  So anyway, I went out there, was asking for $42,000.  And they listened and so forth.  A little while later, I guess a couple of weeks, I got a check for $42,000.  And I thought 'this is wonderful.'  Went off to the controller's office to turn it in, and all hell broke loose.  'What about the overhead?  What about the grants office?'  I said what's a grants office?  What's overhead?  'We can't accept this.'  But they did, needless to say.\n\nQ.  They may complain, but--\n\nA.  Yeah.  \n\nQ.  What have been some of the, I guess the way I'm beginning to conceptualize (??) is kind of a crisis of faith.  Have there been any of those along the way, or times when you felt uneasy in some way or the other about choices?\n\nA.  Never felt uneasy about choice for me personally, or about the rightness of what we were trying to teach as family practice.  I've had (??) at times when I feel that our teaching misses the mark, and that at times I'm concerned that we produce excellent general practitioners, and somehow miss the distinguishing features of the family physician.  And these are ongoing concerns, I guess they always will be, but those have been concerns.\n\nQ.  What about as you look at the products of all that effort back then, I mean how are you feeling about you know, whether--you said there's some people that haven't learned really about family medicine, they've learned general practice.\n\nA.  I think in general I've been enormously pleased with the product, with the people who have come out the other side.  Not just from our own program but in general, as I've interacted with them, I've been very pleased.  I think--but there are exceptions.  I think people who are well-trained technically but who are very money-focused and production-oriented, and that disturbs me.  Not everybody has the same glimpse of, or same interest in overall family wholeness.  And that bothers me.  \n\nQ.  Does the organizations around family medicine, like the Society, I mean what's your sense of how those have functioned?\n\nA.  The Society has pleased me enormously.  You look at the program now and it's just as exciting, far more exciting than it was 8 or 10 years ago.  It just--and that continues to grow.  And that pleases me very, very well.  And as I can perceive it, I'm not in the inner workings, but I get the feeling that the STFM and the Academy are working pretty well together, and not in conflict.  The two foundations have been sort of in conflict, which bothers me, I think it's unnecessary, but I think generally the organizations and the chairs have found a separate role that is not conflictual and works well.  And I'm pleased with that.\n\nQ.  Quite a different period.  I mean one of the things that gets (wished??), I'm not sure exactly by whom, probably various groups, is this whole idea of whether the vision about what it is that we're supposed to be doing, not just as a society but as physicians and so on is as clear these days as it has been before.  \n\nA.  Well, this I think worries me too, and yet a meeting like this, at least among the teachers, I get the feeling the vision is clear.  And I think there is always a danger that we as teachers have got to recognize that what we teach must not only be correct philosophically but it also has to provide our students with a way to make a living.  And I think it's awfully easy to, as Ed (??) saying this morning, talk about a person that's being, having spent an hour per patient and you just can't do that and make a living.  So I think there's always that tension.  \n\nQ.  What other thoughts do you have as you reflect back on things, I mean you had a chance to do that a number of times in the last--seems like we won't let you get away.  (??)\n\nA.  I think in general we've done well, I think there's some things that, a lot of things that I wish I would have differently or better.  And one of the major ones is that I don't think I ever did a successful job of educating the rest of the faculty as to what family medicine's all about.  And that has to be a continual thing, partly because that's how people learn when there's something so radical it doesn't, it takes more than one dose.  And partly because the rest of the faculty is a continually changing (??).  You're really trying to educate residents as they go through there.  And I don't think that's that I ever did that well.\n\nQ.  Well Gail's talking about this tension between being a church and being a sect is one of the really--\n\n[tape side ends]\n\nA.  I just gave a talk in Albany on the future of family medicine and I said then something that I really believe, and that is, I believe very strongly in the concept that family medicine stands for.  But I don't really care a great deal about the titles, and if at some point we needed to develop another specialty that wasn't called family medicine, if that was a way to deliver these precepts, that's okay by me.  I think there's a danger always of, as an organization, of making decisions on the basis of the good of the organization rather than on the principles of the organization.\n\nQ.  And I think that being weighted too strongly to one or the other name or term can really paint us into corners that we don't want to be in.  I remember one of the things that someone had said is, you know, this idea of reexamining our past--I think Ted was talking about the reexamining past decisions in light of present realities, and he said you're changing from general practice to family medicine, you know, I still find it helpful that when people say well, now, what's a family doctor do, and there's a lot of people who, you know, it's a continuing education.  And the easiest thing for me is often to say well, you know what a GP is?  They say oh, yeah, I say that's me.  They have a sense of what a GP does, but a family doctor seems to be something different.  So we've paid some prices for these kinds of changes.\n\nA.  Yeah, I use that too, general practitioner except in training, focus on the family, the whole person, prevention, and so forth.  But it begins with that.\n\nQ.  What do you think from your point of view, looking at the history of the discipline, what are the moments that are the most important to focus on?\n\nA.  I think, I wasn't part of the struggle, but I think the struggle to get board certification was the monumental struggle in the very beginning.  And as I hear people talk about that such as Ed (??) and Nick Pizzicano, I see that as really a big struggle.  And probably a struggle, certainly a struggle within the organization first, to get the organization to back that thrust and to go for certification.\n\nQ.  You saw that it was a struggle within our own--\n\nA.  Oh, yeah.\n\nQ.  It was a family fight, in a way.  I mean it wasn't, but at least that's how it comes across.\n\nA.  Yeah, yeah, I think it was.\n\nQ.  Thank you.\n\n[interview ends]","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277832#t=0.0,1911.40569"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277830","type":"Canvas","label":{"en":["Media File 2 of 4 - Leaman_Tom_1991.05.06_-_Side_2.mp3"]},"duration":199.64675,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277830/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277830/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/277/830/original/Leaman_Tom_1991.05.06_-_Side_2.mp3?1750279467","type":"Audio","format":"audio/mpeg","duration":199.64675,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277830","metadata":[]}]}],"annotations":[]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277833","type":"Canvas","label":{"en":["Media File 3 of 4 - Leaman_Tom_1991.05.06_-_Side_3.mp3"]},"duration":1933.66306,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277833/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277833/content/3/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/277/833/original/Leaman_Tom_1991.05.06_-_Side_3.mp3?1750279469","type":"Audio","format":"audio/mpeg","duration":1933.66306,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277833","metadata":[]}]}],"annotations":[]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277831","type":"Canvas","label":{"en":["Media File 4 of 4 - Leaman_Tom_1991.05.06_-_Side_4.mp3"]},"duration":1614.632,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277831/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277831/content/4/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/277/831/original/Leaman_Tom_1991.05.06_-_Side_4.mp3?1750279468","type":"Audio","format":"audio/mpeg","duration":1614.632,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150647/file/277831","metadata":[]}]}],"annotations":[]}]}