{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/707wm14z4s/manifest","type":"Manifest","label":{"en":["Dr. Randall Oates and Julie Kegley"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2022-04-27 (created)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Keyword"]},"value":{"en":["Arkansas","family doctors","rural family medicine","physicians","speech recognition software"]}},{"label":{"en":["Subject"]},"value":{"en":["Arkansas Academy of Family Physicians (corporate name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/196/785/small/Oates_Randall_andKegley_Julie%284-27-2022%29.mp4_1689093836.jpg?1689093837","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/99090/file/196785","type":"Canvas","label":{"en":["Media File 1 of 1 - Oates__Randall__and_Kegley__Julie_(4-27-2022).mp4"]},"duration":9167.2581,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/196/785/small/Oates_Randall_andKegley_Julie%284-27-2022%29.mp4_1689093836.jpg?1689093837","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/99090/file/196785/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/99090/file/196785/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/196/785/original/Oates__Randall__and_Kegley__Julie_%284-27-2022%29.mp4?1689093819","type":"Video","format":"video/mp4","duration":9167.2581,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/99090/file/196785","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/99090/file/196785/transcript/45028","type":"AnnotationPage","label":{"en":["Transcript of Dr. Randall Oates and Julie Kegley interview [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/99090/file/196785/transcript/45028/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Dr. Sam Taggart: Good evening, my name is Sam Taggart and I am in the home of Dr. Randall Oates....by the way, are you any kin to Willie Oates?\n\nDr. Randall Oates: You know, especially when I was in med school in Little Rock, people asked me that almost every day.\n\nDr. Sam Taggart: Sure....they had to...\n\nDr. Randall Oates: Uh, I am...I’m not closely related; there is a very, very, distant relationship.\n\nDr. Sam Taggart: She was from up here; wasn’t she?\n\nDr. Randall Oates: Well, I was very distantly related to her husband.\n\nDr. Sam Taggart: Oh, ok...alright. \n\nThe purpose of today is to document Dr. Oats’ life and what he has done with his life from a professional standpoint and anything else that he would like to include in this is fair game. There is no such thing as rambling and Dr. Oats, you can talk as long as you want.  \n\nThe best place to start is at the beginning: When and where were you born?  Talk about the circumstances of your birth and little bit about your parents.\n\nDr. Randall Oates: My date of birth is January 18, 1955 and I was born in Russellville, Arkansas.  I was delivered by the original Dr. Henry of the Millard-Henry Clinic and my mother’s maiden name was Henry; she’s of that family.  Her father was a pharmacist in Russellville; Pope County for over 50 years...\n\nDr. Sam Taggart: What was your mom’s name?\n\nDr. Randall Oates: Emily.\n\nDr. Sam Taggart: ....And your dad?\n\n\n\nDr. Randall Oates: Wade...They both grew up in Pope County and were married in 1949.  My sister was born in 1950 and I was born in ’55 and I always lived in or around Morrilton, Arkansas.  When I was born, they lived on a farm in a little community outside of Morrilton called Sardis and we had....\n\nDr. Sam Taggart: North or South of town?\n\nDr. Randall Oates: South of town.....south and east.....\n\nDr. Sam Taggart: Towards the river.... \n\nDr. Randall Oates: Yeah, towards the river...between Morrilton and the river...there in the bottom land.\n\nDr. Sam Taggart: Now is that the same place where the community of Lewisville used to be?\n\nDr. Randall Oates: It’s very close to Lewisburg...\n\nDr. Sam Taggart: Lewisburg; I’m sorry...\n\nDr. Randall Oates: It’s a couple of miles from Lewisburg and we had cows, chickens, and pigs.  I mean, it was just a wonderful place to grow up; I grew up on the farm.\n\nDr. Sam Taggart: You are a bit younger, but not a lot, than Joe Stallings.  \n\nDr. Randall Oates: Than who?\n\nDr. Sam Taggart: Joe Stallings...\n\nDr. Randall Oates: Oh yeah...yeah, Joe was ahead of me.  He was...of course, they had the big grain bins there in Morrilton; they were the super family.\n\nDr. Sam Taggart: He has two cousins, I think both from Morrilton, who both became physicians.\n\nDr. Randall Oates: Uh huh....really..?\n\nDr. Sam Taggart: One is a urologist and I don’t know the other...Alan Stallings and there is another fellow there...\n\nDr. Randall Oates: Huh...I didn’t know that.\n\n \n\nDr. Sam Taggart: Joe’s great, great, great, great grandfather was a doctor in Lewisburg during the Civil War...\n\nDr. Randall Oates: Oh really...\n\nDr. Sam Taggart: And died of dysentery...\n\nDr. Randall Oates: No kidding....\n\nDr. Sam Taggart: He was a confederate doctor there in Lewisburg and so, right from your community.\n\nDr. Randall Oates: Oh my gosh...wow.\n\nDr. Sam Taggart: So you were born there at St. Mary’s in Russellville.\n\nDr. Randall Oates: Uh huh...\n\nDr. Sam Taggart: Dr. Henry gave you birth....you were talking about farmers in the family...what kind of work did your father do?   \n\nDr. Randall Oates: Well, farming was his love and he...there is a wonderful story; in 1944....no, he went to college and when the Japanese bombed Pearl Harbor, it was in December and so, he didn’t sign up for the next spring semester thinking that he would be drafted.  So, he went back to the farm outside of Atkins and waited to be drafted....well, three years went by...\n\n(Laughing)...\n\nAnd in 1944, he still hadn’t been drafted and so, he went down to the draft board and asked, “Why haven’t I been drafted?  I’m getting tired of hanging around Atkins” and they said, “Are you kidding; we would never draft you off of that farm.  That is the most productive farm in Pope County.”\n\n        \n\nDr. Sam Taggart: Huh...\n\nDr. Randall Oates: And he said, “To heck with that; I’m going to figure out”... he was really fascinated with electronics...radar and sonar...and there was some special program where they were advancing soldiers that could get that because they needing them on the destroyers, and the planes, and here and there.....so they had this real accelerated program and he had to take this aptitude test in Little Rock in order to apply for this program...this was 1944 and he went down to the draft board and said, “I want to take that test” and they just laughed at him and said, “No one in Arkansas has passed that test in two years and you’re not going to do it.”  He said, “Well, I’m going to take it”....well, I’ve heard many funny stories about that trip to Little Rock that he shared with me; but longest story short....\n\nDr. Sam Taggart: Are those written down anywhere?\n\nDr. Randall Oates: Uh, not written down anywhere....but he said that several weeks later there was a knock on the door and there were military officers there who said, “You need to get your things and come with us.” They said that he had knocked the top off the score and they needed him.  He went through this training that made medical school sound like a piece of cake; I mean, it was so intensive....and they would shift him from the naval yards in San Diego to Chicago, back and forth, and there was another spot that I forget where it was..the navy training centers where they would get different parts of this course on radar and sonar....and when they traveled, they were under guard and it went first class...that’s how.....nobody knows about this program that I have ever heard of.\n\n       \n\nDr. Sam Taggart: This was not the “V” Program was it?\n\nDr. Randall Oates: I don’t know what the name of it was.\n\nDr. Sam Taggart: There was a “V” Program where there was some people who got into it from that was related to the Navy.  \n\nDr. Randall Oates: That’s what it was; but they treated him like first class.  When he finished all his training, he was commissioned to a destroyer, “The Demato,” and it was being completed in the shipyard near New York City.  So, he got to spend the last few weeks of the war cruising around New York and going to the Statue of Liberty, seeing all the sights, and waiting for the ship to be commissioned; the war ended while he was in New York waiting to go out in the ship. But for all my childhood years, he could fix TVs, radios, or anything; he was...\n\n  \n\nDr. Sam Taggart: Just out of curiosity; prior to the war had he been one of those kids who tinkered around with radios? \n\nDr. Randall Oates: Not to my knowledge.\n\n  \n\nDr. Sam Taggart: Huh....\n\nDr. Randall Oates: He was a farmer and he wanted to be out in the fields.  His right arm was an inch longer than his left from chopping cotton.\n\n(Both laughing)....\n\nHe had to have all his suits altered.\n\n(Laughing)...\n\nAnyway, that was a diversion; but, I think that is a fascinating story.\n\nDr. Sam Taggart: Yeah; sure it is...\n\n \n\nDr. Randall Oates: There were just a lot of interesting stories around that...but anyway, his love was farming.  But, we didn’t own very much land and it’s hard to really get ahead in farming when you don’t own land and having to rent and didn’t have equipment; we had some crops burn up one summer.  So by the time I can remember anything, he wasn’t farming; he had become the manager of the Co-op Store and my mom a school teacher.   In review, my mother was a school teacher and my daddy was the manager a Co-Op Store while I was growing up in Morrilton.  By the time I was in the fourth grade, I was working at the Co-Op and by the time I was in sixth grade, I was in charge of the garden seed department.   Then all through his school, I managed the whole garden center; we had a huge garden seed department and that was just a lot of fun with just all the farm equipment... I was organizing that and loved doing that.  At the Co-Op, you’re selling feed, seed, fertilizer, tires, batteries, accessories, and all your farm needs.\n\n(All laughing).....\n\nThat was great...there were lots of gadgets and interaction with people and I really enjoyed that.  I grew up all twelve grades in Morrilton.\n\nDr. Sam Taggart: Lets back up just a little bit….tell me about your extended family.\n\nDr. Randall Oates: My mother’s family is not farmers; they are healthcare.  Her oldest brother, Forrest Henry Jr., was an ophthalmologist in Little Rock for many years and then her next brother, Bill...William, went into cardiology and he was a math guru and became an actuarial consultant for an insurance company and had quite a career doing that.\n\nDr. Sam Taggart: You said your mom was a school teacher; where did she go to school?\n\nDr. Randall Oates: She went to Arkansas Tech for her undergrad and then got her Masters at UCA.  She actually went to work...when I was in medical school, she was the health department, the State Department of Health, and was in charge of vocational and home economics.\n\nJulie Kegley: You mean, the Department of Education...\n\nDr. Randall Oates: Yeah, in the Department of Education.....what did I say?\n\nJulie Kegley: You said health....\n\nDr. Randall Oates: Oh...habit...The Department of Education and was the director of vocational and home economics for over a decade and had a very rewarding career doing that.\n\n \n\nDr. Sam Taggart: What time frame was that.....that she was there doing that?\n\nDr. Randall Oates: She started doing that....it was early ’70s.\n\nDr. Sam Taggart:  I was going to say the Farris Center....The Ferris Center at UCA; his forte was health education and he built up that center real strong in the ‘40s and ’50s with the help of the Department of Education and the Department of Health.... both....so, I was kind of curious about your........\n\nSo, obviously education was something that was important to your family; is that fair to say? \n\nDr. Randall Oates: Oh gosh; yes.....that was very important.  I could get by with most anything if I could come up with a logical explanation....\n\n \n\n Dr. Sam Taggart: (Laughing)....Ok...\n\n\n\nDr. Randall Oates: So, I very young was very....as far back as I can remember....science and how things worked; I was the kid that would take things apart and they’d get upset.  I was that nerd. You know, taking animals into my desk at school and getting the teacher all upset; things that I would find \n\nwalking to school that I thought was interesting.  I love nature; I love nature as much as I love gadgets and that was always a ...I always had a project; whether it was flying kites, dissecting worms, or building a metal detector or CB Radio.  I mean in elementary school, I was building radios and fiddling with electronics...I was just that nerd.\n\nDr. Sam Taggart: I’m going to take a break and inject her part of the bio here; talk about your life.  Where were you born, what was your maiden name, and those types of things. \n\nJulie Kegley: Ok; well, my name is Julie Kegley and still is.  I was born in Pigeon, Arkansas and lived there for the first six months of my life and then we moved to Wynne, Arkansas.\n\nDr. Sam Taggart: Do you mind saying when you were born?\n\nJulie Kegley: I was born December 9, 1965.  We lived in Wynne till I was three and then, we moved to Marked Tree where I grew up and graduated from high school; Marked Tree.\n\nDr. Sam Taggart: I graduated from Augusta, so I know where......\n\nJulie Kegley: Oh ok...so you know where I’m talking about then.\n\nDr. Sam Taggart: I know exactly where you are talking about....What did your family do?\n\nJulie Kegley: Uh...well, we’ve talked about this....our parents were a lot alike as far as temperament and...of course, I never met his dad; he passed away long before we met, but he met my dad .  But, we think that our fathers were very much alike because my dad was a TV repairman... (laughing)...that’s what he did for a living.\n\nDr. Sam Taggart: So all this EMR stuff kind of comes naturally....\n\nJulie Kegley: I guess so.\n\nDr. Sam Taggart: It’s got to......it’s got to.\n\nSo your father was a TV repairman...\n\nJulie Kegley: He was....my mother worked in factories until...well, my first job out of college ...my mother went to school to become a nurse and she became an LPN, which she did until she retired.  She worked at St. Bernard’s Medical Center in Jonesboro for 15 years as a floor nurse; that’s what she did.  I left Marked Tree to come here to Northwest Arkansas and attend the University of Arkansas; I majored in journalism.\n\nDr. Sam Taggart: You graduated about when?\n\nJulie Kegley: 88 ....I had a degree in journalism and went to law school for six weeks and decided that that was not how I wanted to make a living.. \n\n(Laughing)...\n\nSo, I dropped out of law school and needed to get a job... I fortunately was trained for a profession, which was being a newspaper reporter, and did that for about six months in Forrest City.  So, I moved back to Northeast Arkansas and quickly realized , you know, that I needed to be back here and so....\n\nDr. Sam Taggart: Did you work for the Arcus.....or was that in Brinkley?\n\nJulie Kegley: That must be Brinkley....no, it was the Times Herold; Forrest City Times Herold.\n\nDr. Sam Taggart: Ok...\n\nJulie Kegley: So, I came back up here and worked in the office at the University where I did my internship, which was the Office of University Relations; the PR office.  I did that for 10 years and then went to Tyson Foods where I was in investor relations for 22 years. I left Tyson Foods two years ago and took a year off, we were going to travel and do all kinds of fun things...\n\nDr. Sam Taggart: Then Covid hit...\n\nJulie Kegley: But you shouldn’t do that at the beginning of a global pandemic; it really put a damper on our plans.  \n\nDr. Sam Taggart: That’s right....right....\n\nJulie Kegley: So after sitting around the housed for 9-10 months, I was like, “I’ve got to do something; this is making me crazy” ....so, I’m working as a consultant now; an investor relations consultant.\n\nDr. Sam Taggart: With who?\n\nJulie Kegley: Financial Profiles; an agency based in Los Angeles....obviously, I don’t commute; I work from home.”   (Laughing)....\n\nDr. Sam Taggart: Do you have brothers and sisters?\n\nJulie Kegley: I have a brother, an older brother; he is currently disabled.\n\nDr. Sam Taggart: Where does he live?\n\nJulie Kegley: With my mother in Marked Tree.\n\nDr. Sam Taggart: So your family, your mom, still lives in Marked Tree...\n\nJulie Kegley: Yeah...my dad passed away about seven years ago and my brother is with her, which is great because that made a big difference as she has gotten older and he is there with her...so, that has turned out well.\n\nDr. Sam Taggart: Talk a little bit about your schooling. I know you lived in several towns, but mainly in Marked Tree....\n\nJulie Kegley: Mainly Marked Tree and Fayetteville...\n\nDr. Sam Taggart: You went to high school in marked Tree...high school, junior high, and all that. \n\nJulie Kegley: Yes...\n\nDr. Sam Taggart: Did you enjoy school?\n\nJulie Kegley: I did; I was in band and choir.  I was a different kind of geek; I wasn’t the science geek....I was the music geek in school.  I was good in school and by the time I got to my senior year, I was just done with it; I was ready to go and I came up here because it was 300 miles from Marked Tree.\n\nDr. Sam Taggart: Right....\n\nJulie Kegley: And you know, at the time, that was important to me and I just needed to get away....and I needed to get away to school.\n\nDr. Sam Taggart: After a while, after you got out of school, did you ever think about going back?  Not early on, but later on.....going back to Marked Tree?\n\nJulie Kegley: No...\n\nDr. Sam Taggart: Ok...\n\nJulie Kegley: No, because I needed to earn a living and I couldn’t do that there.\n\nDr. Sam Taggart: (Laughing)....You couldn’t do that there in Marked Tree..... \n\nJulie Kegley: No...\n\nDr. Sam Taggart: You obviously did well in school; you got into law school....\n\nJulie Kegley: Yes, I did.  I did well in school.\n\nDr. Sam Taggart: And if you were a journalist, you probably did well in school to be able to do that.  Did you work after you got your journalism degree, or after you worked in journalism; did you work in one of the papers here?\n\n\n\nJulie Kegley: No, I worked in public relations; so it.....actually the best piece of advice that I got from my advisor was that if you wanted to go into PR, you should go to work as a newspaper reporter and it was absolutely right.\n\nDr. Sam Taggart: Huh....why?\n\nJulie Kegley: Because you understand the process and you understand the pressures that journalists are under and what they need for a story; so that you are not wasting their time and you’re more likely to get your stories placed.\n\nDr. Sam Taggart: Sure that makes sense.....\n\nBack to you Dr. Oates; in elementary school or junior high school, were there any people.....outside of your mother and you father as it sounds like they had a pretty big impact on you.... teachers, preachers, business leaders, family friends, anybody who had a big impact on your life and maybe turned you in one direction or another or had an impact on what you would do with your life? \n\nDr. Randall Oates: I was really fortunate to have an incredible suite of elementary teachers.  I mean, they were truly...it was Reynolds’s Elementary; Rockefeller’s Demonstration school.  His son went to school there and so, it really was a fine polished school; I was really fortunate.  I had real problems in the classroom and couldn’t...I found out later that I have a learning disorder with my hearing.  I don’t hear things until I repeat them in my mind; things I hear I don’t learn, I have to repeat it and if I want to remember it, I have to type it out or write it out and look at it.  But, I just \n\nthought that everybody did that. So sitting in the classroom, it was a huge effort to stay focused.  Now, I could read and get things; I was a good reader but I really had to struggle in a classroom because I couldn’t pay attention.\n\nJulie Kegley: You really need to talk about how that effected you in medical school.\n\nDr. Randall Oates: Yeah, I didn’t go to class; but I graduated as an honor student because I could read and most of the things came from the text material.  Some of the professors were a little upset with me graduating as an honor student because they couldn’t recognize me and there was a little protest there for a brief period of time.\n\n(Laughing)...\n\nIs that what you were referring to?\n\nJulie Kegley: Yeah, the fact that you didn’t go to class, but you still.....what was it; second or third?\n\nDr. Randall Oates: Third...\n\nJulie Kegley: Yeah, third in class...\n\nDr. Sam Taggart: Now you mentioned that you had a group of elementary teachers....can you remember any of those people by name?\n\nDr. Randall Oates: Oh gosh, first was Ms. Hutchison...second grade was Ms. Wright and Ms. Wright really, in a cool way, interjected values of making a contribution and being productive; I just remember her. She was also in my group in the First Methodist Church, she was in there, and her husband was my Scout Master.  So, I really had a very privileged and very wonderful childhood in many ways.  Third grade was Ms. Wallace, fourth grade was Ms. Keller, fifth grade ...I don’t remember.... sixth grade was Ms. Johnson, bless her heart.  Sixth grade was my....I had wonderful teachers that were very forgiving. \n\n(All laughing)....\n\nAnd a principal that was very understanding.  I mean, it was a good experience; but, I did not enjoy the classroom. I wanted to be out digging in the dirt, looking for bugs, building something...I just did not like sitting in the classroom.... But, I could read and I’d have it.\n\nDr. Sam Taggart: Now, you had a sister who is three years older than you...\n\nDr. Randall Oates: Right and she was the smart one.\n\nDr. Sam Taggart: (Laughing)....OK....so, what did she do?\n\nDr. Randall Oates: She was a pharmacist.\n\nDr. Sam Taggart: That’s right; you already said that....where did she practice?\n\nDr. Randall Oates: Kansas City eventually...she eventually went into research, pharmacological research.\n\nDr. Sam Taggart: Backing up a little bit, do you know much about the history of your family and how they came to be in Morrilton, Russellville; Pope County?  How did that happen?  Are you English, French, German, Irish?\n\n\nDr. Randall Oates: Oh yeah.....oh yeah; Scotch-Irish...Northernest Ireland; the Scottish area and probably 80% of my ancestors in the last four generations are in the Episcopal Cemetery in Pope County. Most of my relatives, from both sides of my family, were Scottish or English and came over originally to North Carolina and some up in Pennsylvania and then came over to Pope County, Arkansas just before the Civil War. The Henrys and the Oates, they.....my mother’s grandmother in fact was a distant Oats ....s, when I talk about Willie Oates, I was related to her husband very, very distantly through my mother ...not my father and that’s why I said or I hesitated so bad.\n\nDr. Sam Taggart: Right...ok...that’s alright....\n\nDr. Randall Oates: They were farmers for the most part and then my grandfather, my mother’s father, became a pharmacist in Pope County for over 50 years.  All his children either became doctors or married doctors and then almost all of my cousins have gone into medicine on that side.\n\nDr. Sam Taggart: Did you have any tie-ins with the Teeters in the Russellville/Morrilton area?\n\nDr. Randall Oates: No...\n\nDr. Sam Taggart: That was another over in...you know where Pottsville is obviously..\n\nDr. Randall Oates: Oh yeah...\n\nDr. Sam Taggart: That’s where the Teeters were kind of headquartered and now there is a Teeter in Russellville practicing; Stanley Teeter who is about retired now....but, they are all in that same part of Arkansas River Valley. \n\nDr. Randall Oates: I’m sure we’re related then.....yeah, we’re related; no doubt...\n\nDr. Sam Taggart: In both of your families, it sounds like medicine has just kind of run through or at least some form of healthcare.\n\nJulie Kegley: Well my mother was an LPN, but didn’t become one until she was 50. But, my cousin was also an LPN and just retired after, I guess, 40 years; working as a nurse in a doctor’s office.”\n\n\nDr. Sam Taggart: Do you have good memories of your childhood?\n\nDr. Randall Oates: Uh...yes, for the most part. I mean, everything was amidst, but I was very fortunate.  All in all, I would have to put it at an 8.\n\nDr. Sam Taggart: Ok...you worked hard.\n\nDr. Randall Oates: Oh yeah...\n\nDr. Sam Taggart: Yeah, you worked hard.....and you were expected to work hard...\n\nDr. Randall Oates: Yes...\n\nDr. Sam Taggart: You were expected to go to school?\n\nDr. Randall Oates: Yes...\n\nDr. Sam Taggart: And expected to excel in school...\n\nDr. Randall Oates: Yes...\n\nDr. Sam Taggart: I’m putting words in your mouth... (Laughing)\n\nDr. Randall Oates: Yes, but all those are true.\n\nJulie Kegley: You’ve got it...\n\nDr. Randall Oates: Pretty much so...\n\n\n\nDr. Sam Taggart: Did you have a group of friends back when you were a little bitty kid...cousins or whatever... in elementary school or in secondary school that you’ve stayed in contact with or that you were very close to during that time frame? \n\nDr. Randall Oates: I’ve had friends that I’ve stayed in contact with over time, but I wouldn’t say I’ve had a whole lot; I’m the loner type...a precarious type.  But I have wonderful friends who I have stayed, half of them are gone now, but..\n\nDr. Sam Taggart: Right...\n\nDr. Randall Oates: But yeah, we still get together from time to time.  I have a reunion coming up next year.\n\nDr. Sam Taggart: Were you athletic?\n\nDr. Randall Oates: Uh, I was a....I played football and I was big with a lot of lower body strength; so, I was the nose man and I did a real good job there...\n\nDr. Sam Taggart: Now Morrilton wasn’t a small school...\n\nDr. Randall Oates: Well, it was 7,000; I don’t remember how many there was in the school.\n\nDr. Sam Taggart: That is a pretty good size school.\n\nJulie Kegley: For those of us from northeast Arkansas that’s a big town.\n\nDr. Sam Taggart: Yeah; yeah, that’s a real big school....so, how many kids were in your class?\n\nDr. Randall Oates: Uh....around 130.\n\nDr. Sam Taggart: Yeah...Augusta was 34.\n\n\nJulie Kegley: My class was 84, but we had a big one.\n\nDr. Sam Taggart: A consolidated school...yeah...\n\nJulie Kegley: No, it wasn’t consolidated; we just had a really big class.\n\nDr. Sam Taggart: Just a particularly big class...ok... \n\nDr. Randall Oates: I can’t say that.....you know, junior high and high school were a real challenge for me because I was such a nerd and didn’t really fit into the culture.  I didn’t enjoy football; I played and did well.....\n\nDr. Sam Taggart: Because you were supposed to....\n\nDr. Randall Oates: Because I was supposed to; right, but I was not enjoying it....but, you do what you need to do to ...I mean, you couldn’t be big in a small town in Arkansas and not play football.\n\n(Laughing)....\n\nYou just can’t do it.\n\nDr. Sam Taggart: Did they try to make you go on the basketball team as well?\n\nDr. Randall Oates: Of course...but when they saw how uncoordinated I was, that battle ended quickly.\n\nDr. Sam Taggart: (All laughing)....\n\nDid you hunt and fish?\n\nDr. Randall Oates: Oh yeah...oh yeah.\n\nDr. Sam Taggart: So, that was also a part of just....what you did... \n\nDr. Randall Oates: That’s what you did; right.  I mean all winter and weekends, you were out hunting or fishing; mostly hunting.  In the summer, you were out at the lake or in the streams and rivers; that’s what we did.\n\nDr. Sam Taggart: We already talked briefly that you did well in medical school; talk about high school....did you do well and graduate well in you class....I assume....\n\nDr. Randall Oates: Yeah....I shouldn’t tell that story; but, I almost didn’t graduate.\n\nDr. Sam Taggart: Ok...\n\nDr. Randall Oates: Should I tell it?\n\nJulie Kegley: About your English teacher ...\n\nDr. Randall Oates: Yeah...\n\nJulie Kegley: And your mother...Yeah, tell that story; it’s a good story.   (Laughing)... \n\nDr. Randall Oates: Well, that’s another one; no, I won’t tell that one.  But, I got asked to leave in my senior English class ....and almost didn’t graduate because I didn’t have senior English, which was one of the requirements.  I aced most of my other classes and all; so, I wrote a letter to the school board.  Long story short, I got to graduate.  Like I said, I had trouble in the classroom in high school and I tried to get along and usually did, but we had this young new English teacher and the girls in the room just adored him; they just thought he was Mr. Super-cute.  They were just very effusive and as a senior student in high school, it was really...I found it difficult to tolerate.  We were studying haiku one day and he was reading about and the girls were like...”Aw, I can just see the little butterflies flying around” and I was over there just really having an almost nauseous experience.    \n\n(All Laughing) \n\nAnd he said, “Mr. Oates, it sounds like you really like haiku; what do you think about this one?” and I said, “Well, I think that the Japanese are ignorant.”  It was this verse about “when the fresh morning dew falls on the rose; all is beautiful“  and I said, “Dew doesn’t fall, it forms.” He gets all upset, throws down his book, and says, “Mr. Oates, we are in English class, not science class; why don’t you remove yourself until you can figure out where you are”....I didn’t go back.\n\nDr. Sam Taggart:      \n\n(All laughing)...But you did graduate.... \n\nDr. Randall Oates: I did graduate.  To end the story, I would not take English my first semester in college... even though everybody said, “You have to”... I said, “I want to get settled and I want to get...I had an event earlier with an English teacher where I had a bad attitude about English...so, I want to get established, become a stable college student, and then, I’ll take freshman English starting my second semester.” So, that’s what I did and they had Faulkner English at the University at the time, which was very different than what they were teaching in high school, and I absolutely loved it...thrived it...craved it.  The long story short...at the end of taking freshman English, I got two “As” and the grad student brought me in and she said,”I think you should reconsider going into creative writing.” I said, “What?” and she said, “I think that you have...if you went into creative writing, I think you have real potential.”  I said, “I am not believing this” and so, I wrote a letter back to the school board and said, “I just want you to know that I did ok in English....”  \n\n(Laughing)...\n\nThey did an all day retreat and they brought my college professor and some others around....an all day retreat with the school board and the English department on revamping the English program....they invited both of us to come down and for me to share my experience for them to talk about their program as a result of that...now wasn’t that cool?\n\n \n\nDr. Sam Taggart: (Laughing)....Right....so when you graduated from high school....a little awkward, but you did get there...what informed your decision about where you would go to college?\n\nDr. Randall Oates: Uh.....my father went to U of A...my sister, five years ahead of me, went to U of A...and it looked like the right place for me.\n\nDr. Sam Taggart: This would’ve been what year?\n\nDr. Randall Oates: That would’ve been ’72.\n\nDr. Sam Taggart: By this time, Vietnam was beginning to wind down...\n\nDr. Randall Oates: Uh huh...\n\nDr. Sam Taggart: We were beyond the getting a number in the lottery; I think....\n\nDr. Randall Oates: Oh, I got mine.\n\nDr. Sam Taggart: Oh...you did get a number?\n\n\nDr. Randall Oates: I was 18.\n\nDr. Sam Taggart: Oh my....no, 18...you mean, your number was 18?\n\nDr. Randall Oates: Yeah, my draft lottery number..\n\nDr. Sam Taggart: Oh my....so, you were going to get drafted.....\n\nDr. Randall Oates: I was...they were...yeah...I was sweating bullets when Nixon ended the draft.  I mean, I was right up to the very...I was the last group that they didn’t get.\n\nDr. Sam Taggart: So, did money play a role in where you went to college?\n\nDr. Randall Oates: Nuuuu.....\n\nDr. Sam Taggart: Did you have scholarships?\n\nDr. Randall Oates: I had scholarships, but I really didn’t....it was a consideration, but I just wanted to go to U of A. It was just where I wanted to go since I was a little kid.\n\nDr. Sam Taggart: Did you have friends in your class who went there with you at the same time?\n\nDr. Randall Oates: I did, but that didn’t play a role in it.  I was really...I tried to avoid them at first and generalize.\n\nDr. Sam Taggart: (Laughing)....\n\nDid you live in a dorm?\n\nDr. Randall Oates: Uh huh..\n\nDr. Sam Taggart: Which dorm did you live in?\n\nDr. Randall Oates: My first year in Yoakum, my second year in Yoakum, third year in Hotts, and fourth year off campus in housing....\n\nDr. Sam Taggart: By the time you went to college...you had been working at home in the store, at the Co-Op... did you work your way through college?\n\nDr. Randall Oates: Uh...no; in the summers, I worked to get my money yes.  By the time I was in junior high, I mowed grass, delivered a paper route, worked at the farmer’s co-op, and I can remember in the summer of ’68, I was making more money than my mother was as a school teacher.\n\n(Laughing)....\n\nAnd it really upset her.\n\nJulie Kegley: As it should...\n\nDr. Randall Oates: As it should...\n\nJulie Kegley: It’s really more of a commentary on the state of teachers pay in Arkansas versus what a ...I’m sure you were a great paperboy.\n\nDr. Sam Taggart: Right...teacher’s pay in Arkansas....\n\nDr. Randall Oates: I was compulsively working to save money so that I could get out of town.  I wanted to get out on my own and I was....that’s what I did.  So, I probably did not...I was focused more on achievement and getting passed on than socializing; I guess that would be fair to say.  But, I worked hard and I played hard; I had a good time, but I wasn’t necessarily Mr. Social.\n\nDr. Sam Taggart: When you got off to college, at some point everyone starts thinking, “Ok, what am I going to do with my life?”...”Am I going to go home and run the Co-Op with my dad?”...When did that start happening with you?\n\nDr. Randall Oates: My senior year in high school; I did that all.  I went and considered  ...I did a deep dive into multiple professions and I credit two people really with...I would not have gone into medicine, which I’m so glad I did.  During my senior year, two people made comments....a senior in high school, my guidance counselor in high school and ....gosh...I’m trying to and coming up with a blank, but I will get back to her in just a minute...oh my gosh...her son who was the chairman of the department of pediatrics all through my medical school training...Robert....” \n\nDr. Sam Taggart: Pfizer...\n\nDr. Randall Oates: Pfizer; yes, Bob Pfizer.....his mother was my guidance counselor and he was my guidance counselor in med school.  She’s... \n\nDr. Sam Taggart: Oh my...he’s good; he’s really good. \n\nDr. Randall Oates: Oh gosh, he was wonderful and I stayed in touch with him long after; just a wonderful guy.  But she, my senior year, sat down and said, “well, what are you thinking about doing?’ and I kind of went down the list of things I thought about and she said, “I thought you were going into medicine.”   I said, “I can’t do that” and she just said....she really berated me for not considering medicine.  I had this concept that I could never do that and that I wasn’t....for some reason, I just didn’t think that I could do that and it would be more than I could handle.  She said, “Well, that is what you should really seriously consider.  I have a son that is doing that and is loving it. Do you want to talk to him?”  And she pushed me...more than a guidance counselor would typically push.\n\n     \n\nDr. Sam Taggart: Yeah...Right.....\n\nDr. Randall Oates: But, she had an insight that I think was right on...so, when I got to medical....\n\nDr. Sam Taggart: Had she known you well?\n\nDr. Randall Oates: Oh yeah...she’d known me since I was born.\n\nDr. Sam Taggart: She knew you as a child....\n\nDr. Randall Oates: Oh yeah..\n\nDr. Sam Taggart: And watched you grow up..\n\n\nDr. Randall Oates: Oh yeah...right.....I really hadn’t seriously even considered thinking about it until that point in time.”\n\nDr. Sam Taggart: That was in your senior year.....was that during the first part or second part of your senior year; do you remember?\n\nDr. Randall Oates: Uh, I was the first part of my senior year; but, I really owe a lot to her. As far as those who really had an effect on me in high school....well, in junior high, I had a science teacher that really encouraged me and inspired me, but he is no longer alive either; George Konine.  The Pfizer’s are really...they really impacted me in a positive way; that family.\n\nDr. Sam Taggart: Dr. Pfizer went to Hendrix; didn’t he?\n\nDr. Randall Oates: Yes, he did.\n\nDr. Sam Taggart: I think he did....I kind of knew him preferable; he was not teaching at the med center when...I was 5-6 years before you..... \n\nDr. Randall Oates: I see; ok...\n\nDr. Sam Taggart: Was your family...I was about to miss this, but I don’t want to miss it....was your family religious?\n\nDr. Randall Oates: Yeah.....United Methodist; they were, I would say, very advocate and leaders in the church up until they passed.\n\nDr. Sam Taggart: Mike Young from Prescott told me one time that when he was a kid he had a drug problem; every time the church doors were open, he got drug to church.... \n\n(Both laughing)...\n\nDr. Randall Oates: Yeah...\n\nDr. Sam Taggart: Did you spend a lot of time in church?\n\n\nDr. Randall Oates: Yes...right.....right...\n\nDr. Sam Taggart: Ok....\n\nDr. Randall Oates: Any socialization I had growing up was typically church related.\n\nDr. Sam Taggart: So, you go off to college and you end up at the University, again where they any people in college that were influential in turning you in one direction or another or saying something like that comment, ”You should go to medical school” that made a light bulb go off in your head saying, “I want to do this”?\n\nDr. Randall Oates: Well by the time I got to college, I had my mind made up and I was on a mission; it was just more like who was going to facilitate it and who was in my way.\n\nDr. Sam Taggart: Right.... (Both Laughing)\n\nDr. Randall Oates: But, I had wonderful professors; many of which inspired me in many ways, but it wasn’t anything really related to going into medicine.....it was cool coming back to Fayetteville and being able to go back and relate to them on that level after having been their student; I really enjoyed that.\n\n \n\nDr. Sam Taggart: Was Dr. Saacs still teaching organic when you were there?\n\nDr. Randall Oates: I don’t remember that name.\n\nDr. Sam Taggart: Who was your organic teacher?\n\nDr. Randall Oates: Seems like it started with a B and was a long name.....he was a middle aged man with glasses.\n\nDr. Sam Taggart: How did you do in organic?\n\nDr. Randall Oates: I did well...yeah, I did well.  I loved organic; that was fascinating.\n\n\n\nDr. Sam Taggart: What other courses in college did you like or didn’t like or had a particular ...it really hit you as something very pertinent and something you liked?\n\nDr. Randall Oates: Uh, well, I did....I naturally did well in all the sciences and I enjoyed all my....I really did, but also, I really enjoyed...I was fortunate enough my senior year to have a lot of time to take just credits and I took a lot of humanities and I took a course Twentieth Century Thought.....there was one with John Lock and we just got to be really good friends and were for decades.  Getting back to something pertinent...it was great going to college; I do well in big classes were they don’t ....where they get their test material out of the book and don’t expect you to be there and pay attention.\n\nDr. Sam Taggart: Right...\n\nDr. Randall Oates: I can do well....but. I had several good classes where I could actually pay attention and really get something out of it; that was more my senior year.  I just had a great college experience and don’t know what else to say about it.\n\n      \n\nDr. Sam Taggart: Did you, the one teacher who said that you should consider going into creative writing...\n\nDr. Randall Oates: Uh huh....that was a grad student...\n\nDr. Sam Taggart: Did you continue that throughout your college career?\n\nDr. Randall Oates: Oh no....no, I was too interested in other things.  That would’ve been fun, but I was on a mission to get into medical school.\n\nDr. Sam Taggart: Right...You had a narrow beam of focus...\n\nDr. Randall Oates: I did.\n\nDr. Sam Taggart: (Laughing)....Ok.....so you started college in what year?\n\nDr. Randall Oates: ‘72.\n\nDr. Sam Taggart: And graduated in what year?\n\nDr. Randall Oates: “76.\n\nDr. Sam Taggart: At what point in the process did you start thinking about the MCAT test and making the application and all that for medical school?  \n\nDr. Randall Oates: Oh that was back when I was a junior in college...as early as I could do it; but, I don’t remember the specifics.\n\nDr. Sam Taggart: What kind of degree did you end up with in college?\n\nDr. Randall Oates: Zoology...\n\nDr. Sam Taggart: Did you ever consider, I don’t even know if it was still allowed at that point, to just quit college after 90 hours and go on to medical school....did you ever think about doing that?\n\n \n\nDr. Randall Oates: For some reason, that wasn’t an option; but, I don’t remember why.\n\n \n\nDr. Sam Taggart: I think they had quit doing that by that time...it was getting close when I was there.\n\nDr. Randall Oates: Yeah; I don’t think that was an option or I would’ve done it.\n\nDr. Sam Taggart: Ok.....So again, the same thing as going to college....you decided you were going to medical school, you got the grades, took the MCAT test...at some point, you had to make an informed decision on where to go to med school....did you apply to just the University or did you apply to other places? \n\nDr. Randall Oates: No...\n\nDr. Sam Taggart: Just the University...Ok...\n\n\nDr. Randall Oates: That’s where I wanted to go.\n\nDr. Sam Taggart: So, you started there in 1976….\n\nDr. Randall Oates: Yeah....yeah, it would’ve been; I would’ve graduated in ’77.  I started my senior year in ’76 and graduated in ’77.... No, I ‘m sorry; I graduated from medical school in ’81 and college in ’77.\n\nDr. Sam Taggart: Ok, that’s right...I got you....so when you got to medical school, were you prepared for it?\n\nDr. Randall Oates: Oh yeah...yeah, I had a good excellent preparation; because I had really focused on sciences at U of A and they were excellent.  So, I was well prepared.\n\nDr. Sam Taggart: How about those first two years?\n\nDr. Randall Oates: I did well; I had a blast.  Like I said, I didn’t go to class much, but...\n\nDr. Sam Taggart: Were you still using Can-notes at that time?\n\nDr. Randall Oates: Yes, we had can-notes.\n\nDr. Sam Taggart: So, that that fell right into your lap...\n\nDr. Randall Oates: Yes....right...exactly.  But, I found it all fascinating and I was a good reader; if I could read it, I usually could retain it.\n\nDr. Sam Taggart: Yeah…Were there any teachers during that time that made an impression on you?\n\nDr. Randall Oates: Uh...in the first two years...I’m trying to think...I didn’t really; I mean most of them...I really didn’t ...I just wasn’t around them very much to really develop a.....\n\nDr. Sam Taggart: What do I have to do here to get through...who is in my way and who is not...?\n\nDr. Randall Oates: Yeah....yeah.....yeah...\n\nDr. Sam Taggart: I understand....What about the second two years?\n\nDr. Randall Oates: Oh, then we got to get out and do clinical...my peak experience was doing my preceptorship with Les Anderson in Jacksonville.\n\nDr. Sam Taggart: Was that a senior or junior preceptorship...senior?\n\nDr. Randall Oates: Senior preceptorship...well actually it was a junior preceptorship but during my senior year, all the hours I could I went back out there to be with them.  He and the Crestview Clinic in Jacksonville was the epitome of the dream that I wanted to be.\n\nDr. Sam Taggart: Maybe I need to go back a little bit here....when did you start thinking about what you wanted to do in the practice of medicine?\n\nDr. Randall Oates: Uh, well, I started in college thinking...I was....everything interested me; so, I was thinking and I couldn’t really....when I was doing neurology, I wanted to be a neurologist...while I was doing orthopedics, I wanted to be an orthopedist..I loved all of it and I couldn’t eliminate any of it.  I wanted to be able to cut it out, poison it, or physch it out...no matter whatever tool I needed.\n\n  \n\nDr. Sam Taggart: Did Les have an impact on you?\n\nDr. Randall Oates: Huge....\n\nDr. Sam Taggart: In what way..?\n\nDr. Randall Oates: I’d have to say during medical school, it seemed a bit at times impersonal and the spirit of what I consider family medicine, that connection and relationship related, wasn’t really a part of what I was seeing at the University.  But, I always thought that that was really what was important and I didn’t really see much of that until I did my preceptorship with Les.  He is a master at it and I just found myself captivated watching him and how he related to people with honesty and how he shared it; it was a different style than what I saw at the med Center.  It was much more humble, much more inclusive, and I saw the effect it had on people; it was very inspiring.\n\nDr. Sam Taggart: Now was he still full time at Jacksonville or had he moved over to Cabot at that time?\n\nDr. Randall Oates: They were....they had the three clinks: Lonoke, Cabot, and Jacksonville and they would rotate, which I did too when I was...but that’s another story. But, I got to go to call those clinics.  They were....I said, “That’s what I want to be”...”That’s what I want to do. ”\n\n \n\nDr. Sam Taggart: Yeah....he’s what you want to be....\n\nDr. Randall Oates: Yeah...he was the one that; there was no doubt after that.\n\nDr. Sam Taggart: This would’ve been in about what year?\n\nDr. Randall Oates: That would’ve been 1980...yeah...\n\nDr. Sam Taggart: Obviously, Les is a contemporary of mine; he’s a little older than I am, but not much.  I interviewed him for this book; he is going to be in this book.  I think everybody has much the same kind of response to Les Anderson.\n\nDr. Randall Oates: I just think he is amazing.\n\nDr. Sam Taggart: Right; he is... but, you wouldn’t know it just seeing him casually....you wouldn’t know it.\n\nDr. Randall Oates: Just to talk to him; no....right...he is just the most.....I liked him so much, my wife got pregnant when I was a senior in medical school and we drove all the way out to Jacksonville for her delivery with Les.\n\n(Laughing)....\n\nI just like....I just liked that style.\n\nDr. Sam Taggart: I am remiss and need to go back and pick that up; when did you start dating seriously and get married?\n\nDr. Randall Oates: Well, being the nerd that I was in high school, I probably didn’t have more than half a dozen dates.  Like I say, I was just preparing to get out; I was the nerd and didn’t date much.  Now \n\nwhen I got off to college, I made up for lost time; like I said, I played hard and studied hard.  During the week, I studied hard and on the weekends, I played hard.  I just started..I was determined to overcome my natural introversions...I had just a blast.  I did a lot of dating, had a lot of fun, a lot of good friends, and did what you should do in college.  I met my first wife when I was starting my senior year; we were both in Hots Hall and she lived on the sixth floor and I lived on the third floor. We married the next summer right before I started medical school.\n\nDr. Sam Taggart: What kind of work did she do?\n\nDr. Randall Oates: Uh, she actually was going to be a home economics teacher, but when we got there....my uncle Forrest Henry, the ophthalmologist in Little Rock, was really needing an assistant in his practice....he hired her to work in his practice and so, she worked in his ophthalmology practice in downtown Little Rock during my medical school.  Once we moved up here and I went to my residence here, she didn’t work anymore after that and took care of the children; she worked at home.\n\nDr. Sam Taggart: But, she went....y’all got married your junior year...sophomore year...\n\nDr. Randall Oates: No, senior year before medical school; yeah...\n\nDr. Sam Taggart: Senior year before medical school… and she got pregnant during medical school…\n\nDr. Randall Oates: No during my senior year...no sorry; during medical school, yes....my senior year of medical school, she got pregnant; yes.\n\nDr. Sam Taggart: And you went out for Les to do the delivery...\n\nDr. Randall Oates: Right...\n\nDr. Sam Taggart: At some point, you were obviously already leaning to the direction of family medicine to some extent...had you had any physicians when you were a kid, a teenage, or young adult who had an impact on you before Les?\n\nDr. Randall Oates: Oh yeah, my...growing up, I idolized our family doctor, Dr. Hyder; he was just my hero.  I got to get to know him as an adult when I was in my third year of residency and did an obstetrics’ rotation in Houston.  He was there in Houston and I spent quite a bit of time with him while I was in Houston doing that rotation.\n\nDr. Sam Taggart: Why was he in Houston?\n\nDr. Randall Oates: He left Gerald Practice in Morrilton and went to work for a railroad company managing their work comp and their legal medical stuff; he would be the negotiator with folks.  He was a really awesome guy.        \n\nDr. Sam Taggart: At some point...now you’ve been introduced to Les Anderson, family medicine, and “Yes, this is what I want to do”...Back to the same question as before, what informed your decision about where you were going to try to do your residency program?\n\nDr. Randall Oates: Uh...when I went to college in Fayetteville, I loved Fayetteville.  So, there was a real big biased...\n\nDr. Sam Taggart: Ok...\n\nDr. Randall Oates: ....when I started applying to residencies to want to go to Fayetteville....\n\nDr. Sam Taggart: Right...\n\nDr. Randall Oates: But, I traveled all over and went to multitudes of the best programs in the country and seriously looked at them....but, I could not see how they had an advantage over Fayetteville.\n\nDr. Sam Taggart: By this time Lee Parker, Jim..... Lyndon McGhee...\n\nDr. Randall Oates: McGhee, Danny Profit, and Jim....we know who we are talking about.....\n\nDr. Sam Taggart: But, they were all kind of the core of that family medicine residency...\n\nDr. Randall Oates: Uh huh...\n\nDr. Sam Taggart: Talk about your residency a little bit; you applied and got accepted obviously.  \n\nBy the way, did you ever run into another female resident......\n\n\nDr. Randall Oates: Patrick...\n\nDr. Sam Taggart: Yeah, Jim Patrick; yes... \n\nDr. Randall Oates: Isn’t it funny how a mind works...\n\nDr. Sam Taggart: Yeah, real interesting...\n\nDr. Randall Oates: I’m sorry...\n\nDr. Sam Taggart: .....A female by the name of Evelyn Cathcart....\n\nDr. Randall Oates: That sounds...I know the name..\n\nDr. Sam Taggart: She was in the residency somewhere around that time, maybe a little bit before...she became one of my partners.\n\nDr. Randall Oates: Aw.\n\nDr. Sam Taggart: Jim Cooper also had been a resident up here, but he was well ahead of you I think...\n\nDr. Randall Oates: Yeah.\n\nDr. Sam Taggart: He came into practice with me in ‘82 or ’83; so, I had several guys from this residency program up here.  So, talk about the residency program itself and relationships with the physicians, and talk about Lee Parker for a little bit....  \n\nDr. Randall Oates: Oh gosh...I don’t think I could’ve had a better residency experience; it truly was wonderful.  Lee Parker leading the show and Jim Patrick, Lyndon McGhee, and Danny Profit; they were perfect for me.  They gave me good direction when I needed it and we all thrived.  I know our...I had four residency mates and I know on the...at the end of the year when you do your testing...the national exam, we all scored in the high 90 percentile; so, I think you could say that there was nothing academically limiting in our...\n\nDr. Sam Taggart: Right...\n\nDr. Randall Oates: We were real proud of that...we were community based, but we out performed most of the academic programs; but, it was because the local physician community was really supportive.   I mean, they really sort of adopted the residency program at that point in time; in particularly, the diagnostic clinic here in Fayetteville.  They had these doctors...these doctors were like Dr. House in their abilities to see things and figure things out...it was just so much fun to work with them.\n\nDr. Sam Taggart: Kind of like you....\n\nDr. Randall Oates: I don’t know if I’d say..\n\nDr. Sam Taggart: No, I mean that is kind of how you described yourself...you had intentionally describe yourself as seeing how things work....\n\nDr. Randall Oates: Right...\n\nDr. Sam Taggart: Tearing things down and looking at the innards….\n\nDr. Randall Oates: Yeah....yeah...\n\nDr. Sam Taggart: Ok; they perfectly fit you...\n\nDr. Randall Oates: Right...I just loved residency.  I didn’t like the hours, but the experience was phenomenal.  I wish I had kept in better touch with my.....but, I haven’t been directly involved with the residency probably like I should’ve been.  But, I sure have warm feelings for them all.\n\nDr. Sam Taggart: When did you finish your residency?\n\nDr. Randall Oates: In ’81...no, I’ sorry; I started in ’81 and finished in ’84....yeah, it was.....it would be of interest to...but that really...I think in being able to go into practice in the community and having trained with a lot of the elder physicians. It really made early years in practice smooth and delightful in many ways.\n\nDr. Sam Taggart: You said that you really liked Fayetteville; did you practice in Fayetteville or did you practice in Springdale?\n\nDr. Randall Oates: No...Springdale....\n\nDr. Sam Taggart: So you’re just barely over the border in Springdale here….\n\nDr. Randall Oates: Right...\n\nDr. Sam Taggart: Right now where you live is.....\n\nDr. Randall Oates: I don’t consider myself Fayetteville or Springdale, I’m both.\n\nDr. Sam Taggart: Right...you’re just right here....\n\nDr. Randall Oates: I’m northwest Arkansas...that’s what I am.\n\nDr. Sam Taggart: At some point, you had to start thinking...even as early as 1984, corporate medicine was beginning to be a thing.  Hospitals were beginning to buy practices...a little bit before that or after that...but they were beginning to buy practices and stuff. Group practices were getting much more common as opposed to solo practices....what informed your decision as to what you were going to do when you got through with your residency program?  \n\n   \n\nDr. Randall Oates: You know, I had done my preceptorship and spent a lot of hours in Jacksonville with that group practice and they were kind enough to invite me to their business meetings and the whole deal...so when I got out, I wanted to join a group practice; that looked like shared responsibility and that’s what I looked for when I got out.  The reason I landed in Springdale was ...I didn’t think I was going to be able to practice in Fayetteville or Springdale at the end of my residency; I was planning to go back to Morrilton because the medical community was really filled then. Actually, I recruited Peter Post, Mike Kuhn, and who was the other.....well, the three of us went to Morrilton, spent time, and they eventually opened up that practice there.  I’ll take credit for helping get that off the ground; but as that was proceeding....I had done a rotation in a cardiology with Dr. Inlow in Springdale....at the end of that rotation, Dr. Inlow said, “You’re not going to Morrilton; you’re going to come to Springdale.” He was on a mission and I landed in Springdale because of Charlie Inlow.\n\n  \n\nDr. Sam Taggart: Where you with a large group?\n\nDr. Randall Oates: A small group at first...and then after a while.....\n\nDr. Sam Taggart: Who did you join?\n\nDr. Randall Oates: I spent a year at the Springdale Clinic and it was two physicians in the practice, other than me, and then after a year, I moved over to the Family Clinic in Springdale and there were four other doctors; I made five.\n\n \n\nDr. Sam Taggart: Who were the four doctors?\n\nDr. Randall Oates: Dr. Whiting...Tom Whiting, Tad Morgan, Dr. McAvoy, Dr. Bill Kendrick, and yeah, I was the fifth.\n\nDr. Sam Taggart: Does the name Ed Wheat ring a bell?\n\nDr. Randall Oates: I do...I was very fortunate to get to know Ed Wheat well.\n\nDr. Sam Taggart: Ok...alright...\n\nDr. Randall Oates: He was a fascinating guy.\n\nDr. Sam Taggart: An interesting man….interesting man…\n\nDr. Randall Oates: His work with reproductive physiology and sexuality and normalizing that in the Christian tradition is just phenomenal.  How he normalized that in a healthy way...I just truly admired him; he was a very interesting guy.\n\n  \n\nDr. Sam Taggart: You ended up coming to Springdale, setting up in the Family Clinic of Springdale, and I assume during your residency you did OB, some minor surgical procedures, and a full range of everything else.. .intensive care and coronary care....  \n\nDr. Randall Oates: Uh huh ...\n\nDr. Sam Taggart: Were you able to continue doing that when you went into practice?\n\nDr. Randall Oates: I was...I was able to get any privileges that I requested.\n\nDr. Sam Taggart: Ok...how big of a hospital did you have in Springdale at the time?\n\nDr. Randall Oates: I don’t know...\n\nDr. Sam Taggart: How many beds?\n\nDr. Randall Oates: I have no idea.\n\nDr. Sam Taggart: Was it a gigantic hospital?\n\nDr. Randall Oates: It wasn’t huge, but it wasn’t small.  We had a pretty full service.\n\nDr. Sam Taggart: This sounds majority, but I don’t mean for it to; had Sprawl already hit by the time you went into practice?.....This whole business that for those of us who don’t live in northwest Arkansas think of Fayetteville, Springdale, and Bentonville all as one place...had that already hit? \n\nDr. Randall Oates: It was starting; yeah...it was starting, but not near the extent that it is now.\n\n  \n\nDr. Sam Taggart: Yeah...\n\nDr. Randall Oates: It had certainly started, but I’d say that each community had a little bit more individuality at that point.\n\n    \n\nDr. Sam Taggart: At this point, let’s turn your attention a little bit...no exclusively, but a little bit....to what you ultimately got involved with with the MRs and when did that start to be something that you found that you knew you were interested in and wanted to get involved?  When did you get involved with Sam Brown or was that later in the process....those kinds of things.\n\nDr. Randall Oates: That’s a really fun story.\n\nDr. Sam Taggart: Ok do.....let’s talk about it; that is an interesting part of your story.\n\nDr. Randall Oates: It’s fun; one of the wonderful things about the residency program was that they required you to go to an outside conference every year.  I had, early in my freshman year, read this article that showed that....they did a research on how much do patients accurately retain after a doctor’s office visit... I was terrified when I looked at it; I mean, it was like 10% could accurately recall of what information was conveyed and for whatever reason, as a first year resident ,the thought of that terrified me to the point that I had to....\n\nDr. Sam Taggart: Was this in 1981 or ’82?\n\nDr. Randall Oates: Yeah...’81...the thought just terrified me and I was carrying that with me thinking, “What can I do about this” and I thought....there was a patient education conference in Kansas City and I’m trying to remember the doctor’s name there, but he made a name doing patient education....it starts with an “R”.....but, he did wonderful work and did an annual conference and I said, “I’m going to go to that.”  I got turned on into creating patient education material at that conference, but learned about the whole challenge of doing that well...so, I thought, “I’m going to have to create my own that reflect the language that I use for the patient’s that I see.”  These handouts that were given to us were great, but none of them...I mean, they are all generalized and every patient is unique.  By that time, Apple had come out with the Apple II and there was word processors and I said, “I need to get a word processor and create my own patient education materials and come up with a system of creating handouts”...you know that little spill the...”We as family doctors give with each type of patient”....\n\nDr. Sam Taggart: Yeah...\n\nDr. Randall Oates: Take that spiel and put it into common language and hand that to them so that they can take that home and when their caregiver asks, “what did the doctor say?” they can have something. So, I spent my residency creating patient education materials with my word processor....I bought a computer and ...that’s a whole other story that’s kind of funny...but I got a word processor and started creating patient education materials and that’s what I did as a residency.  I had my computer and a filing cabinet and I’d manage that; but, I thought that was real important.  When I got into practice, I continued to use that.\n\n    \n\nDr. Sam Taggart: When you got into practice, obviously, you used paper records in 1984; were your financial records on the computer at that point or had that gone that far yet? \n\nDr. Randall Oates: Yes...uh, I’m not sure in that first practice....no, they weren’t, they were still manual and they had the 5x7 cards as the chart notes in the first practice.  An office visit would be ROM, right otitis media, Amoxicillin and that would be the extent of the note in ‘84.  When I moved to the bigger clinic... \n\nDr. Sam Taggart: Right....now you had already been introduced to the SOAP...The lead method earlier in your training...right?\n\nDr. Randall Oates: Right...\n\nDr. Sam Taggart: So, you had all that.....\n\nDr. Randall Oates: Not only that, but my senior year, I got a job in Morrilton working for Dr. Hickey, Thomas Hickey, doing his history and physicals and he had a high volume practice.  I would go up to Morrilton three nights a week and do his history and physicals; so, I developed this manual system of organizing the information to create a very complete and concise note very quickly....manually.  I had a manual system down as a senior in medical school.  When I went into practice, obviously the 5x7 cards wouldn’t allow me to continue doing the things that I was doing; organizing things....I had chronic problems, active problems, inactive problems, med list....\n\nDr. Sam Taggart: Allergy list.....yeah...\n\nDr. Randall Oates: The whole section; I had a very elegant mechanize for that established, which is part of the electronic medical records now....or should be.  I would argue that it’s not done very elegantly in most applications; but, anyway I was doing that.  For me to see a patient, I had to prime my ram with all that information before I could really make a decision or help them; so for me, it was a compulsion that I just had to do.  Which was the main reason I had to switch medical groups, I couldn’t do what I needed to do on 5x7 card and the other group had a paper chart...with all the colors on the bottom, the big filing cabinets, and all that like we had forever; that’s what we did.\n\nDr. Sam Taggart: My impression is...from my experience was that financial computerization preceded EMRs by a couple of years...but not a long time.\n\n\nDr. Randall Oates: Oh yeah...right.....Oh yeah, Crestview Clinic back in the late ‘70s had a computerized billing system; I remember.  I remember the hard disk that was like 5 megabytes and it was this big...\n\n(Laughing)....\n\n“But, they didn’t have paper charts.  Yeah, most of us computerized our...my residency used a system, RMS systems,.....a local fellow IT guy got the contract to put in the billing system for our residency program: Randy Matthews.... and when I went into the big clinic, one of stipulations was that they get a billing system and I brought his system into that practice and we used that for years and years.\n\n \n\nDr. Sam Taggart: This was the second clinic you were at?\n\nDr. Randall Oates: Yeah...right....right\n\nDr. Sam Taggart: Did you have any problems initially.....I don’t mean this in any way negatively, ok....getting your partners to accept what now seems like was becoming intuitive to you?\n\nDr. Randall Oates: Yes, very much...\n\nDr. Sam Taggart: Talk about that a little bit.\n\nDr. Randall Oates: Well, they thought I had lost my mind.\n\n(Laughing)...\n\nBless their hearts; they were very patient with me.  I understand...I’m kind of getting ahead of myself...lets back up...I went into a family clinic in what ‘85/‘86 and had paper charts, we had put in the billing system that year, and we’re rocking along and getting around ’86 or ‘87....we had a horrible flu season, one of those years, and I had seen like 70 patients just as fast as I could see them.  You know, you’re in survivor mode and just trying to see the people; so, I didn’t have time to do that much charting.  I made a few little scratch notes; but by the end of the day, I was exhausted and it was around 7:30 pm and I had like 70 charts.  I went through and worked until..I don’t remember how late it was...but almost the same history, same exam, same treatment plan, very little variation....because it was influenza.  I said, “this is nuts” and I thought, “You know, I can...” and I got out my word processor and created a template and started modifying that template; a standard influenza sub-note....because they have a typical history, a typical exam.  So, the next few days and using that, I got home a lot earlier and I thought, “Hmmm, why don’t I make template notes for most encounters like I have patient handout?  That way, we’ll collect the data” and so, that is what I did ...I turned them into....I said, “You know what, this is so standardized that I could have my nurses do this” and so, I started taking some text out and putting blanks in and said, “fill this in and add what else they need. You see them before me and go through this.”  In the process of doing that, I was able to delegate six minutes of history taking to my assistants.  Long story short, I could save six minutes per patient and give them better care by systematically collecting a consistent set of information.  I started doing that, developed that over the next 3-4 years, and then by 1990, plus or minus a year, I had my Mac computer...one in every room...and I was using speech recognition.\n\n  \n\nDr. Sam Taggart: Really...that’s early...that’s very early.\n\nDr. Randall Oates: No one...I was the first to report the use of voice recognition at the bedside in America.\n\nDr. Sam Taggart: Really?\n\nDr. Randall Oates: Yeah...there was an article published in the Journal of Family Practice, lead author was Lefler.  I think it was ’93 and we did a randomized patient study on the acceptance of automation or computers in the exam room.  What we did was take a group of patients, randomly assigned to one of three groups, and one was the traditional visit where the computer sat in the corner and never touched or mentioned....group two had my usual print out prescription and patient education materials from the room using the computer, but nothing else...and then group three had the prescriptions that I entered and then the diagnosis and treatment plan I voice entered in front of the patient. At the end of the visit, there was a survey of patient acceptance on what it was.  I won’t go into all the details, but the patient acceptance was very good.  At that point in time, doctors were saying, “My patients will never accept this” and that was one of the first things to show that patients would accept it and not only that, they actually had a higher acceptance then in the traditional models.  But, it was...I hated it at that point in time.   I did not like using voice in front of my patients and I quite doing it; it was too much of a distraction.  I might do it again; but at that point in time, it was too novel.  Nobody knew about speech recognition...\n\n  \n\nDr. Sam Taggart: Where did you get the voice recognition?\n\nDr. Randall Oates: Uh...it was a company called Articulate Systems and it was called the voice navigator; they wrote it up in a national publication and I’ve got me at a beside...if you want me to get it for you...in a national publication talking into the Mac with a patient who actually was my first wife; the patient was.  We are still dear friends, me and my fist wife.” \n\n(Laughing)...\n\nBut anyway...Lefler...’93 journal of family medicine...Lefler/Oates....it was the first study of acceptance of speech recognition in the exam room; that was a lot of fun.  From there, right at that same time, who was it that...I think it was Carla or was it Les....somebody said, “You really ought to take this what you are doing to the AAFP meeting in Little Rock and just show them what you are doing.” Carla said, “Yeah, just set up over here and show people what you are doing because that is just pretty interesting.”  I was using my Macintosh and I had all these...not only would I talk to it, but I had it programmed where it would talk back to me.  If I said some snidy little thing, it would say...it would take like the 2001 space odyssey where when the guy tells Dave the computer, “I’m going to turn you off“ or tells the computer to turn itself off...the computer tells they guy, “I’m sorry, Dave, I can’t do that”....and I had a little; it was just a hoot.  Well, Chuck Rogers was on the national program committee and he said, “You know, you really ought to take this and do a scientific exhibit at the national meeting in Dallas.” I said, “Ok”....I didn’t know anything about it and there are also pictures in the National Vocation of me at that national meeting sitting there with people all around; if you’re interested in that.\n\n \n\nDr. Sam Taggart: Oh yeah; I’m really am...\n\nDr. Randall Oates: I’ll dig those things out.  But that was...after I did that...\n\nDr. Sam Taggart: Was this about ’93 or ’94?\n\nDr. Randall Oates: No, that was in ’90- ’91...it was in there somewhere.\n\nDr. Sam Taggart: I can look that up...I can find that...\n\nDr. Randall Oates: I’m sorry...getting the computer was in the ‘80s; I got my time off on that.  I got my first computer in ’83 when I was a resident.  But coming back around to the time when I was in practice...we were around 1990...I was using this in my very busy medical practice...I did the state meeting show and we had a lot of fun....Chuck said, “you really need to take that” and I did; I just was overwhelmed with interest.  I mean, I had a crowd there and afterwards, all these people said, “can I use that?” and I was sharing it and giving it away.  Sam Brown was actually one of the ones there at the state meeting and I gave him a copy of the software.  He went and got a Mac and so, I had something like 30-40 doctors all over the country, Sam being one of them, and we were all with this very open architectural programming system creating the software and it evolved over...\n\n  \n\nDr. Sam Taggart: Did you have any experience prior to that in writing a program?\n\nDr. Randall Oates: No, none...\n\nDr. Sam Taggart: How did you develop that knowledge?\n\nDr. Randall Oates: Just determination...\n\nDr. Sam Taggart: Just sitting down and doing it…\n\nDr. Randall Oates: Just sitting down and doing it between patients.\n\nDr. Sam Taggart: Ok....\n\nDr. Randall Oates: At night....it was fun.  At that time Macintosh had an application called, “Hyper-card” which was revolutionary.  You didn’t have to be a programmer to write code; it helped if you were a programmer, but it wasn’t...it was a higher level language and it used almost only English as a starting point, but you could go much further.  Another interesting story, I mean, it was one of the first applications that allowed Hyper-linking...where you can link to another system or another set of content from another set of content....it was one of the very first applications that did that...I really utilized that to create a medical record.  In fact, before I created...\n\n \n\nDr. Sam Taggart: Creating a database....\n\nDr. Randall Oates: Right...\n\nDr. Sam Taggart: An extended database using other...\n\nDr. Randall Oates: Other tools...\n\nDr. Sam Taggart: Sources of information....yeah....\n\nDr. Randall Oates: Right...right...back before I created SOAPware and was selling software, it...let me back up, I want to tell you about NASA in a minute when I talk about hyper-linking.  I did a project with NASA in the space station...but anyway....I also in the midst of all this got to spend time in Darga, where they created the internet...that’s another story and maybe we’ll get into that....getting back to where we were on my practice and ‘90-’91..in the early ‘90s, I had all these doctors and Sam Brown...Sam would fly up, or come up, and spend a weekend or a few days up here...or he’d come up and get me, fly me down to his practice, and we’d be like, “how can we modify this to...”  The whole point, Sam, was to tie the medical record, get it out of the way, to free us up to be able to deal with the patients.  I went into that...I love family medicine, but I hated records...doing charting, it was just a waste of time.  I wanted to use the tools to automate the creation of what needed to be created; of course, you know, as time has gone on there has been this pressure on us to collect and mange all this information that really has poor correlation with patient outcomes and they actually get in the way of good healthcare. I was trying to use the technology to get around that, but they’ve actually over time used the technology to entrap the doctors into that sadly; which is why I got out.  But anyway, that’s getting ahead of myself....getting back to the early ‘90s, we and all these doctors, we’re cranking along and doing this...well, I had this buy practice and it was getting overwhelming.  I was getting calls from doctors all over while I was seeing patients and so, I had to shut it down for a couple of years.  I said, “I just can’t be giving away software and supporting it and having a busy practice.”  I said, “What I need to do is come up with something that I can at least charge something for and have a”.....so, I created, wrote, a little manual and put it on a floppy disc and called it “MedMos”.  I was really infatuated with Cosmos with Carl Sagan, it was my favorite TV show, and so my program was going to be “Medmos.”  I sold like 30 of them and the last one that I sold was to NASA.     \n\n       \n\nDr. Sam Taggart: This is again in the early ‘90s?\n\nDr. Randall Oates: Uh, yeah...uh huh, yeah...they were working on the space station and the medical for it and they wanted to be able to...”how could they at the point of care link to different information on things” and I had done apparently a lot of what they were trying to figure out with my software and so, they bought the last version of Medmos; I think I sold it for $300.00...but anyway, that was fun and a little exercise of what they were having to talk about and how they...the issues they were trying to address, it was fun.  Then, I guess it was ’93...when was Clinton....\n\nDr. Sam Taggart: ’92...President...yeah...\n\nDr. Randall Oates: That would’ve been ’92-93...I was in Washington, DC if not every month, every other month, in ’92-93 with just a host of really wonderful projects.  The Office of Technology and Assessment is no longer in existence, but the OTA used to be the Congressionals technology research wing...I don’t know if I should share this, but I became real concerned about the issue of privacy and security with electronic health information because I could see at that point that that’s where it was all going...there were no protections at that point for electronic health information.  I communicated with someone in the central Pryor’s office people and long story short, they started a research that they wanted to assess the need to address privacy and security for electronic medical records and they had several meetings over many months...I was one of the commissioners on that....Pryor’s staff lost interest and Kennedy and Castlebaum...picked it up for..I don’t want to go into politics, but what they came up with was HIPPA.\n\n       \n\nDr. Sam Taggart: HIPPA; yeah, I knew that was where you were headed.\n\nDr. Randall Oates: Yeah, which I think it’s a disgrace, but that’s where it landed.  But, I got to go on the hill, meet lots of neat people...I spent lots of time with Arthur Ash...we just did; it was...getting to really know how Washington operates and how they work....going over to Darka...I really became just a bit disillusioned with that whole scene.  The whole notion of using technology and information of technology to chase metrics to put people into categories so that we can know where to send the money...is all that it’s evolved into. To me, the technology should be to serve the patient and by that, it has to server their physicians; the priority should be on the patient...like they did in Denmark.  There again, I want to come back to tell you about the mission work that I got to do with AAFP and going to Denmark and New Zealand; looking at their use of technology and healthcare and reporting back to the academy.”   \n\nDr. Sam Taggart: Ok...when was that?\n\nDr. Randall Oates: That would’ve been in 2007-2008...I’m getting ahead of myself, but don’t let me not talk about that.  We had these doctors and we were creating this...I created Medmos and it still was just more than I could handle; so, I hired a....I was really into Apple Computers, the Macintosh...the U of A Apple computer rep to take what I had written, the code that I had written...the program with our doctors.....it was bailing wire and duct tape from a programmers prospective...we were doctors, we weren’t programmers; but we made it work...he could take two pages of what we had written and it would be a paragraph of code...it would give him an idea and it would run that much faster whenever he ran it.  We turned it into a...he turned it into a commercial product that we could put out there and it was the first visually oriented medical record, graphic based is the word I should say....the first graphic based medical record broadly distributed in America. There were a lot of text base...you know, the old DOS.... a lot of those, but the one that ....where you could use a mouse and it was the first graphic...\n\nDr. Sam Taggart: About what year was that?\n\nDr. Randall Oates: Uh.....’93.......\n\nDr. Sam Taggart: Now realize on this, you are going to get a transcript to this interview....\n\nDr. Randall Oates: So, I can correct the dates...\n\nDr. Sam Taggart: You can go in and correct the dates, if you need to....you can look at it and say, “They’re fine; that’s great” ....but just so that you’ll know, this is not your final last chance...\n\nDr. Randall Oates: Yeah, I want to verify it....yeah...right.  Let me tell you, the reason I.....I wasn’t in a programmer, but I started wiring code simply because I went out there and looked and could not find any software that was graphically based... and that’s what I knew was the future; I mean, every system is graphically based now and so, you may not even know what I’m talking about.  If you remember the old DOS...do you remember the old day’s with MAC verses DOS?\n\nDr. Sam Taggart: Yeah...yeah...I remember..\n\nDr. Randall Oates: DOS has got to be graphical and Windows at that point was just a kind of shell; but I was playing with that then.  Actually in ’94, I did convert to DOS because the market demanded it; once I got my programmer in who could do that and I didn’t have to mess with it, we developed it into DOS.\n\nDr. Sam Taggart: Did you run parallel programs or have graphic interfacing? \n\nDr. Randall Oates: No, we just made the switch; I didn’t have enough resources to do both.\n\nDr. Sam Taggart: So we’re up to ’94, electronic medical records began to get a pretty good acceptance in the state of Arkansas.\n\nDr. Randall Oates: Not in ’94...\n\nDr. Sam Taggart: No, no, no...by about 2005-2010 somewhere.....now back in that time frame,  where there any practices in Arkansas other than yours and Sam Brown’s maybe....that was using.....\n\nDr. Randall Oates: No, Sam wasn’t then....I’m not aware of anyone.  Let me tell you, it wasn’t just the technology that I was using, I was creating a different process, a work flow process; I had nurses doing histories by large and I would just come in and validate it and it was getting much better histories.  Because I was saving an average of six minutes per exam of all that history, my volume went way up and then, I was....at that point, we had six physicians as Dr. Olson had joined us...but, that year I had the highest revenue of income by far of all the doctors.  So, they all turned around and went,”Hmmm” and so, I started showing each of them what I was doing.\n\nDr. Sam Taggart: That’s a very practical thing....\n\nDr. Randall Oates: Uh huh...\n\nDr. Sam Taggart: A very practical thing.....\n\n\n\nDr. Randall Oates: And they said, “Well, I can do that too” and so, they all hired a second nurse and started using...I had forms based on the type of visit...it was a starting process that they’d fill out the reason for the visit, which would determine the initial direction of the encounter...so by ’96, four of the six of us were on my electronic medical record and then, I think it was like three years later when the hospital offered the record to anyone in the community that wanted to use it as I recall.  So, there were a lot of practices in Springdale using my record.\n\n  \n\nDr. Sam Taggart: You had said earlier that you sold the very earliest version.....\n\nDr. Randall Oates: Medmos..\n\nDr. Sam Taggart: That you sold 300 copies of that...\n\nDr. Randall Oates: No, 30...\n\nDr. Sam Taggart: 30 copies of that....\n\nDr. Randall Oates: For $300.00\n\nDr. Sam Taggart: Where did those go?\n\nDr. Randall Oates: Uh.....\n\nDr. Sam Taggart: NASA was one....\n\nDr. Randall Oates: A lot of those were ...most of them, I would say, were people I had met at the national meeting doing the scientific exhibit...or people they knew...almost all of them.\n\nDr. Sam Taggart: What about here in the state?\n\nDr. Randall Oates: Here in the state....let me think if there were any other than Sam Brown...that early, there weren’t many of them in Arkansas.....I think Sam Brown, that early, was the only one.  Yeah, just Sam Brown.\n\nDr. Sam Taggart: When did you make the switch back over...I may be pushing you off your line of thought there....but when did you switch back over from the DOS based to the graphic based?\n\nDr. Randall Oates: By the time...when we went to DOS, that ‘94-‘95, Windows had matured enough that we could reproduce in Windows what I had done on the Mac and we went forward with that; simply, it was a market driven necessity.\n\nDr. Sam Taggart: Right...So, you had a Windows based graphics interface... am I saying that correctly?\n\nDr. Randall Oates: Yes...exactly and I was able to get it into a wide distribution on Windows because I had been developing on the Mac for so many, a decade, beforehand....\n\nDr. Sam Taggart: Right...\n\nDr. Randall Oates: So, I was ready to go once Windows had matured enough to support our graphical interface.\n\nDr. Sam Taggart: Well, talk about that....obviously your company now is called SOAPware...\n\nDr. Randall Oates: Well, it is not longer in existence.\n\n \n\nDr. Sam Taggart: Yeah, but, it was called SOAPware....\n\nDr. Randall Oates: At that point...right\n\nDr. Sam Taggart: At what point did SOAPware become a reality and where or how did you go about marketing this to people?\n\nDr. Randall Oates: Well, I...I was in a busy practice in ’94, overwhelmed with interest in the software, consulting, going to D.C., and doing all this stuff...so, I hired my brother-in-law to help me create SOAPware and run it while I was doing all my stuff; David Powell.  So, I said, “Creating a company. I want to go out and...”..... I love medicine; that was my love, not computers.  Computers were a way to free me up to be there for the patient; that is not what they are now in most settings.  Here I’m going off on a tangent again.....\n\nDr. Sam Taggart: That’s alright; there is no such thing as a tangent.\n\nDr. Randall Oates: Well, I’m just.....it’s just really sad what’s happening to EMR is all I have to say.\n\nDr. Sam Taggart: Ok...\n\nDr. Randall Oates: It was my third child and then they...I feel like they all but destroyed it.  Even if we stopped and turned around, it would take a decade to overdo all the damage that has been done to the EMR industry by those who shouldn’t be involved; you know.  But, I want to go on with this......Ok, we are in practice, we are getting up to the late ‘90s....\n\nDr. Sam Taggart: David is taking over the company...\n\nDr. Randall Oates: David is taking over the company and we’re cranking out floppy discs with SOAPware on them, I think it was 7 or8...$300.00...we had like 10,000 sites at one time; 30 different countries...\n\nDr. Sam Taggart: Really?\n\nDr. Randall Oates: Using SOAPware...\n\nDr. Sam Taggart: Any particular distribution in the United States....?\n\nDr. Randall Oates: Uh...well it, I mean....it followed the population; if you look at our installed sites, it completely matches the population.  Now east coast/west coast...Texas...\n\n  \n\nDr. Sam Taggart: In areas of concentration...\n\nDr. Randall Oates: Right...right...\n\nDr. Sam Taggart: What about in rural health; was there any penetration in rural health at that point in time?\n\n\nDr. Randall Oates: Oh yeah....yeah, I mean, we had a lot...\n\nDr. Sam Taggart: In Arkansas?\n\nDr. Randall Oates: In Arkansas...ironically not as much...  We had several and so, we probably at one point had 12 sites in Arkansas; it could’ve been more than that...but I never had a whole lot in the state; I guess because they knew me.\n\nDr. Sam Taggart: (Laughing).....When did the big boys jump into the market?\n\nDr. Randall Oates: I would say that it had been gradual....it was a...I mean, it has been gradual since I’ve been in it and I can’t say that there was a point in time when they all jumped in.\n\nDr. Sam Taggart: What about the impact of...obviously, this has been going on.....throughout the time that you had been in practice, Steve Collier started ARcare in 1984-’85 from a nonprofit corporate medicine standpoint; he, Baptist Hospital, Washington General...all of these places have gotten involved.  Do you think the emergence of the...I’m trying to think of the right word...laterally integrated practices where you have physicians and hospitals and multiple clinics....has had an impact on the acceptance of electronic medical records?    \n\nDr. Randall Oates: Well, if you call...”You can’t work here, if you don’t use it” as acceptance; yes...\n\n   \n\nDr. Sam Taggart: Right...\n\nWere they early on in making sure that it got accepted; early or not?\n\nDr. Randall Oates: I wouldn’t say that they were early in the process of the development...I mean, the big systems accepting EMRs came later.\n\n \n\nDr. Sam Taggart: Ok....like when?\n\nDr. Randall Oates: There again, it’s a spectrum... but, it wasn’t...early 2000s, I think, is when they really started automating; it may have been later...\n\n\nDr. Sam Taggart: You said Springdale; was Springdale an early accepter? \n\nDr. Randall Oates: Yeah...\n\nDr. Sam Taggart: They were an early accepter....ok...\n\nDr. Randall Oates: Yeah very definitely...\n\nDr. Sam Taggart: What about Washington Regional?\n\nDr. Randall Oates: They didn’t have.....well, that far back, I can’t accurately say that I know for sure what they were doing.  I can make a guess that I can correct later....\n\nDr. Sam Taggart: Well, make a guess...because again, you can correct this later.  I’m taking this home and this is going to be the first thing....I have three interviews built back up...but, this will be the next thing that my transcriptionist is going to transcribe. Our practice was an eight man practice called Family Practice Associates of Benton.  In 2008, we went electronic medical records and we weren’t affiliated with any hospitals.  We went electronic medical records because we were just out of space and our records were this thick....\n\nDr. Randall Oates: Right...\n\n         \n\nDr. Sam Taggart: Would that have made us a.....middle of the road?\n\nDr. Randall Oates: Probably, yeah...I think so; yeah.\n\nDr. Sam Taggart: When would you say that the early acceptors...again, I’m talking about the state of Arkansas here as much as anything else.... when did the early acceptors in Arkansas, outside of you and Sam Brown, really start picking this up?  \n\nDr. Randall Oates: I would only have to go with my intuition; I don’t have any direct data. But, it seemed like right around...this is one that I’m likely going to come back and correct...but, I think, right after 2000...early 2000’s was when we started seeing....\n\nDr. Sam Taggart: Was it more smaller practices or larger practices liked a 5-6 man group practice?\n\nDr. Randall Oates: Well it was both, but mine was almost exclusively smaller practices; because that’s what I was designing...built within and for.\n\n   \n\nDr. Sam Taggart: In reading the history of EMRs and going back into the history of how other people who were consilience....where there are a lot of people coming up with the same idea at the same time; independently....\n\nDr. Randall Oates: Yeah, ok..ok....\n\nDr. Sam Taggart: One of the things that I read repeatedly was that in the early ‘90s, there were a number of people in the United States...physician practices and maybe not even all physician practicies...who were coming up with EMR systems.....did you have any contact with people like that?\n\nDr. Randall Oates: Uh huh...oh yeah....the early ‘90s was....\n\nDr. Sam Taggart: Talk about that….talk about some of those people that you had contact with…\n\nDr. Randall Oates: Yeah...like Hal Hedges Jr....\n\nDr. Sam Taggart: Really?\n\nDr. Randall Oates: Yeah, that was one of the other things...when I went to that state meeting, they said, “You need to talk to Hal Hedges Jr.”....he had been fiddling and developing an EMR within their practice there in Little Rock.  That’s Hal Hedges III, I guess...\n\nDr. Sam Taggart: Yeah...it’s not Harold.....\n\nDr. Randall Oates: The younger one.....yeah, not Harold...\n\n(Both laughing)...\n\nAnd..\n\nDr. Sam Taggart: Harold is in the book, by the way.....I interviewed Harold for this book...\n\nDr. Randall Oates: Yeah...yeah....gosh another inspirational guy......but anyway, Hal said, “You really ought to go to SCAMC; it’s an annual meeting of medical nerds in Washington, D.C.” and that was...that was actually in...that must have been in ’89....not ’90 when I did the AAFP because I went to SCAMC that year In November and it was like going to Fantasy Island with all these doctors doing like what I was.  We were sharing ideas of what works and using hypercard and similar type things where you didn’t need to be a programmer...Hal and I worked on some things together for a little while.  But yeah, there was just thousands doing something similar from all over.\n\nDr. Sam Taggart: Let’s jump forward to the late 1990’s and early 2000; how many of those thousands were left?\n\nDr. Randall Oates: They were gone, a large part; I mean, it was a hobby and there was not a business model to sustain it.  It is...to go from having an application that you can use in your practice to one that can be used in multiple different practice settings, the gap is huge.....people just don’t realize that and many tried to, but they just couldn’t weather the storm.\n\nDr. Sam Taggart: How many of them had a brother-in-law, like David, ....(Laughing)...who could take over the business so that they could keep practicing medicine and their brother-in-law, or somebody else, could be a good manager? How many of the ones who survived had that?\n\nDr. Randall Oates: I think that was the key; as physicians, one of the traits that I have tried to be cognizant of is that we sometimes have less of a tendency to recognize what we’re not good at and what we should delegate.  Early on, I realized that I needed to delegate programming and business to people who are better at it than I am and to focus on medicine; so, that’s what I did.\n\n   \n\nDr. Sam Taggart: By the late 1990s, MRs and whatever other initial you want to put behind it, started to become....they are mainstreamed a little bit, ok.....you started out doing OB, a little bit of surgery, a lot of other kinds of family medicine....talk a little bit about your practice and we’ll come back to the EMRs again in just a minute.  Talk about your practice during all this period, did it change?    \n\nDr. Randall Oates: Oh gosh, yes....\n\n    \n\nDr. Sam Taggart: How did it change?\n\n\nDr. Randall Oates: Uh...like I said, I joined a four man group and then, we added another one the next year and had a six man group; Dr. Olsen came.  Then Mark Kendrick was with us for a while too; so, we had seven for a while as I recall. Mark Kendrick and Olsen could have traded off, but anyway we were thriving.  We actually implemented most of what’s called the Patient Centered Medical Home during that time...\n\nDr. Sam Taggart: Before it was required...long before...\n\nDr. Randall Oates: Oh yeah, long before...I mean, it was a...the practice was a complete cross section of the community; all ages, all social economic...a tremendous practice, a very busy practice.  Right after I got there, I realized that we needed to....another thing, when I came in they didn’t have room for me because the office was for a four man group and suddenly we were five when, I came in.  Before I came in I said, “Let’s create an express clinic”...we had a lot of working class people that the work day is a real issue for them to get in and there’s...the long story short is that we split up and created two shifts; an 8-3 and a 3-9 shift during the week days and we traded off.  Then, we were there on Saturday and Sunday too; like I said...one person there on Saturday and Sunday and we traded off.  But, we were basically there from 8 in the morning to 9 at night....and soon that what we called the express clinic became busier than our regular clinic and it was bringing in people from all over; it was tremendously successful doing that and I really tried to advocate people...I said, “you really need to figure out a way to extend your hours to serve your community because they really will appreciate it.”  We were using more consistent history taking and data gathering and I can remember...I’m trying to remember the name of the HMO....but one day, we were all working and these suits came in and they were from..one of the first HMOs that came in and we had a big practice...they came in and the office manager came back and said, “the group from”...it’s bugging me that I can’t remember the name of that HMO, one of the early day HMOs...the big one...long story short, they came in and they wanted to list the practice that we had “as the best outcomes of any practice in the region” and “the lowest hospitalization rate” and “the lowest cost per patient.”   By those metrics, we were the best in the area; that was in the last ‘90s and by that time we had, most of us, hired a nurse practitioner and had quit going to the hospital. I had one going into the hospital and we were all really focused on that.  We were using all electronic medical record; mid levels...we were delegating record taking, doing patient education...we were doing like I said, so whenever the initiative for our PCMH came along, I was saying, ”Heck, yes”....\n\nDr. Sam Taggart: Sure...that’s us...\n\nDr. Randall Oates: That’s what you...I mean, it works”....so, I was actually on the...\n\nDr. Sam Taggart: Was there any mandating before the Affordable Care Act?\n\nDr. Randall Oates: No...\n\nDr. Sam Taggart: The Affordable Care Act is where it officially began to be mandated right?  Some of the stuff like the Patient Center Medical Home and those kinds of things....\n\nDr. Randall Oates: It was Meaningful Youths.....\n\nDr. Sam Taggart: Meaningful Youths; I’m sorry, yeah...\n\nDr. Randall Oates: Not the.......that’s really what....Meaningful Youths was around 2008.\n\nDr. Sam Taggart: 8 or 10; somewhere along in there.....\n\nDr. Randall Oates: That’s whenever it really...it just....the industry really....with all the pumping in of medical use monies and all that, it just really....I think the EMR industry got off course at that point when the focus become on throwing money at it to encourage it and justifying it by using quality metrics.  The metrics are supposedly valid proxies for quality; they’re not....quality is what the patient determines is quality.  I’m getting off task again, but really....in the early days, the EMR...the physicians that learned to use it and delegate, they loved it.  It made their lives better; they got home and didn’t have to do records when they got home.  They were done when they got through seeing the patient; that’s what I focused on....your records needed to be done when you leave the room.\n\nDr. Sam Taggart: Yeah...right....\n\nDr. Randall Oates: And the only way that I could do that was by having someone else do a lot of the record collecting.  During that time, I experimented a lot with patient tools to gather histories too; I don’t really want to go into all that, but that played a role for a while.\n\n         \n\nDr. Sam Taggart: In 2002, the American Academy and several different other organizations had a conference, a major conferences, called “The Future of Family Medicine” and they talked about the new model of practice and they talked about the Patient Center Medical Home and all that kinds of things.  Do you remember....personally, I don’t remember a thing about it until I started studying this and I retired in 2012...do you remember that conference or remember anything about that conference?  Because, they were talking back in 2002 about electronic medical records in family medicine physician’s offices.    \n\nDr. Randall Oates: Uh huh...uh huh......that’s really what lead directly or subsequently a few years later to the AAFP creating their PCMH project.  I actually had been involved...I think it was 2000...as a precursor to that, I made a couple of trips to Kansas City and we met with the current President...I’m trying to think of his name...he was...he played a role at the Academy.....gosh, I’ll get that to you...but, we met there at the National office there in Kansas City talking about the role of EMRs in family medicine and what the Academy should be looking at and doing; they were sensitive way back then...that President.  The problem is is that I’m blocking on his name, but I’ll get that back to you because he made a significant contribution to getting the leadership thinking about it and so, the academy has been looking at it since 2000, I know, and actively thinking, “what do we need to be doing?\n\nDr. Sam Taggart: Did you ever have any or did you ever read about the Cheyenne Conferences?\n\nDr. Randall Oates: No...\n\nDr. Sam Taggart: Ok...they are part of the leadership lead by Gail Stevens of the National Academy...\n\nDr. Randall Oates: Yeah...ok...\n\nDr. Sam Taggart: A series of conferences...there have been four of them...three were in 2000...it’s where the Future of Family Medicine collaborative party came from.\n\nDr. Randall Oates: Ok...\n\nDr. Sam Taggart: It was that one and then there was a fourth one was after he died in 2014/2015....but that didn’t; that name rings a bell, but that doesn’t necessarily....that wasn’t something that you were involved in....\n\nDr. Randall Oates: No.\n\nDr. Sam Taggart: Ok.   \n\nDr. Randall Oates: I was not involved in that; no. I briefly toyed...back when Hillary was starting her medical thing, I visited the team and met a lot of the people in it...Her, Magazine, George Staphanopulos and probably people you know...but long story short, it was apparent to me that that style of intervention was top-down.  You know when they would have meetings, they would bring very academically acclaimed people, not physicians, into a room and they would come up with policies for physicians to follow and I found that....I thought the meetings should be open and so, I didn’t want to be part of a system that had closed meetings ...you didn’t; there was not a .....so, I did not get involved in that and I was on the edge of that because I was working with the Congressional OTA at the time on what should be written into regulations regarding information flow.  But after I made my last...in ’96, I think was my last presentation on the hill, I became convinced that family medicine needs to be grass roots and that subsequently really stimulated my interest in direct primary care and all that... but that’s getting ahead of us here.  We are getting up into the early 2000s and I’ve got two jobs....I’m consulting and developing software and I’ve got this very busy medical practice.\n\n  \n\nDr. Sam Taggart: By this time, you are 55/56 years-old...\n\nDr. Randall Oates: Yeah and it’s a lot of fun, but it’s taking a toll.  I had to scale down my practice; I was just too distracted.  At the same time in the software business.....like is said, I had 2000 sites and it was just exploding....so, I decided to build an office for my software business and a little medical office.  In this little medical office, I would be doing just direct primary care where I wouldn’t have to deal with all these intrusions and ....\n\nDr. Sam Taggart: A concierge’s-type practice....\n\nDr. Randall Oates: More a direct primary care; it would be cash based, but it certainly was not expensive.  It’s a movement where I think like 2% of family doctors now are doing direct primary care; it’s not concierges, but it doesn’t involve third party payers.  Anyway, I’m against anything that interferes with the doctor/patient relationship because that is what is so poorly understood and \n\nso underestimated in healthcare.  Technology should be used to enhance and not interfere and control that doctor/patient relationship and that is not what’s happening today; it’s just the opposite.  But, that was my focus and we were able to do that for a long time.\n\nDr. Sam Taggart: So you left the practice that you had been in to open this?\n\nDr. Randall Oates: Oh, I’m sorry; I got off base....yeah, like I said, I was overwhelmed and built an office building for my practice and my software...Ieft my group practice, all on good terms; they were still using my software.\n\nDr. Sam Taggart: Yeah...sure...\n\nDr. Randall Oates: I just can’t do it all and I need to just....I could have 200-400 patients that I can test with...with my software...but, I was too distracted and by that time, I’m all over the place; I just couldn’t consciously develop a following.  I never really promoted it much...I saw a few; but I never really developed a clinic practice in my new building, because I was doing too much software.  I really...I still miss it, because that’s what I love the most.\n\nDr. Sam Taggart: When did you stop seeing patients?\n\nDr. Randall Oates: Oh gosh; well, I mean....when I moved into the building in 2006... (2004, 2005, 2006ish) ....after that, I really saw just a handful for the first five years and then after that, I shut it down.\n\nDr. Sam Taggart: Your wife said that you retired 10 years ago; so, that’s...I’m figuring....\n\nDr. Randall Oates: Medical Practice...\n\n \n\nDr. Sam Taggart: Medical practice; right...how long did you keep the software business going?\n\nDr. Randall Oates: I shut it down in 2017.\n\nDr. Sam Taggart: Was there a reason why you shut it down at that point?\n\nDr. Randall Oates: Uh...my market was small practices and they were being...my market was basically being taken away from me.\n\nDr. Sam Taggart: Yeah... \n\nDr. Randall Oates: In order to sell into the larger systems, I had to develop software in ways that I ethically didn’t consider a program; they are designed to manipulate and control and not serve the patient.\n\nDr. Sam Taggart: I interviewed Mathew Nix, a younger guy; he is 10 days younger than my youngest son.  A wonderful, delightful physician in Texarkana and he was talking about the fact that....he teaches at the Texarkana Family Practice Residency....he said when he went in, it was right after the Affordable Care Act and the Patient Center Medical Home had just been mandated \n\nfor the University; he was handed that as his first project... (Laughing).. \n\nDr. Randall Oates: Wow...\n\n\n\nDr. Sam Taggart: He said the leader of the residency said, “Here, you make this work.”  He said the electronic medical records that they had available at the time were simply not conducive to doing that.  He said now in the last six to seven years, that has changed for them; the University’s system.  Is that some of the changes that you are talking about?  Its formalized, its big business now, a commodity, and not health care....not what we think as healthcare in the past...a commodity as much as anything else.  Do you think that evolution.....is that what you’re talking about when you say that you don’t think it’s a good idea?   \n\n  \n\nDr. Randall Oates: I...I’m saying that I don’t think it’s a good idea to use the technology almost with the focus being on...let me just whittle it down...EMR is a tool to create numeric codes to serve, to attach dollars to, and to control the flow of dollars through the system through manipulation of various numerical codes.\n\nDr. Sam Taggart: A commodity; yeah...\n\nDr. Randall Oates: The whole system is a game of having the right codes and the right set of data at the right time and I would argue that that is more likely to lower the quality than improve the quality of care.  You know, what is it...5% of the population consumes 50% of the healthcare dollars...if you want to affect that 5%, you’re not going to do it through collecting a bunch of codes and throwing out a bunch of education; you have to develop a relationship with these people to figure out where they are uniquely with their disease and how to treat it.  Well, you can’t do that if somebody is over here focused on entering all this ____ stated that the administrators need in order to know where to send the dollars. It’s a total disaster in my opinion.\n\nDr. Sam Taggart: Right...\n\nWhen you first started working in this area, you were trying to sell this to physicians who had not grown up in the internet age, not grown up with computers, had not grown up with cell phones....now, these kids who.....excuse, I shouldn’t say that....these young people who are practicing medicine had a telephone/computer in their hands by the time they were 1 or 2 years old.  Is there another generation....you may not anticipate what I’m going to say next....is there another generation of physicians who is coming along who will modify this process to make it more physician/patient friendly and usable? \n\nDr. Randall Oates: I think that is going to be determined in a large part by where our culture goes in general.  I don’t think that physicians are going to be the ones driving the show here.  I think it’s going to be the younger generation who are just not accepting this and are looking for alternatives and they are going to start with their phone or their computer.  I think the solutions are going to be those where enlightened physicians are working collaboratively with enlightened developers incrementally over a period of time to create systems that meet the needs of patient and their doctors; then you won’t be hearing doctors and patients cursing the portal and the EMR.\n\nDr. Sam Taggart: Right....\n\nDr. Randall Oates: At that point, we’ll have the revolution.\n\nDr. Sam Taggart: Ok...now, you practiced medicine for 35 years...\n\nDr. Randall Oates: Not quite that long; but, yeah..\n\nDr. Sam Taggart: 33-35 years....did you enjoy it?\n\nDr. Randall Oates: I loved practicing medicine.\n\nDr. Sam Taggart: What did you like the most out of practicing medicine?\n\nDr. Randall Oates: Uh....it’s like a chess game; I mean, it’s just looking for the options, the nuances, and figuring about the best plan.  Just meeting people where they are and being creative with where they are; “what’s going to work for you”.....having just the relationships over time and the appreciation.....I mean, how could you not love it?  I had wonderful patients, it was a wonderful community to practice, I had great partners.....I was just very fortunate.  I miss it.\n\nDr. Sam Taggart: So, you’re retired now...what do you do with your days?\n\nDr. Randall Oates: Well, I love what I’m doing now; I’m very active....we are getting ahead of ourselves here a little bit.  But, I’m very.....I exercise every day.  I’m out on my bike; very active. I have my two children, my two granddaughters, who I spend a lot of time with.  I love doing deep dives into this or that issue; right now, I work....seven years ago, I was 316 lbs...\n\nDr. Sam Taggart: Really...?\n\nDr. Randall Oates: I had been over 300 lbs for many years and been morbidly obese most of my adult life.  I lost 50 lbs three other times, but gained it all back...long story short, I did a deep dive into obesity ...even took the pre-course to take the boards in obesity medicine...but anyway, I was able to gradually take off 116 lbs of body fat of which I have maintained all but 16 lbs of it.  I’ve gained a little back, but I have kept most of it off. In the process of doing that, I have had a real brainstorm unearthing a huge gap that I see in my career in dealing with people with chronic disease such as obesity, addictions, or so many things that has to do with...now, I don’t want to sound corny here, but....body, mind, and spirit.  Using current tools, particularly things that might ring a bell, would be like neuro-feed-back, to/and alternatives to pharmacology and counseling to people with ...practicality chronic trauma related PTSD; people who have entered their adult life with serious trauma. You know, they come in our office with hypertension, obesity, or whatever; but if you really want to look at what....sure we can throw a diet at them or put them on an exercise program, but the weight is going to come back because there is unresolved trauma that they might not even recognize.  Learning how to recognize, identify, and deal with that; all the...I mean this whole industry focus on diet and exercise as the 95% of what you need to focus on if you have the disease of obesity doesn’t work; when are they going to figure that out?  The data is  there; I mean, anyone who loses weight has to know that there is a 50% chance....50% of people who lose a significant amount of weight will gain it back within two years and 80% within five years; that’s just the data in who doesn’t and looking at those who don’t.  That has taken me into a place that I wish I had known when I was in practice because a lot of those people who came in with bizarre behaviors that I thought was borderline or ...I mean, they’re trauma victims and we did not have the tools to effectively deal with them. In doing a lot of deep diving and figuring out what to do, I think I will have another career that’s probably going to be community based; something like the same flavor of AA where the community people come together and say.”We share a challenge” and “what are the tools that we can crack.”     I think that and using our technology to bring those communities together is going to be the way we transform healthcare; it’s not going to come from CMS and the medical community....I’m sorry, I’ve given up on them.  It’s going to come from the ground up and that’s what I want to be a part of.\n\n    \n\nDr. Sam Taggart: What......I’ve known you for two hours now and I know and can tell that you don’t let anything rest.... (Both laughing)....what are you doing objectively to make that happen?\n\nDr. Randall Oates: Well for the past year, I’ve done an intense...I’m working on myself first.\n\nDr. Sam Taggart: Ok.\n\nDr. Randall Oates: I’m maintaining my weight, maintaining a healthier lifestyle, trying to develop healthier relationships with those around me; dealing with my own issues so that I can be more available to connect and have....I want to do something I see as community based with technology and it may be virtual communities.  I’m not sure, but we need to bring people together in a safe place where they won’t get non-sense.  People need guidance and I think a true physician of the future is going to be a guide in the community; that’s what I see and I’d like to kind of see that.\n\n  \n\nDr. Sam Taggart: If you haven’t read the Future of Family Medicine article that was published in 2004; you really should because you’d love it.\n\nDr. Randall Oates: I did back at the time; I don’t remember the details....\n\nDr. Sam Taggart: You should reread it because that is exactly some of the things they talk about. \n\nDr. Randall Oates: Well, I’m doing it.....I’m doing it.  I mean, I could do a men’s group on Monday nights...where we group men together who are all struggling with the disease of obesity.  I call them the \n\n“outliers” because everyone who has been there for more than a couple of years has maintained more than 10% loss of body weight.  It’s really just about...most men really don’t have any authentic relationships.  It’s about power, ego, and they don’t feel safe where they can be vulnerable; but if you really want to deal with a chronic disease, you need a safe place to go. Anyway, that’s the kind of thing I’m doing and I have a whole bunch of gadgets that I can show you.\n\n   \n\nDr. Sam Taggart: So, you really haven’t retired....\n\nDr. Randall Oates: No....I’m very busy.\n\nDr. Sam Taggart: (Laughing)....I didn’t much think so...\n\nDr. Randall Oates: I have an EEG that I can sleep with so that I can see my stages of sleep and I don’t have my smart watch on at the moment because I have a battery issues with it...but, what I’m doing is looking at...there are a whole host of technology tools ion smart devices that are giving us more data by which we can make better decisions; particularly the ones that are looking at the brain are fascinating.  Within the next few years, we will have home tools to help us recognize what mental state we are in and tools, if we so choose, to get to a more positive mental state; we will have technologies that will help us guide us there and I mean, I’m using some of that now.  It’s crude, but it’s just...\n\nDr. Sam Taggart: Have you ever heard Steven Caldwell, the cardiologist from Little Rock, talk?  If you ever get a chance...and haven’t...you probably need to.  He talks about remote medicine....it’s the same concept....\n\nDr. Randall Oates: Yeah...the same concept....\n\nDr. Sam Taggart: It’s having blood pressure monitors and blood sugar a monitor....monitoring that remotely... but, it’s the medical model of doing that. \n\n\nDr. Randall Oates: Do you want me to show you a couple of gadgets that I mean?\n\nDr. Sam Taggart: Sure...sure, but let’s finish what we are doing here and then, we’ll look at that stuff...\n\nDr. Randall Oates: Ok.....I’m having a blast!\n\nDr. Sam Taggart: I’m glad you are....\n\nDr. Randall Oates: The next generation, I don’t think, is anything like what we think of as healthcare now.\n\nDr. Sam Taggart: Right....right... that again is what the Future of Family Medicine...I wish I had it with me because I would’ve given it....because if you haven’t read it....\n\nDr. Randall Oates: I have...\n\nDr. Sam Taggart: In 2002, they were pressing in what they presented and some of it, not all of it, got written into the Affordable Healthcare.  I’ve heard what you’re saying about the patient center/ medical home..I’ve heard that echoed about the combination of EMR, remote medicine, and a that...it’s being twisted and not being as functional as it probably should be or as it had the potential to be. \n\nDr. Randall Oates: Right...exactly...I totally agree.\n\nDr. Sam Taggart: I want to talk about a couple of other things now, ok.  I have a couple of questions that were not in the questionnaire...they’re not “gotcha” questions, ok...\n\nDr. Randall Oates: Ok....\n\nDr. Sam Taggart: In 50 years from now, you’re going to be a picture on the wall; it’s just the nature of it...what do you want your great, great, great grandchildren to know about you?  Other than the fact that you became your father in some ways.... \n\nDr. Randall Oates: (Laughing)....Uh....simply that I left the world in a better place than I found it.\n\nDr. Sam Taggart: They will be able to see this...they will have the potential to be able to see this.\n\nDr. Randall Oates: Oh yeah.....I hope that the world is a better place.  I’m trying to do what I can to leave it a little better place; that’s kind of my motivating underlying principle.....“How can we improve this”...”How can we make it better?” Hopefully, I made the world a little bit better.\n\n \n\nDr. Sam Taggart: Would you have done anything else about the practice of medicine that you didn’t do given what you just said in the last 2-3 minutes?\n\nDr. Randall Oates: Oh gosh......would I have done anything different?  I would’ve gotten out of the EMR business 5-10 years earlier; that’s what I would’ve done and tried to get back into some kind of practice.  By that time, the industry...I think...had been corrupted beyond repair and still is.  Hopefully, that can be corrected; but yeah, I wish I’d gotten out of the EMR and gotten back into direct care earlier.  Then, I might still have a place to piddle; but, I’m enjoying what I’m doing.  I’m not....I’m loving what I’m doing, but I just love practicing family medicine.  There is nothing more fun than family medicine.  I mean, you’ve got the whole arm of material of healthcare at your disposal and you’re....to me, it was just golden.\n\nDr. Sam Taggart: My version of the same thing that you said when you were doing the EMRs and the balance of trying to practice medicine was in 2012; I spent the year.....when I wrote the book “The Public’s Health” ....I spent 30 hours a week writing and researching and 20 hours a week practicing medicine.  I went to my partners and told them, “People deserve more than a part time doctor with part time interests.”  I knew where my interests were going to go and so, that’s when I retired; that’s what prompted my retirement.     \n\nDr. Randall Oates: Right....\n\nDr. Sam Taggart: So, this is my last question I have and then, we can keep this going as long as you want to keep going because you’re a great fountain of information.  \n\nDr. Randall Oates: I’m enjoying this by the way; I just thought...\n\nDr. Sam Taggart: Ok good...\n\nThose same great, great, great, grandchildren who looks at your picture on the wall ...\n\nDr. Randall Oates: I’d just be stunned if they even know who I am or want to look at me.\n\nDr. Sam Taggart: Well, we’re going to kind of make that a possibility anyway...what do you want for them?  \n\nDr. Randall Oates: I want them to have peace, love, and to be able to pursue happiness in their own unique way.  I mean, the principals in which our nation was founded; that’s what I want for them.\n\nDr. Sam Taggart: Yeah...\n\nOne of the purposes of this book that you’re going to be a part of...the book is called, “For Every Family, a Family Doctor”.... is to look at the history of modern family medicine in Arkansas...I’m being very specific about Arkansas...and the Academy.  I think everyone in medicine understands not that what is going on with EMRs, telemedicine, and all these kinds of things.....well, for the first 50 years of the Academy,  one of the fortes of the academy was that it produced good continuing medical education.  As a practicing physician, they could either come to your community, Lee Parker was a big part of that, or they could make sure that you got the continuing education that you wanted.  Now, you can log on the television and in an hour, you can get 20 hours of free good credit; ok. How do organizations like/and especially the Arkansas Academy of Family Physicians....retain their not credibility, but the necessity for them?   Because people are beginning to turn away from the Academy; not just this one here, but the National Academy...the American Medical Association, the Arkansas Medical Association, the County Medical Societies have gone away.....     \n\nDr. Randall Oates: They have...\n\nDr. Sam Taggart: How do they maintain their viability?\n\nDr. Randall Oates: I’m sure I’ll have more to add after I’ve had some time to think on that; they’re in a tough position.  We haven’t had a chance to talk about my...other than the 2000 with the....I’ve had a lot of interaction with the National Academy that I haven’t gotten into yet.\n\n \n\nDr. Sam Taggart: Well, let’s get it in now....if you’ve got time....let’s talk about it.\n\nDr. Randall Oates: Yeah, I’ve got the time...I started to go into that; I had this practice where I was doing all and I had actually opened my clinic and was really promoting a PCMH...it was by the national definition, but I done it organically...grass roots.\n\nDr. Sam Taggart: Right...\n\n\nDr. Randall Oates: I had been following all the national stuff.....the academy asked me to be on the board of directors for transfer med; that was the academy’s PCMH initiation project and it was a big effort initiative during the late 2000s or early 2010s.  But, it was the academy’s effort to promote PCMH.\n\nDr. Sam Taggart: Are you talking about the National Academy?\n\nDr. Randall Oates: Uh huh....I did that for a couple of years and I left because...I parted ways because they decided to ask NCQA to certify them.  I felt that was the wrong direction for a whole host of reasons; I felt that our certification should come within our organization and if they wanted....I would say of....one of the ways of being viable would be if they could interact in some way that would help communicate to the community....well, they are doing that; let me think on that..\n\nDr. Sam Taggart: Ok, sure....\n\nDr. Randall Oates: That is a tough question.  I’ve been off and on to the state meetings and have quit going to the national meetings; you know, we’re just busy.....\n\n    \n\nDr. Sam Taggart: I will tell you that there are...I’ve talked to a number of people on the board who are going to be in this same book...there are some really bright minds who are looking into those questions right now. \n\nLonnie Robinson up from Mountain Home....\n\nDr. Randall Oates: Oh, he is awesome.\n\n \n\nDr. Sam Taggart: I’m going to go interview him next week.\n\nDr. Randall Oates: Oh, good....good...\n\nDr. Sam Taggart: Glenn Kemp from Perryville...this young Matthew Nix....Julie Garner....\n\nDr. Randall Oates: Oh, she is awesome.\n\nDr. Sam Taggart: Yeah...yeah...\n\nDr. Randall Oates: Oh yeah, there is tremendous talent.\n\nDr. Sam Taggart: Wonderful talent out there...\n\nDr. Randall Oates: We just got to get to that next place...\n\nDr. Sam Taggart: Yeah and they are...another thing; this is my opinion...my opinion time... (laughing)...they are making the step of being politically involved, which is...\n\nDr. Randall Oates: That triggered something; I’m sorry I interrupted you....\n\nDr. Sam Taggart: No...No....I’m just saying that being politically involved is a really important element of this and has been for the last 75 years.\n\nDr. Randall Oates: Yeah...I’ll tell you what; if the family practice community would do what they did in Denmark, they would become relevant again.  As part of my work at the National Academy, I got to spend at bit of time in Denmark and looking at their system. In Denmark, way back like around 2000, they came up with this board of directors commission to deal with the future computerization of medical records and from the beginning, the leadership had to be patient based; community based with guidance from their primary physicians.  So in contrast to this country where everything starts from government, health insurance companies, big industry...they come up with something and then it comes down and meshes down with the community; it doesn’t work and we get what we have right now.  In Denmark, they said “No, this is for the community...for the public” and so, the commissions are really community based and directed primarily by the primary care community for guidance.   So, they have developed a system that is just so much better than ours.  It’s one that the doctor’s and the patients go to, enjoy, and appreciate rather dread, hate or curse; because they created it.  We need to get back to that and the tools are out there to do it.  The more that the academies can focus on collaborating with enlightened people in the community to develop the tools and the processes that serve them; that’s how they can become relevant and it’s going to happen whether they become part of it or not...the millennials are going to do it with or without them.\n\nDr. Sam Taggart: Right...\n\nDr. Randall Oates: So, why aren’t they going to join in and get on board?\n\n    \n\nDr. Sam Taggart: Right; that is my impression as well.  But, there are a bunch of them out there.....in my former practice where I retired from, there are still seven now and I’d say four are under the age of 50 and they are really sharp...really sharp.  \n\nNow, you mentioned nurse practitioners and physician assistants.....where do you think we stand with that right now?  The laws have changed over the last year or two....\n\nDr. Randall Oates: I’m not going to claim to be real up on the current legislation of the process of that; I know it appears to be an inevitable trend that mid-levels are going to replace physicians within most institutions for primary care and for other care for that matter, which is a mixed bag.  I was the \n\nfirst doctor in this area to start using a mid-level and was probably one of the first to quit using mid-level.  It’s not a criticism of them; it’s just my style evolved and I went into more direct care and didn’t need one.  It’s risky and I think it can be the best of care if it’s a team approach.  I say that whether it’s a physician or a nurse practitioner; it needs to be a team approach.  So, it’s not saying that one is above the other; it’s saying that we all need to be a part of a team.  A physician is better when he has a team where he can delegate certain tasks to a mid-level where they can probably do a better job than they are.  But to turn...for anyone to operate without a team today is less than optimal.....did that answer your question?\n\n  \n\nDr. Sam Taggart: Oh yeah....In 1948, Ruphus B. Robbins of Camden, Arkansas...very politically active, involved in the Arkansas Academy of General Practice...he went all over the country talking and one of the things that he said was that the family doctor is the quarterback of a football team...\n\nDr. Randall Oates: Should be..\n\nDr. Sam Taggart: Yeah...he said, he was and I paraphrased him in my book to say, “Yes, the family doctor is still the quarterback, but somebody else is standing on the line calling the plays.” (Both laughing)...And that’s part of the difference in that Future of Family Medicine paper that I’ve got and wish I had with me....\n\nDr. Randall Oates: I’ve got it.\n\n \n\nDr. Sam Taggart: It talks about that same thing, the team approach...the community based approach.....\n\nDr. Randall Oates: I’m not saying anything that dozens haven’t or others have said.\n\n\n\nDr. Sam Taggart: Yeah, the only thing about that is that....like electronic medical records...I thought about when I first started to do this book that I was going to cut off the book in 2000; because it’s hard to write history that is happening right now.  You don’t’ know what’s going to happen.\n\nDr. Randall Oates: Yeah....Right..\n\nDr. Sam Taggart: You don’t know that the outcome is going to be... I said, “No, I’m going to be fearful that I will write something down that people will look at later and laugh”...but these things are so important and in the last 20 years, you’re ....part of your time frame here...has been so important to what’s going to happen.\n\nDr. Randall Oates: I love to think that; yeah...\n\nDr. Sam Taggart: To not write this into this book would just make it...well, that’s all ancient history...but, this is all real history right now...it’s going on and our lives are quickly becoming other people’s history. \n\nDr. Randall Oates: Yeah...\n\nDr. Sam Taggart: Quickly......is there anything else you would like to put into this document?  Remember I can edit and move things around if you want me to, but...\n\nDr. Randall Oates: I could go on and on; there has been so many interesting experiences.  I mean the consulting work that I did and the special projects.....there was a bunch of us family doctors in 2004ish, Alan Winter had an instrumental history program and the guy in Mayo, a physician there...a family doctor...we did these conferences for a while...I started back; well, it was 2004 when we did petting zoos at the national meeting.  I don’t know if you knew about that...\n\nDr. Sam Taggart: No...\n\nDr. Randall Oates: Winter, I, and several of us...we got the academy to gets this big room, filled it with computers, we got vendors to give us software, and we staffed a petting zoo...\n\n(Laughing)...\n\nThe attendees would come in, play with the different software, and we’d be showing them how to use it....You know, back when it was first, the academy was trying to get the folks on it and that was a great....we had a lot of volume.  People would come in and we’d show them this or that software; that was a neat thing that the academy did.  They did that for 2-3 years.  There were other things academy related...but, I really want to get back to talking about what the future...what we can do, what the academy can do...I want to talk about...I really think family medicine has got to....we know where the control in healthcare is; you know, follow the money... and there is going to be huge obstacles, but there is not going to be enough money to care for the population if you run simple math; it’s just not going to work out.  You know, I think the more that the doctors, particularly primary care doctors, can learn how to connect and communicate with the people in the way that they want to be connected and communicated with...they are going to do great. This working for the man and sitting on the hamster wheel cranking through patients is not going to...it’s not sustainable.  I think we are going to see some major collapse of some systems and then, some grass-roots opportunities...if those young family doctors with all those god skills can be ready, I think it will be a glorious day for the community.\n\n       \n\nDr. Sam Taggart: That may be the next generation....it may not be them, but it may be the next....may be 10-15 years down the road.\n\nDr. Randall Oates: Right...right....I really...I said earlier that it really depends on the culture....which way the cultures goes...whether we go towards...if it’s going to be more of a centralized system with control at the top and mandates for this and that and control of the patient/doctor encounter; things are only going to get worse and I think that is a real possibility that that will happen and we’ll have to journey through that.  I would love to have an alternative where those are allowed \n\nto say, “You know, this is my body, my health, we are going to have transparency, and we are going to be on the same level.”  The risk is that the millennials, the people in community-based health, need guidance; they don’t have the medical knowledge and they go into all these extraneous tangents, dead ends, and hoaxes.  They need guidance; we need to be the ones in the community that guides the community.\n\nDr. Sam Taggart: Right...\n\nDr. Randall Oates: That’s what primary care needs to be...whether that’s family medicine, nurse practitioners, pediatricians, or...it’s going to be all of us.  We need to...that’s what we need to be.\n\n    \n\nDr. Sam Taggart: In Cotton Plan, Arkansas... when the nurse practitioner walks in...Cotton Plant is going away...but, when the nurse practitioner walks into the room to see the patient...do you know that the patient calls her?\n\nDr. Randall Oates: Doctor...\n\nDr. Sam Taggart: Doctor..... (Laughing).....that’s right...that’s true and somebody’s got to do it.....\n\nThank you, sir.  I have enjoyed this.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/99090/file/196785#t=0.0,9167.2581"}]}]}]}