{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/7p8tb10j6z/manifest","type":"Manifest","label":{"en":["Dr. Ian McWhinney (1991)"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1991-05-23 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Interview"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. John Frey (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","family medicine","family physician","Dr. Ian McWhinney"]}},{"label":{"en":["Subject"]},"value":{"en":["Dr. Ian McWhinney (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278291","type":"Canvas","label":{"en":["Media File 1 of 2 - McWhinney_Ian_1991.05.23_-_Side_2.mp3"]},"duration":1264.784,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278291/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278291/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/278/291/original/McWhinney_Ian_1991.05.23_-_Side_2.mp3?1750857902","type":"Audio","format":"audio/mpeg","duration":1264.784,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278291","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278291/transcript/81395","type":"AnnotationPage","label":{"en":["Dr. Ian McWhinney interview transcript 1 [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278291/transcript/81395/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview by John Frey of Ian McWhinney\n\nMay 22, 1991(Note:--all spellings of proper\n\nChateau Frontenac, Quebecnames should be considered suspect)\n\nQ. - John Frey\n\nA. - Ian McWhinney\n\n_________________________________\n\nQ.  Can you tell me what got you started in general practice and then family medicine?\n\nA.  I went into general practice in 1954, and that was after graduating in '49 and doing some internships and then my military service, and then doing a one-year, just over a year's residency in internal medicine, which wasn't with the intention at that time of becoming an internist, it was – I really hadn’t made up my mind what I was going to do. Then my father was in practice in Stratford-on-Avon, and at the end of that one year I decided to go into general practice, which had always been a major option and you know, the likely thing I would do. And so I started there in practice with my father and his partner as a, the third, the third physician in the practice. And it was a practice my father founded in 1939 and I entered of course without any training for general practice, and--\n\nQ.  Except your father's, as a kind of--\n\nA.  Mentor, yeah, but you know, it was before the days of formal training, so it was really being thrown into the deep end. And I very soon became, I found I very much enjoyed it, you know, right from the beginning. But I very soon became aware of my deficiencies, the mismatch between the experience that I'd had and the experience that I was having in practice. I think the experience that I'd had as a, for example as a resident was very useful for one thing, it was the days before, certainly in the smaller places, before subspecialization. So we really saw, a general medical unit saw every, pretty well everything that came in. So it was a very broad experience, and I had a very good clinical teacher. So they prepared me well in one respect, as a clinician in the classical sense, but for all the other part, general practice, I wasn't well prepared at all and I remember searching for answers and going to postgraduate courses and – I was particularly concerned with how one helps people, you know, with vague problems or keep coming back and that kind of thing, and I used to go on psychiatry postgraduate courses and found they didn't help either. So, and then also I got very interested, right from the beginning in the thinking patterns in general practice and found I was thinking in a different way, and I got interested in kind of introspecting what these differences were and why they were different. It's a long time ago now, so I have to really think about what, trying and track back to those times. I joined the college which was just beginning, the College of General Practitioners, at that time as an associate and then as a full member. That put me in touch with a group of people that, who were having similar thoughts.\n\nQ.  I was just going to say, that support of one sort or the other, the intellectual support to do that work was really necessary.\n\nA.  Yes, yeah. And particularly they were a group in my area, in the Birmingham area, and so we used to--\n\nQ.  Was Pat Byrne(??) part of that?\n\nA.  No, Pat was from the north of England. Well, he was eventually, he went on and became involved more nationally, but it was a local group, of people like Neville Crombie, who's still there, and Robin Pinsent from the Midlands. And quite soon I became interested in the problems of early diagnosis and how one encounters problems long before they actually reach hospital and the problems of early diagnosis, in the early stage of the disease. So I started to keep notes and case notes and I can't remember when I started the idea of putting them in a book, but I remember having a visit from a colleague, he was actually working for a, he was the research adviser for a drug company, and I just mentioned I was doing this, and he said, 'Well, why don't you write a book?' So I said, 'Well, I couldn't write a book.' So he said, 'Who else is going to do it?' So I said, 'Well, why not?' So I, I can't remember when I started doing that, but it must have been within that first five years in practice, I think, and eventually--\n\nQ.  Late '50s, is that right?\n\nA.  It was actually published about 1962, I think, and it was The Early Signs of Illness and published by Pittman. So that was one thing and also I was, had a kind of personal interest in the career of James MacKenzie, and I know that you know the story of James MacKenzie, because my father had come to Stratford from Birtley, where James MacKenzie worked and did all this original work and practice. And of course I was born there and raised there till the age of twelve, and one of my early memories is of my father showing me the place where James MacKenzie practiced. And so I started to read some of James MacKenzie's at that time, in the early years of practice, and was struck by how he encountered the same problems and had the same, very similar thoughts. And I, one day I picked up a copy of his early biography in a second-hand bookstore and I think it was out of print at that time. It was written just the year after he died, and it was a very, it was a popular biography written by one of his – are you familiar with that? It's called The Beloved Physician, by McNair Wilson, and it's, it's really, it's not the sort of academic bio-graphy, it's really written by a friend as a kind of memorial. So it's not really a medical biography, it's more of a popular one. So I had the grandiose idea of writing a biography of MacKenzie myself. So I wrote to the College and asked them, you know, if they would be, would support this idea, and Annis Gillie was the president at that time, and she wrote back and said yeah, they thought it would be an excellent idea and they'd be very supportive. So I, my father was going up to visit Birtley and I asked him to go into the library and see what they had there as a collection. And so he went and they had a collection of MacKenzie's works. And the librarian said to him, 'Did you know somebody else is doing this?' And so they said, yes, there's a man from Dundee called Nair who is doing this. So I wrote to him and asked him if he was, and got a rather curt letter back saying, 'Yes, I'm the official biographer.' So I then dropped the idea, and it's probably a good thing, because I think I, it would have been a very absorbing thing. I don't think I would have written this other book if I had gone ahead and anyway, Nair's biography I think is a good – are you familiar with it?\n\nQ.  I know of it, I don't--\n\nA.  Yeah, and so he was, because of that sort of personal connection, and also we come from very similar backgrounds. I mean my father was a child of the Scottish small farming class and MacKenzie came from exactly the same background, and so then where do we go from there? I think I became more involved with the College, first of all the Midlands, and then more nation-ally, I eventually became a member of the College of Counseling, I'm a member of the Education Committee, and at the same time started thinking about education for general practice and postgraduate training, and met people like John Horter, who's the chairman of the College Postgraduate Education Committee, and George Swift, I don't know whether you've ever met George--\n\nQ.  I know his name.\n\nA.  --who, he really established what was I think the first model postgraduate training program in Britain, was that integrated program in the Winchester area. And this was based on the trainee assistant program, which had been in existence for a long time. It had never been really organized into an educational program. The financing was there, which was a big--\n\nQ.  Well, he was really the conceptual organizer of postgraduate training in general practice, in the sense of creating the first model?\n\nA.  He created the first model in England. Now there have been other models, as you know the – Yugoslavia, you know, was one of the very earliest models. You weren't aware of that?\n\nQ.  No.\n\nA.  Yeah, one of the earliest pioneers was, in the immediate postwar period, was a man whose name I forget in Yugoslavia, which is--\n\nQ.  Actually, this is – a friend of mine for many many years, his name is Ben Dates, and his father was the head of the Community Health Services branch of the Public Health Service, and I remembered when I was a resident, Ben and I were residents together, he talked about how much his father looked at Yugoslavia, and I thought that was just a kind of hobby, but his father was quite interested in the training programs. I'd forgotten that.\n\nA.  I don't remember the man's name, but he was really an early thinker in that field.  \n\nQ.  What got you interested in the educational aspects of things? Do you remember what--\n\nA.  Well, I think one thing was the realization that I'd been so poorly prepared for the experience, and there must be better ways. And also the existence of this training scheme. Right from the very early 1950s, or maybe late 1940s, the government would actually pay – you may be aware of this already – for a trainee to be in a practice for a year. They paid the trainee. But it was a very unorganized system. It was – the trainee applied to go to a practice and was recruited by the practice, and there was no, there were no formal requirements, and it was abused, in fact, because in some practices the trainee was just used as an extra pair of hands. But the basis was there, the financing was there, and so it had the potential for being developed into a much more formal training program, and this is what the College started working on. So I got involved with people like John Horter, and then it became increasingly clear that if one's going to do this, there had to be some kind of definition of what the discipline was, and the common response to that in those days was, well, you can't define general practice. A lot of people say you can't teach general practice. And it was still really thought of as what you did if you didn't specialize, you know it was--\n\nQ.  (??)\n\nA.  --the rest of medicine. And so that's when I started to think about that, and then I applied for and was given a Norfield Traveling Fellowship in the early 1960s, in 1963, so I read an editorial in the Lancet describing the fellowship in family medicine at Harvard, and so I wrote to Bob Haggerty at that time and asked if I could--\n\nQ.  I'm just amazed at how that particular piece of history, that Harvard connection for so many people at that time, which of course Harvard being what it is, that it doesn't have anything to do with family medicine.\n\nA.  Yes, strange, really--\n\nQ.  It's very odd.\n\nA.  And so I got a very nice letter back from him and so I applied for the Norfield Traveling Fellowship to do the Harvard fellowship in family medicine. And he suggested that I don't spend all the six months at Harvard, that I spend six to eight weeks there and then spend the rest of the time visiting other parts of the country that were beginning to think about those educational issues. So we all, the whole family came over and we came over the old-fashioned way, on the boat, brought our car with us and drove the car off, took the car, drove the car away from the quay in New York. And so I suppose I had about six weeks in Boston, and then Bob Haggerty had mapped out a route for us to visit and I, most of the people doing that program (I found) pediatricians but Lynn Carmichael had done it the year before. And I never actually met Lynn during that time, because I didn't, I think he had gone back down to Florida and I didn't get to Florida. Whether there were other family physicians who did it, I don't--\n\nQ.  (??) Gene Farley did that--\n\nA.  Did he do it?\n\nQ.  Yeah, and Nik Zervanos has done that, and there were – I have the list somewhere, but it was really stunning to me, I didn't appreciate how many people had been involved, and considering it was a pediatrician-run--\n\nA.  Yes.\n\nQ.  Called the Family Health Program, it wasn't even called family medicine, it was family health, but I haven't ever – and Charlie Janeway, I was in Massachusetts for a number of years teaching, and I was always interested, and I never did get over to talk to Charles Janeway about it, because he was involved with that program later on, and so I'm most curious why they came up with this idea.\n\nA.  I think it was probably Bob Haggerty's creation.\n\nQ.  Do you have any sense of why he wanted to get this program going?\n\nA.  Oh, I, well I think he had a strong sense of the need for a better preparation for primary medical practice in both pediatrics and in family practice. Now he had left by the time I got there, he'd gone to Rochester, so Joel Alpert had taken over, and they, other people who were doing it while I was there were pediatricians. The places where he suggested that I visit were – of course those were the very early days, and they, they were just kind of thinking about these things. There were no, as far as I recall there were no departments of family medicine, there were--\n\nQ.  The first one was in, I think '68 was Hershey.\n\nA.  Yes, so this was '63, '64. The places I visited were the University of Maryland, which was (??) epidemiology with some general practitioners as members and their teaching program. Then the, George Miller's department of medical education in Chicago, Palo Alto, Stanford, where they had a division--\n\nQ.  Still do.\n\nA.  --of ambulatory medicine. They still do, yes, somebody was telling me that yesterday. And also Philip Lee had developed a clinic that was interesting (??), so I met him at that time. And Larry Schneiderman was a fellow at that time, and he later went down to San Diego. Kansas City was one, was more of a continuing education, they had a big CME program at that time. And then there was the Academy, Kansas City, then Columbus, Ohio, where Tom Rardin, who died a few years ago – did you remember that? – Tom Rardin was a very active local practitioner who was doing teaching but without a formal departmental structure. I'm not sure, I can't remember what his kind of affiliation with the medical school was. And Lexington, Kentucky, where there was the new medical school, new department of community medicine, Kurt Deuschle was the chairman of that and Nick Pisacano was there at that time, and met him. And then Chapel Hill, North Carolina. And I spent, I spent about two weeks in those two places, and visiting the practitioners in--\n\nQ.  Who did you see in Chapel Hill?\n\nA.  Chapel Hill, who I saw most of was Bob Huntley, who--\n\nQ.  He's now retired back to Chapel Hill.\n\nA.  Has he, oh, yeah--\n\nQ.  --town about a year ago.\n\nA.  Do give him my best wishes.\n\nQ.  I will. I didn't know that there was a connection there.\n\nA.  Yeah. And (??) he came and visited us in Stratford and the last time I saw him was in Washington years ago. And there again these were people who were thinking along these lines, but as you know there were, there was nothing formal. It was just, I think just prior to the two major reports, the--\n\nQ.  '66 was the year I think that Millis and--\n\nA.  The Millis Report.\n\nQ.  --and Willard.\n\nA.  The Willard Report, and so all that kind of going on. But I also encountered a good deal of skepticism, because I met a few leaders of academic medicine, you know, deans – and they, there was a good deal of skepticism that general practice had the potential to, it could produce the people, you know, with the necessary academic qualifications or brainpower--\n\nQ.  Lots of things haven't changed unfortunately.\n\nA.  Don't you think so?  \n\nQ.  Well, I'm sure they've modified (??).\n\nA.  Yes, the other person that I met at that time and who I really probably maintained the most contact with was Kerr White, and I met him first out at Berkeley, because he was teaching in the, I think the summer program out there, and then I visited Burlington, Vermont, where he was head of the development of community medicine there, I think, at that time. And 'cause he was one of the people who was giving a lot of thought to that at that time. And I don't know, I went to Canada and visited the College there, though I never – and Toronto – I never actually went to London, Ontario. So then as a result of that experience I wrote a couple of articles in the Lancet.  \n\nQ.  So that was, general practice as an academic discipline was a result of that kind of (??) places and having time to put--\n\nA.  To think about it, yes, and talk to people. And so then anyway we went back into the practice in Stratford and got involved with the College again, and then out of the blue, a few years later, I just got a letter from Weston(??) in London saying they were establishing a chair in family medicine, and – the first one in Canada, and invited an application. So I kind of put it aside and wasn't going to do anything about it, 'cause I really hadn't thought in those terms. And then after a lot of kind of heart-searching and agonizing, decided to have a look at it. And so that was--\n\nQ.  What you saw, you decided that was what you wanted to do?\n\nA.  Well, I was very naïve, really. I don't think anybody would believe how (??) naïve in those days, it just wouldn't happen today. Because I was, I had to submit a curriculum vitae and I wasn't quite sure what a curriculum was, because I never, I'd never really applied for a job before, you know? The internships and residencies that I thought were some, you know, you talked to somebody you knew, you know, you wanted to go and work with them and you talked to them and they said, okay, write me a letter. And then I went into practice with my father, you know, there wasn't a formal process there. And it was a very unique recruitment process, because instead of asking, meeting over there, and my wife to go over there, they sent three people over to England to – and that was Carol Buck, the head of community medicine at Weston, who was, really the, one of the prime movers in getting the new family medicine chair established, which was a major thing, really, for a – an old and conservative medical school. They really had some very advanced thinkers there and a lot of support from the dean. And so she came over with two, with Frank Botson(?) who was in practice in London, who was involved in – and one of the pediatric faculty, and they came to our home and spent a day with us and then a few weeks later there was this phone call from the dean.\n\nQ.  So you hadn't actually seen London?\n\nA.  So I hadn't seen London until, and I asked very few questions. But I did actually visit, but pretty well after it had been, not after it had been all sort of signed, but after kind of decided, and it wasn't really how one should do things, because it was, I'm sometimes horrified by the risk.  \n\nQ.  To some extent that's one of the things that I'm curious about personally, is what, what the kind of conversations were in your family, what was the conversations you were having in your own mind about what might have, as you – maybe retrospectively it looked like a risk, obviously was a risk but one that you were certainly willing to take.\n\nA.  Yeah, well, and the other thing was that we weren't united as a family in the desire to do this. I had sort of had it in the back of my mind at some time that I would like to do this some – you know, 'cause I was thinking of doing it in Britain – at some time to make the move to try and establish general practice in the medical school, that was my thinking at that time. And then this came out of the blue, and my wife really didn't want to go, she was – we were all very happy where we were, really, and my older daughter, who was 10 at that time, unfortunately before we had time to--\n\n[tape side ends]\n\nA.  --and became extremely hostile to the idea. It amazed me that a 10-year-old could be so determinedly, to have such a strong mind about that. And we laugh about it now, but when the visiting team came from Canada to spend the day with us, she plotted all kinds of terrorist activities, like putting prickly holly in their coat pockets, you know, their overcoats. And, you know, my wife agreed for my sake, really, and because she saw that I wanted to do it, and – but it was, and it was a traumatic few years (??) to be sort of uprooted and transplanted.  \n\nQ.  But your feeling was, at that point, despite all of the obvious objections or at least the strong feelings of your family that said you ought to stay, that there was something that made this decision clear to you.\n\nA.  Well, I was 40, which seemed to me at the time to be a time when, if I didn't dare take that opportunity, maybe it wouldn't recur. And I was wrong, I think there would have been plenty of opportunities probably. But that's the way I saw it at the time. I felt I was ready to do it, although I had also the self-doubts, you know, about whether I really was up to it, you know, whether I really could handle it once I got into the position. And so I just felt that it was, this was the time, if I was going to do it, this was the time to do it. And I'd also, I thought it was ambitious, and I'm not sure that was a good motive for me.\n\nQ.  Ambition shows up in a variety of ways. I'm more struck by some people who were explicitly ambitious. Other people were more quietly ambitious.\n\nA.  The other traumatic part was that although my father put, you know, the best face on it as he possibly could, I think it was a very big blow to him, and it only, I think gradually dawned on me over the years what it meant to him. And he was, 'cause he only died two years ago at the age of 90, and he was 70, about 70 when I moved, so a person would normally be retiring at that time, but I learned in the course of years that the practice to him was of tremendous importance in his life, and the, his association with the practice and having his name there on the brass plate on the front was – actually it isn't a brass plate now, but the shingle – was of tremendous significance to him. And I think the idea that my name would still be there (??) was also of much greater significance than I realized. And my mother at the time was just in the early stages of Alzheimer's disease, and within a few years she died, it was rather rapid and aggressive, so he was left a widower. And the, it became very, it was very difficult for him to retire, to relinquish his connection with the practice. And he developed a good deal of bitterness about that which was painful, really. I'm not sure whether it could have been avoided if I'd stayed or not, but you know, it's one of the things that one doesn't foresee. You know, it's one of the, probably one of the hazards of father and son working together in any kind of pursuit or business or profession.\n\nQ.  It just occurs to me that if one of his concerns about his legacy, which I think is one thing that happens as people get older, is that his own work be acknowledged in some way, and that your presence in that practice was one way of acknowledging it, and perhaps he didn't see, or was unable to see how, what you've done in your work and your influencing whole generations of family doctors has extended his teaching far beyond what it would be--\n\nA.  Well, I think he did, yeah, I think he did see that, but I don't, I'm not sure that that helped. I don't think that completely took the place of – and he might have had some of the same difficulties even if I'd stayed in England, 'cause I just didn't realize what a powerful thing it was in his life, that – and I think it, I also came to realize much later how I think a lot of it going back to his own childhood, I've become more and more convinced that early childhood has a tremendous influence. And I think he had a strong feeling of rejection by his own father and I didn't understand that till much, much later. And he spoke often very bitterly about that, he was, his father was actually one removed from the family farm, he was a steelworker in an industrial town in Scotland, and he, all – a strong believer in education and all of his sons, his five sons were encouraged to continue their education, and four out of five went to university. They all had the choice of going to Glasgow University and under the Scottish system, it's very much open to all income, you know, your financial situation wasn't a major problem, it was easy for people – not easy, but it was possible. And, but my father I think was unfortunate in encountering a very destructive teacher or head teacher, and he told his father that there was no point in him staying on at school, that the only thing he could see before his eyes was a football. And so he left school at 14, which was the school legal(?) age, and I think what saved him really was that his mother's brother, his uncle, who was interested in him, encour-aged him to go back to school. So he entered school again in one of the Glasgow high schools and then he went on and entered the medical school at a very early age. Then he, the First World War came, so he broke his education then and went into the Royal Artillery and became a junior officer in the artillery and did his war service. And because he was fairly late getting in he didn't get out until 1919, then he went back to medical school and gradu-ated and he, 'cause he was very poor, had no money, so he didn't – in those days you could go straight into practice, didn't have to do an internship. So he didn't do an internship and he came down – it was also in those poor postwar years very difficult to (make) a practice, so he came down to this industrial town in Lancashire and became an assistant. And it was really a hard life in those days, particularly in the industrial north.\n\nQ.  I've read the Collings Report.\n\nA.  Yes, yes.\n\nQ.  That was when I went over to work with Julian, I mean the first thing he said was, 'Read this.' And it was a stunning document to look at, what the conditions were.\n\nA.  And it was really – young physicians were very exploited. He worked till about 9:00 every night and on call every night and Sundays, office hours on Sundays, Saturdays and Sundays. Even when I started in practice in Stratford, there was a Saturday evening office hours I used to do. And not only Saturday afternoon but Saturday evening. And so, and this wasn't (??) exploitation, it was just what the expectations were, you know, we – even up to the time I came to Canada we always had office hours Saturday mornings. It was just what one expected to do. It didn't seem unusual.  \n\nQ.  So despite all that you still chose to do (??) your father (??). It's interesting.\n\nA.  Yeah, now I – but I should say that I did, before I go through a period of restlessness and, you know I did think of one time of leaving practice and doing internal medicine, and I developed quite an association with one of the physicians from the Birmingham Medical School, because we were only 20 miles from there in Stratford, and I used to get him out as a consul-tant on some of my patients, and he used to say, you know, why don't you come and finish your residency and by the time you're 40 you'll be a consultant. So I must say I had thought of that and turned it down, but I, and I think, (??) think about what my thoughts were at that time but I think it's a measure of how much I've changed over the years, and that I, first of all I'm very glad that I didn't do it, and I think when I, when I – in my early years in prac-tice I saw myself as an internist in a way, with that thing added on, you know, and I didn't have a concept of what it means to be a family physician, but I do now, you know.\n\nQ.  The \"Family Medicine in Perspective\" was an absolutely important article for people of my generation who were searching for some sense of what our intellectual and philosophical roots were, and we (??) in some way that we weren't getting from a lot of teachers who were more oriented towards, you know, practical work, which is – where did, at some point between the time when you thought when you were an internist with a few other things added to that, at least for me that article was such a seminal work that – how did you get clear about what the family doctor was?\n\nA.  It's difficult to remember how it happened. I think, when I look back at some of the things I've written over the years to try and recapture that process, the seeds were there and I'm not sure, I'm not sure where it came from except probably just reflecting on the experience. That article was written fairly, quite a long time ago, wasn't it?  \n\nQ.  '75.\n\nA.  Well, that's, that would be another ten years of experience and reflection. So I think the seeds were there, but I think it took some time for me to become consciously aware of them. The other thing was that I, you know the people that I talked to and worked with helped a lot in developing those ideas. First of all, the College people in Britain and then the people in the department of Weston, and that's been an ongoing process of, and been very important I think for me to have, to always have people that I can discuss these things with. And I was just talking to somebody yesterday after the (??) who was talking about the loneliness that he felt where he was, and I was thinking that perhaps I'd never had that problem, which you know, I've been fortunate in--\n\nQ.  It's a real gift.\n\nA.  Yeah, and always having some people who I could talk to and get stimulus from. And I think you know in those early days, although I think I was effective clinically, and I think it, you know reading that first book it's very, it's not as I would have written it now, you know, it's very much clinically oriented and disease-oriented, and I – in other ways I was, I think perhaps I was even better prepared in that sense than some residents are now, because in those days you'd get a tremendous clinical experience in a general medical residency, 'cause you just saw so much. But in other ways I was much less well-prepared. You know, I think I was very naïve in my understanding of for example family interactions, and I think as a result of working with people who were, had more insights than I had, I kind of learned a lot over the years.\n\nQ.  Who would you say in your own mind had been important teachers for you?\n\nA.  Starting, well starting right at the beginning, the clinical teacher I had in my residency, Steve Whitaker, who was a really first-class clinician, internist, although he had all the limitations, you know, that I mentioned, that he really was a model for me as a very great clinician. And my father I think taught me a lot about, difficult to pin down, really, the, how to run a practice is, well was one thing, and the importance of some basic principles of, about service, of actually providing service, you know, being available and of making people better. You know, he was a kind of old-fashioned physician in many ways, very authoritarian and he would almost force people to get better sometimes, 'Throw away that walking stick, you don't need it any more!'  \n\nQ.  The Lourdes approach to that.\n\nA.  Yeah, and then there were people in the, in the College, people like John Horter and Donald Crombie, George Swift, and those early days. And there were some of our, my neighboring practitioners in Stratford at that time. We had a really interesting group, we used to meet every two weeks and discuss issues in general practice. And then since coming here, I, well I think I can think of two groups of people, one group is the people I've worked with, and it's (??) mention (??) because one must be very careful not to leave anybody out, but you have people who I've worked with for a long time, we've been together for about 20, 20 years or so, you have people like Wayne Weston, Mike Brennan, Martin Bass, Mo Stewart, Brian Henry. It's been a kind of fermenta-tion process, you know. Then there have been the people whose writings I've found have influenced me a lot, and people that I've met periodically but have been into the writings and certainly Gayle Stephens and Lynn Carmichael are two who very much influenced my thinking. There must be many more, (Mary Gleason??) some more.\n\nQ.  I guess what impresses me about your work over the years is how you continue to bring in things you read, people you read and try to connect them in some way to what we do, which is an important function for any field of intellectual thought, is that you have to continue to strive to understand. And I guess that's what is important for me to try to understand from your work, is how it appears that you are continuing to constantly strive to, for meaning, some understanding of not just what we do but why do what we do and how that connects with things. Where does that come from?\n\nA.  I'm not sure. I think it probably comes from way back, because I think I was, I was very precocious as an adolescent and I think probably very obnoxious. I remember even at school I was reading a tremendous lot and very, it was during the war, and very actively interested in social change and the, there was a big ferment of ideas in Britain at that time, and what things were going to be like after the war, and the Beveridge Report which laid the foundation of the welfare state, thinking about National Health Service and all that kind of – so even in my teens I got very interested in that. I read the books from the Peckham Experiment when I was at school, and I remember going up for my interview at Cambridge and Dr. Spooner, who was there to be my tutor there, I saw The Peckham Experiment lying on his coffee table. He was a bacteriologist and I don't know why it was there, but I know he thought very much of it.\n\nQ.  (??)\n\nA.  And so I said, 'I see you've got The Peckham Experiment.' He didn't show a lot of interest. And I was reading very widely at that time and I remember him telling me one day that what I needed was intellectual discip-line. I think he was probably right, he was thinking – I was just going off in all directions and I think he was probably right at that time. But I was very unclear as to what – I had no sort of very definite career intentions, and as a student I was interested in medical education, for example, but – and didn't sort of have a clear idea that I was going to go into general practice or become interested in that as an academic field. I just sort of, I think was interested in ideas from the work and in educational of, from those early days. I suppose that's where it started. And of course I've changed over the years, I think I've become much more aware as I've got older of the healing role of medicine as contrasted with the more technical aspects.\n\nQ.  I think the drama of those contacts(??) has been greater and greater over the last 20 years, it seems to me, that feeling is becoming something that is more and more correlated with technology. I think your sense that the commitment to person over commitment to technology is something which very, for me to feel--\n\nA.  Don't you think there's a growing awareness of the importance of feelings?\n\nQ.  I think among, for people who are searching and finding that the technology is not being satisfied, it's like having a very expensive dinner and realizing that you probably are saying that it was a good dinner more because of the price than really what it tasted like, so--\n\n[tape ends]\n\nQ.  So you said you were becoming more aware of the importance of healing.\n\nA.  Yeah, and it's, I think it's a kind of personal change and I was reading something that Cardinal Lumen(??) said about his, change that occurred in him, and saying that it wasn't an intellectual thing, you know, that when you change you can't say where your change is, it's sort of a maturing pro-cess. So I think it's not just a change in thinking, it's a change, it's a change in thinking but it's also associated with a personal change, and I suppose part of it is getting older. And part of it is experiencing illness oneself and I think it's a great teacher.  \n\nQ.  Ought to be on the list there somewhere. I think that's the one, I mean it makes sense, the question that if I had any question that I wanted to ask in the course of our discussion was really to get a sense of what change has been in your life, I mean you've made some very clear, you made a geo-graphic change of some substance, but what types of changes have gone on as you consider what you do, the work we do and how that change, where that change comes from, as you say it may come from a, someplace that we're not quite aware of, and it may come from a very concrete experience.\n\nA.  Yeah, I think, it certainly hasn't been some big external changes, you know, that's been our one big move, and we've really stayed there and it's, and although it was traumatic at the time and risky I suppose, it all turned out well. I think, I think probably the, perhaps the major thing, maybe the major triggers have been the experiences of illnesses myself, which again have not been terribly traumatic but they have been – well, perhaps I shouldn't say that because they, there have been times when they have been, but they've been tremendous, you know, I think it's a very familiar experience that an illness or you know a traumatic experience, particularly in middle life can pull one up sharply and say, you know, lead one to reflect and also to look at oneself very critically. And I think I didn't have that kind of experience in my 50s. And I haven't really talked about this very much, but in a way it was a conversion experience also. I went, after being – I suppose one can call an agnostic for many years, although having a conventional religious education, I had a kind of – not a sudden conversion, not a charismatic con-version, because that's not sort of my personality, but a, certainly a religious type of conversion and I became sort of much more, well I think I wouldn't describe myself as perhaps more conventionally understood term religious, although I belong to a church, but I have a much greater feeling for the religious aspect, the spiritual aspect of my life.  Now this is a very large part of my life now, and therefore covers my approach to medicine. And--\n\nQ.  How has that? I mean I'm curious about that because a number of people I've talked to, you know, as I – there really seems to be very much of a spiritual or pastoral or whatever term you want to use side towards one's work and somehow making that connection's been very important for a lot of people. And I don't understand it as much as I'd like to but it's clear that there's some type of spiritual element to what we do, in our particular type of work.\n\nA.  Well to me now, there's – seems the greatest task is to somehow reconnect medicine with its spiritual roots, and this, I think this is going to be very difficult to do, because I think I, when one talks in this way I think people will very often misunderstand, you know. And yet wherever I go and do try to express it, that I always find that there's somebody there who comes up afterwards and says, you know, they – that is their own feeling and their own, you know, where they've come to as well. So it really impresses me that wherever, almost anywhere in the world, not that I've been many places, but wherever I've tried to express it, there's always somebody there who's at the same, who seems to be at the same point. So I do feel that this is a sort of a groundswell kind of, something that's probably grown. But I think it's so easy to be misunderstood, you know, and I think in, I'm guilty sometimes of maybe overstating it or – in the last five years I've been working palliative care, you know, when I stepped down from the chairmanship I started working in palliative care, and this has also been a big learning experience for me, and I realize how much we have to learn from some of our sister professions, you know, like nursing. And I, one of the things I've thought a lot about it is, for example, the importance of touching in healing, and the trouble is when you start talking about this some people will misinterpret what is said, and I said something about this at the family conference on family systems theory in Calgary, did you know – were you aware of that?\n\nQ.  No.\n\nA.  And I think I was guilty of overstating it, and somebody said, you know, that it really, one of the people there said you know, he was really concerned about this, that--\n\nQ.  Jeopardize our scientific base.\n\nA.  Well, he was worried about, you know, the problem is that our ability to talk about this is emerging at the same time as (??) concern, in other words the same in the States but in Ontario, the College is just becoming aware of the fact that there is a problem or there has been, of course, a problem with sexual assault by physicians. And the trouble is that the two things get, although they're, I mean they're worlds apart, obviously, what he's talking about, but the people get frightened by the idea. So I think one has to be cautious in introducing thoughts like that.\n\nQ.  I understand what the real danger is that, you know to me that the, it's like the classic doctor shot in photographs is the physician, and I'm looking at it very carefully, because the physician is holding the stethoscope on the chest of the patient. In the old pictures there would always be much more physical proximity of, I mean there may be another hand on the shoulder, and clearly physically more intimate. And yet nowadays, I mean I have medical students who are, because of AIDS and of course that becomes a metaphor for all sorts of issues of touching, is that the contagion theory, which is as old as medicine, I suspect, is now threatening to overwhelm us that there's kind of evil vapors everywhere, and that our willingness to physically embrace or somehow console, to me consolation is not something that comes with words but it also comes with, which is the permission that we have that priests and pastors and ministers don't have really. We can touch people. We have a license to do that and if we don't do that, then what we're doing is denying our patients in one way or the other, what it is that (??).\n\nA.  And this, well, you mentioned AIDS and that's where it really becomes so supremely important in the AIDS patients that we have in our unit, you know, it strikes me what a tremendously important thing it is symbolically that they, that the, they are touched, that there are nurses doing their dressings and that nobody who comes in to see them hesitates to touch them, normally, shake their hand or whatever is required. And that is of tremend-ously symbolic significance.\n\nQ.  And dying patients have always been the ones that aren't touched, I mean ironically is that with physicians particularly, the distance between people on rounds and a patient who's dying increases the closer the patient gets to it.\n\nA.  You've noted that, have you? Yeah, that's interesting. 'Cause one of the things that struck me was how good the nurses are at this and how just on occasions they will sense that somebody needs that physical closeness and there's nobody else there to provide it. And I think this is what shocked the physician in Calgary, you know, that they, you know, that that would be some-thing that people would do. And also related to that I think I've become much more aware of the importance of symbolism, of the symbolic dimension of so many of the things that we do. One thing I'm interested in now is, you know, the home, seeing people at home. It seems to me that going to see somebody at home is a symbolic act and in a way a renunciation of power.  \n\nQ.  It's a kind of leveler, it levels we and the patients. I mean we're in their home, not our office.\n\nA.  Yes, right.  \n\nQ.  As you – again, from this perspective, think back on what you thought family medicine was all about, both your interest in teaching and you said very early on you had an interest in education and clearly you've had an interest in trying to understand the deeper dimension to what we do. As you reflect on all of that over these years, what thoughts do you have about how close we've gotten to what we thought we were going to do and what remains to be done?\n\nA.  Well, I'm impressed with how close we have become, although I doubt whether there is a big majority movement. I think what impresses me is that as I mentioned before, wherever I go there are people that I can talk to and who understand what, you know, like ourselves. You know what it's like when you mention some of these things, and you obviously are not communicate – you know, the person really doesn't have, know what you're talking about. But I'm impressed with how many people there are who have got to the same point. Now I think it's probably a minority, but I'm not sure that that matters, you know, because things always start, I think movements always start in a small way like that, and I sense that it's not only in medicine but I think it's a part of a bigger change in society as a whole. What do you think?\n\nQ.  Well, I – there are days when I think what's sustained me in the last period of my life has been talking to these practitioners who are doing what it is that I thought about and read about and extensively talked to, young people, and they're doing it. They're doing it, enjoying it, and it's satisfying and stimulating and it's, and words like service and responsibility and endurance and all of those things come out very easily from what they talk about and so for me to hear that is somehow, in the times where in the academic worlds you've, you know the short term is so, it even dominates our own disappointment(?) – will I get this published, will I get this promotion, will be able to do this class, will I be able to change this curriculum. And all those, they're all important issues, but this ability to step back and look at something over a kind of grand period of time is really difficult to do when you're in, at least in our academic worlds, and so for me to go out and to, you know, to eat lunch with somebody at a local luncheonette and talk about their lives has been the most reinforcing and – it’s kept me on track in some ways. So I think that, the larger change in society, I mean I think it has to come and I'm not sure in to what way it's going to. And I have great hopes for the future. There's a lot of people – as one of my friends said, he has great hopes for the past. You say well, you have to have great hopes for the future. I'm not pessimistic, but I think it's, at least in the States – what you've got in Canada which we don't have, and it's very clear, it's clearer and clearer now that the differences between the countries is that we have no system in which to work, and you – all your life, whether it's in England or in Canada, have had a chance to work in a system where your role is clear. It seems to me what I envy is that you are able to reflect on things which are much deeper in what's going on than what we are in the States, which is, we are so much involved with a kind of mechanical, how we – how do we make this practice financially viable, how do we – we’re busy with all of the stuff, and we're not able to learn the central issues quite as well. So the people who are most insulated from that Sturm und Drang, you know, what's going on in the States right now are the people who are in small towns who have been doing it for all these years. Those are the people who have become my teachers. So I have hopes as long as there's a way of connecting them with what it is that we're going. When that connection is not there, I don't know.\n\nA.  Well, things will change, I'm sure.\n\nQ.  I'm really confident in that. I think they – they won't change easily, but they'll change.\n\nA.  I have to go now, I'm sorry.\n\n[interview ends]","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278291#t=0.0,1264.784"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278292","type":"Canvas","label":{"en":["Media File 2 of 2 - McWhinney_Ian_1991.05.23_-_Side_1.mp3"]},"duration":3897.44,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278292/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278292/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/278/292/original/McWhinney_Ian_1991.05.23_-_Side_1.mp3?1750857904","type":"Audio","format":"audio/mpeg","duration":3897.44,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150908/file/278292","metadata":[]}]}],"annotations":[]}]}