{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/b27pn9090k/manifest","type":"Manifest","label":{"en":["Dr. Patrick Harr"]},"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":["2011-11-17 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Sandy Panther (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","family medicine","family physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Patrick Harr, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153021/file/281650","type":"Canvas","label":{"en":["Media File 1 of 2 - Harr_Patrick_11_a.wav"]},"duration":9.05655,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153021/file/281650/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153021/file/281650/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/281/650/original/Harr_Patrick_11_a.wav?1752081752","type":"Audio","format":"audio/wav","duration":9.05655,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153021/file/281650","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153021/file/281650/transcript/81606","type":"AnnotationPage","label":{"en":["Dr. Patrick Harr Interview transcript  [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153021/file/281650/transcript/81606/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"This is an audiotape interview of Dr. Patrick Harr by Sandy Panther. Good afternoon Dr. Harr.\n\nGood afternoon Sandy. \n\nJust to make sure that we are abiding by audiotaping regulations, you are aware that I’m audiotaping and this is satisfactory with you?\n\nYes.\n\nThank you. I would first like to sort of go through your biographical family data and ask you to give your name in full, present title, where you were born, your parents’ names, what did they do for a living. And then go on into your marriage and your children - where you grew up and so forth.\n\nPatrick Brian Harr. And I am currently a physician on staff at St. Francis Hospital and Health Services in the Orthopedic and Sports Medicine Department. St. Francis Hospital, Maryville, Missouri.\n\nWhere were you born?\n\nIn Maryville, Missouri. .\n\nAnd what are your parents’ names and what did they do for a living?\n\nDad’s name is John Lauren Harr. He was a professor at Northwest Missouri State University from 1944 until he retired in mid-80s. He was there about forty years. And my mom, Helen Marie Harr, turned ninety-six today and she still lives independently. And she was a high school teacher before she got married. Then after she got married, she was a stay-at-home mom.\n\nNow could you tell me wife’s name, children’s names?\n\nI’m married to Teri and we share four kids. The oldest is Elizabeth, Laurie. Both those girls were from my first marriage. Nick is my stepson and then Tracy, who you know well, is our child together. So we have his, hers and ours.\n\nDid you have any particular role models when you were young?\n\nProbably the biggest role model outside my parents was my family doctor, Elvin Imes. He didn’t deliver me but he started taking care of me when I was probably two or three years old and he’s the only family physician I really ever remember seeing and was very helpful in helping me get into medical school and pursue my career.\n\nDid you always want to be a physician from the time you were a child or did you have other dreams and goals?\n\nActually my first goal was to be an astronaut. But I couldn’t ride a rollercoaster, so I figured that was out. And then I thought about being an FBI agent but I was too short. Then I thought about a career in pharmacy or something of that field. And to be honest with you, I remember my coming home one day from college and telling my folks that I was going to transfer to the University of Missouri and go to medical school. I don’t know where it came from because it wasn’t anything I thought about really. It was kind of like one of those moments that happen and you can’t explain them, but it just did and it did happen. My folks thought I’d be a teacher and they thought I was nuts. They just looked at me and said why would you want to do that? That’s what I want to do. So I really enjoyed chemistry and biological sciences in my undergrad years. And I knew I wasn’t going to teach history because that’s what my dad taught. He was a PhD in history. And I didn’t want to compete with him. I wanted to go out on my own. And I liked the sciences and talked to my advisor about research and so on. And he said well yeah, you could do that. Then all of a sudden I just had this idea, I think I’ll go to medical school – so I did.\n\nDo you have any stories at all that you would like to share from your childhood?\n\nMost of the things I remember the most are just doing things with my dad. As the oldest, I got to do things first because I was a few years older than my sister and I was nine and eleven years older than my two younger brothers. And by the time they were out and running around, I’d gone off to school at Mizzou and on to med school. So I really wasn’t around much when they were growing up. But I remember my dad and I would always go on fishing trips. Summer vacation, we dropped my sister and my mom off at my grandparent’s house and my dad and I would take off and go fishing. And just about every spring break, every year-end in May and summer vacation we would do fishing trips together, camping and fishing. Which I can still remember some of those trips – you know, sitting in the boat for ten hours and worms not getting a bite. But it was outdoors and away from my sister, so it was worth it.\n\nWhat high school did you go to?\n\nI started school at Horace Mann which is the college lab school in Maryville. I went there from nursery school through my sophomore year in high school At the end of my sophomore year, that school closed and I went to the public high school for my last two years. I graduated then from Maryville High School and went to Northwest Missouri State for two years, undergrad. There were like 1800 students in the university. Now there’s 7,000. But there [then] about 1800 kids. One of my best friends was a pre-dent[istry] student and I was pre-med and we were the only two pre-professional students in the whole student body, so that’s why I decided to go to MU because I thought I needed to mix with more people who had the same idea I did of going into medicine. Then I transferred to MU my junior year of college and my advisor was an organic chemistry professor. When I sat down and met with him, he said your grades are good, why don’t you go to medical school next year? And I said I don’t have a degree. He said they have an advanced standing program. Why don’t you apply? So I went ahead and applied. Went through the application process and had my interview and ended up being accepted. So after one year of undergrad at Mizzou then I went to medical school. So I don’t have an undergraduate degree from college.\n\nInteresting, I don’t either when I went. When I went, it was a combination med school and you became an MD in six years. And then you did your residency?\n\nI did my residency in Rochester, New York. And I remember we had a residency fair at Mizzou in the fall of ’68. And one of the people there was Gene Farley who was at the time the Chair of the department at the University of Rochester. He reminded me a lot of my family doctor and we really hit it off. There were only like nine or ten residencies in the country then, so I applied there. Then I had gone to several hospitals who were known for their rotating internships, like Akron City, Saginaw. Went to St. Paul-Ramsey in Minnesota, in Minneapolis and to Hennepin County looking at their rotating internships because I wasn’t sure I would match in a program that, because I didn’t know how many other people would be looking at family medicine, so I wanted to get the best rotating internship I could find and then head into what tickled my fancy then. My whole plan was to return to my hometown to practice right from the beginning, right from the first day of med school. So I matched with the program in Rochester. And the attending staff that we had there were some of the giants of family medicine education. The Chief was Gene Farley. From Rochester he went out to the University of Wisconsin. Then he was in Denver, University of Colorado. And Don Treat, from a private practice in Vermont, and then Jack Froom who wrote volumes of stuff in family medicine literature in the STFM was there as was Ted Phillips. So the three years I spent in Rochester, my faculty were some of the giants of early family medicine education and it was like walking into a gold mine. And at the time as a resident I didn’t always appreciate that or realize how valuable that was until after I got out in practice and so many things that I was able to do and take care of was directly because of the way these men had practiced in their communities before they went into teaching. And they really prepared me well for coming to a rural practice.    \n\nThose are some of the giants in family medicine. You were very fortunate. Did you go directly into private practice?\n\nNo, I was in Rochester three years. I was their first Chief Resident from the three-year class. I was in their first three-year class. I wasn’t their first Chief but I was their first Chief Resident who spent all three years there. And I went into the Air Force right after residency and I got stationed at Homestead Air Force Base in Florida. And Colonel Ed Turner was the hospital commander then. And, of course, Col. Turner, I think he made every SOC from No. 1 through like forty years. Never missed. So he was a fantastic person to be involved with at a time when I was right out of residency and in the military. It was my first experience at sort of being on your own and doing active practice without someone looking over your shoulder.\n\nWhat made you decide to do that?\n\nIt was right in the middle of the Vietnam War and I had two kids and thought well, I could try to run the gauntlet like some of my buddies and risk being drafted and going into the Army. And I knew if I went into the Army, I’d be a field surgeon in Vietnam and that wasn’t too exciting for me. So I volunteered for the Berry Plan. And by volunteering for the Berry Plan, I was guaranteed that I could finish my residency and then I would give two years’ service back. So I picked the Air Force and ended up in Florida and spent two years with Col. Turner. It was a perfect place to be because the second year I was there we had the largest concentration of residency-trained family docs in the country. We had sixteen family doctors, all residency-trained, and we had sixteen P.A.s who were graduates of the Air Force P.A. program. Their first graduates. And Col. Turner wanted to set up a prototype practice for the military where each person would have their family doctor, corpsman and P.A. and you would see them the entire time you were stationed there instead of bouncing around in a general medicine clinic. And the active duty troops and their dependents love it because usually they’d go to the emergency room or general clinic and see whoever was available. They never saw the same doctor more than once in a row. So we divided up the base, all the different segments like the Motor Pool and Personnel and so on. Each of those groups on base had their own family doctor and they had their own P.A. and their own corpsman. And it was a great way to practice a group family medicine when there were hardly any of us anywhere else in the country because the residency was so young. So we just picked each other’s brains. There were guys that came from Ventura, guys that came from guys that came from Wisconsin, from Miami, from Kentucky, Rochester, New Jersey, Hershey, Pennsylvania, South Carolina. Some of the original nine or ten programs, there were one or two representatives from those programs and we just sat down and picked each other’s brains about how were you trained, how did you learn to do this? And it was unbelievable. I mean they were really two of the most fun years. Even though we were in the military and you had to do things the military way, it was a great transition from residency because I wouldn’t have had that experience anywhere else in the country.\n\nWas the world of family medicine at that time very similar to what it is now?\n\nNo, most of the other doctors on base had no idea of who or what we were, what we could do. I had done more [C-sections] than one of the OB guys on base in my training. And I remember my second year there, we only had one OB guy and he was doing mostly gyn. He was on leave and the family docs were doing 95% of the deliveries on base. And we had a lady whose baby was in distress, so we had to do a stat section. And one of my colleagues called me and said we’ve got to do a stat section, we’ve got fetal distress, we’ve got green amniotic fluid. So I dropped everything and ran down the hall. And one of the assistant hospital commanders was a gastroenterologist. He said where are you going? I said I’m going to the O.R. to do a C-section. He said no, you’re not. I said what do you mean I’m not? He said you’re a family doctor, you can’t do a section. I said well, I can do a section and I’m not going to argue about it, we need to get this done. He said if you do that section I’m going to court martial you. And I thought good lord. So I said well, get one of the surgeons and send him down then. So he found one of the surgeons. The surgeon came into the operating room and he looked at me and he says I hope you know what’s going on here because I’ve never done a C-section. I said well, just stand over here, keep your hands out of the way. So I did the section and three days later we were having a meeting with the hospital commander, because he was gone on temporary duty. He came in and the vice commander was wanting to court martial me for disobeying an order. So once our hospital commander heard what he was doing, he said well, I’m glad Dr. Harr went ahead and did that section because he’s trained to do them. He has done more than anybody in our hospital here and he should have been doing it and you shouldn’t have been interfering. Well, that was the last of that. But that guy and I were not friends, I’ll tell you. We didn’t get along at all. But the last six months that I was in the military, he and I did not see eye-to-eye. But that was okay. But the guys…I delivered twins for one of them and helped them with their forcep deliveries and so on because I had such extensive training in Rochester. The two guys that came from Ventura, they could do appendectomies and gall bladders and stuff like that. So we all kind of had our own little niche that we could help each other out with. And that’s what made it so much fun because you didn’t have to find one of the subspecialists. You just found whichever family doctor had that area of expertise. It was just really a fun way to practice.       \n\nWhat did you do when you finished your two years?\n\nThen I went home to Maryville and for the last thirty-eight years I’ve been practicing here.\n\nBut you have worked not only in private practice; you also have incorporated sports medicine into your practice? Is that correct?\n\nYes. That started on day one.   \n\nAnd what positions did you hold as far as sports medicine? Obviously you were team physician?\n\nI’ve been team physician for our local high school and for our local university since 1974. Last fall I was on the sidelines for my 1,000th football game between the two teams which just indicated to me that I was getting old. That’s a lot of games and it’s just getting old. But in high school I take care of all the boys and girls sports – wrestling, tennis, track, football, soccer, baseball, softball, volleyball. And we have the same sports at the university. And I travel to the away football games for the high school. I go to most of their home basketball games. At the university I do the home games and then I travel with the football team to their away games and travel with the basketball team to their away games.\n\nWhich position in all that you have held did you like the most so far? Meaning military versus private practice.\n\nPrivate practice trumps. I mean it was a great time in the military. But when you come back to your hometown to practice and you’re taking care of people that were your teachers when you were growing up and taking care of parents of kids that you went to school with, so on, to me that’s the epitome of family medicine.\n\nYou mentioned several areas you explored before you actually chose medicine. If you could do it all over again, would you do exactly what you did?\n\nYes, I wouldn’t change a thing.   \n\nBecause you’ve been so involved for so many years, not only professionally but politically, who are some of the people that stand out in your mind as either mentors or people you worked with most closely?\n\nIn the Missouri Academy, two of them would have been Jack Stelmach and Tom Nicholas. They helped shape me politically very early on. I was the first residency-trained family doc on the Missouri Academy Board. So when we went toe-to-toe with different organizations, I often got to be the spokesperson because they felt I represented what we would be in the future. Because none of them were residency-trained, so that kind of gave me an early start into different skirmishes with people who didn’t always believe in the mantra of family medicine. But those two family docs were very instrumental in helping shape my career. And once I started in the mid-80s becoming involved with the national Academy, it was people like Jim Jones and probably Jim Weber were early on very, very influential. And then of course the people that I kind of grew up on the Board with, Doug [Henley] and Neil Brooks and Dale Moquist and David West. People that were on the Board from ’92 and ’95 when I was there were just unbelievable resources. And the thing I miss the most is the camaraderie of being around them on a regular basis. Now we sort of hit and miss at annual meeting. It’s really funny, when I saw and listened to the speeches this year for the President-Elect race and the issues they were talking about, I leaned over and said to Doug and said golly Doug, back when I was running for President-Elect and you were President-Elect and we were talking about funding the research in family medicine, calling for electronic medical records, calling for universal health coverage, calling for increased pay for family physicians, I said really some things seem to never change. \n\n      \n\nYes, you’re right. Well, let’s go back to the Missouri Academy. Did you become politically involved with them?\n\nYes. Actually I started on their Board of Directors in 1978. I was on the Board for nine or ten years and then became Vice President in ’87, President-Elect in ’88 and I was President ’89 to ’90. And then Chairman of the Board, ’90-’91 in the Missouri Academy. And there were a ton of things that I worked on. I represented the [Missouri] Academy on tort reform at state level meetings with the Missouri Medical Association. I was involved with the state medical society at the same time, but most of my energies were really spent with the Missouri Academy.\n\nAnd then did you immediately apply for the national Academy Board?\n\nI started in the mid-80s with the Committee on Aging. Then I was on the Committee on Professional Liability. I was Chair of that committee in ’92 and that’s when I ran for the Board, in 1992. I was a delegate 1988 to 1991, an alternate in ’87. So my political involvement with the national Academy was about ten years behind my state Academy.\n\nOther societies or organizations you’re affiliated with?\n\nWell, the AMA. And I was the delegate to the AMA for the Academy from about ’98 to 2009. And belong to the American College of Sports Medicine, a member of the local medical society, the Northwest Medical Society since ’74. That’s probably about it. One of my sidelines, for ten years I was a member of the advisory board for the Century Council. That’s a Washington think tank group that Rosie [Sweeney] got me set up with. They do programming to help reduce teenage or underage drinking and promote responsible drinking among those of age. I was on their advisory board for ten years, until this past spring. And that was a great opportunity to meet with people. I think they had only one previous physician on their advisory council who was a surgeon. But I was the first family doctor they had had on that advisory board. And it was a great experience working with that group out of D.C. and going to different meetings and meeting with people in the industry. It was a very interesting sideline, I would say. One of my biggest issues as an officer in the Academy was being associated with Tar Wars and actually very graciously with Jeff Cain, I talked to him about allowing the Academy to purchase Tar Wars and bring it into the Academy so we could really expand its programming throughout the country. And Jeff and I had discussions over that and he was very gracious in letting the Academy take that program over. And a lot of the things that we do with Tar Wars and applying to tobacco, I took a lot of those ideas to the Century Council and applying those ideas to alcohol. And a lot of ideas were readily accepted by the Century Council. \n\nWhen you were with the Academy was the environment and culture of our organization markedly different than it is now? Or how have you seen it change over the years, if at all?\n\nYou know, when I think of the time I was very active within the Academy, of course, with Dr. Graham and Mike Miller and Mickey Schaefer who had been the Missouri exec when I went on their Board. Working with Dan Ostergaard. To me it really opened my eyes as to what an organization can be when it’s member-oriented like the Academy is. I couldn’t have been in a better situation and couldn’t have worked with better people. I learned a ton. And I think a lot of my success in practice as a family doc was due to the fact that I was able to rub elbows with so many family docs from around the country and observe how they did things and what worked for them and what didn’t. And how we could come together and work on issues that would help other family docs and battle issues that were definitely divisive to our specialty. I just feel really blessed that I was given that opportunity. It’s just one of those once in a lifetime things and I just happened to be in the right place at the right time. The only thing I see now that maybe is a little bit different is that we’ve downsized a little bit. We’ve become a lot more electronic, so a lot of the information that’s shared is done more on an electronic basis than on an eye-to-eye, voice-to-voice basis. And I think you lose a little with that. But that’s the way things are done now. And I probably would be a little lost in today’s Academy compared to fifteen, twenty years ago.\n\nWhat are some of your fondest memories? And did you have any dark days at all when you were...\n\nDoug and I got the opportunity to be Board Chair twice because Dr. Graham wisely decided that the Past President should be the Board Chair because he had the most experience and our Past Presidents before would change, really sat out there wondering what are you going to do next. So when we went to the Past President becoming Chairman of the Board, that really I think made the Academy stronger. When I was Board Chair the first time, it was under the old rule where you ran for the position and was voted by your peers. And I was Chairman of the Board and Doug was President-Elect and Jim Weber was President. So the Board Chair and the President share a suite at the clusters and meetings. And my fondest memories really are the hours that Jim and I would just sit and talk about things in practice, going fishing. And we had all these ideas about what we were going to do when both of us got done with the time on the Board. He said we’re going to Alaska, we’re going to go fishing and I want you to see this place and so on. Unfortunately, he had his brain tumor and we never got to do any of that. But the things that I remember and cherish the most are the hours that he and I would spend late in the evening after a long day at a cluster just talking about medical politics, how we could get the AMA to change the way they were doing things. How we could make the Academy a stronger voice in the AMA. How we could get family docs more involved with their specialty. How we could get legislators to pay more attention to reimbursement issues and all that sort of thing. We would talk for hours. Jim liked to snack and his wife always told me, if I’m not there, you and Jim are on the road, you’re in charge. I said what do you mean I’m in charge? She said well, don’t let him eat the stuff he shouldn’t. I was like, right. So it would be","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153021/file/281650#t=0.0,660.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153021/file/281650/transcript/81606/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"at night and my phone would ring and Jim would be on there. I can hear his voice to this day say what are you doing? I said I was kind of dozing off. He said well, are you hungry? He said I’m kind of starving. I’d like to get a cheeseburger and fries and a milkshake. Why don’t you come over and we’ll split it? I’d get up, we’d go into the parlor between the two rooms and he’d ordered room service. I said you know, you’re going to get me in trouble doing this. He said well, we just won’t tell. But the times that we shared like that and the times that we had with the other guys, Lanny and Neil who were right behind me were fun as well. But I’ll never forget the conversations I had with Jim Weber. I really miss him.\n\nAs do we all. And now Cynthia also.\n\nNow I would like to just ask a few philosophical questions. What is your sense of where family medicine is going to go in the future?  \n\nI think we’re just at the cusp of getting where we need to be. I think if we can get the groundswell support for Patient-Centered Medical Home, it makes so much sense for the health of the country. It makes so much sense for the health of our family physicians and their practices. I think it represents the direction that we need to go – and we’re almost there. So to me, I see the sun is rising, not setting.\n\nWhat is your opinion of the state of healthcare in America overall?\n\nWell, it’s a mess. There’s too many “-ologists” and not enough family docs. And –ology costs because everybody has their own little pet procedure and pet sort of doing things. And they’re all expensive and there’s too much repetition. If I order a test and then I get a consult, the first thing the consultant does is order the same damn test. It just makes no sense. Ology is good but there’s a time and place for it. And it’s not at the onset of problems. I still think our premise that everybody should have a family doctor is the way this country should go. And I think it’s been well-demonstrated by different groups that have studied it that healthcare costs would go down if we could do that.\n\nI agree with you.\n\nAny view or important issues in the specialty that we have not addressed?\n\nI think we’ve addressed the biggest issues. We still are struggling a little bit about how do we get reimbursement to the point that we can have people come into our specialty without worrying about how are they going to pay for their loan debt, a practice, start their family, buy a house or what. How are they going to get all these things done without so much pressure? Reimbursement is still a problem. I don’t think that privileging is near the problem as it was twenty years ago. I think we’ve made great inroads on getting the message out about family physicians are capable of doing these different procedures. You know, there are some places where it’s still an issue. But overall I think privileging is less of a hassle than it was twenty years ago. I think liability issues are still a problem. Particularly those family docs who still do OB, it costs a lot of money to do that. I know when I was at the peak of my baby delivering and doing C-sections, when I started practice doing everything that I wanted to do, sections and everything, my first couple of years I paid $300 a year for liability insurance. And in the mid-80s I was paying for the same coverage but with claims made, not occurrence, which is not as good. I was paying $100,000. Now where is the sense in that?\n\nThere is none except to discourage you from doing that for which you were trained.  \n\nExactly right. \n\nCan you tell me the best achievement or the biggest satisfaction you’ve had from your experience in working in family medicine?\n\nI’ve delivered about twenty kids who have pursued medical careers, and being able to provide a place for them to shadow and then mentor them through college and med school has been one of the biggest things. Two or three of them have gone into family medicine. Others have gone into other specialties. But even though they weren’t family docs, they knew what family docs could bring to the table because of the way they practiced here. And that gives me a great sense of pride.\n\nWhat do you plan to do after you retire?\n\nI’ll probably practice medicine, I don’t know. I’m getting to the point, this summer in August I turned sixty-seven. I was thinking good lord almighty, three years I’m going to be seventy years old. My god, where in the heck did my life go? It’s like the faster than a speeding bullet as it went by. But I built a home on Table Rock Lake and that’s where I’m going to retire. And I think what I’d like to do is spend one or two days a week still having my hand in some form of medicine. Maybe as a volunteer, still doing family medicine. I’ll do that as long as I’m physically and mentally able, just to keep the brain going. I don’t know, the thought of quitting, that’s not my cup of tea. I don’t want to walk away from it. I have too much fun doing what I’m doing. \n\nAnd I certainly tried and lasted two months.\n\nYou’re involved in quite a few civic organizations and community service organizations. Can you just sort of outline those where you’ve been most active?\n\nEarly on probably the things I’ve been most involved with would have been like being a medical advisor for the county health department. And when my kids were in Scouts, I was a cub master for awhile. Then one of the Boy Scout troop leaders for awhile. And then when your kids kind of migrate out of those, I sort of just went to their next activity. But I’ve held different offices in the church. My main community project really has been taking care of the athletes in the community, doing their physicals, providing a walk-in clinic where they can come without an appointment. Get their injuries evaluated, get back to their coaches with a plan for return to activity and so on. So my public service for most of the last twenty-five years has just been going to the games, helping the parents decrease their worry because they know someone is there who can take care of their kid if they get hurt. I’ve got so many parents whose kids I take care of, who I took care of them when they were in high school. I’m about to hit my third generation now. To me it’s a lot of time. But when the kids were in high school, I probably had more quality time with my kids because they were at these venues and I actually spent more time with them even though being a physician and spending time with your family is sometimes a problem. My kids were doing to games when they were about two years old and they became part of that community. So it was a family affair right from the beginning.\n\n(Side 2)\n\n...our restaurants smoke-free about eight years ago. And about a year ago our businesses became smoke-free. And our campus is smoke-free. And when Tracy went to MU, one of the first things she did was get involved with a group at the City Council and she was very instrumental in getting the bars and restaurants in Columbia smoke-free. And then she took on the University of Missouri. And when she graduated, the Dean came up to her and said “Tracy, I’ve got some news for you.” He said “All your efforts have not been for naught” because the night before, the Board of Trustees had voted to make Mizzou smoke-free. And that was her biggest goal going through college other than graduating, was to get that campus smoke-free. So our family, I’m sure we have targets or we’re on the wall of ---- for all the tobacco companies.\n\nWell, speaking of Tracy, I didn’t realize she had graduated already. My goodness. And I don’t want to negate the other children. But I do want to get on this tape because I had the very great pleasure of traveling with her. But one of the questions that was in there was did you travel a lot? And I’m sure you did. But I specifically would like to ask your impression of Physicians with Heart and remembrances of that trip.\n\nI had a little bit of angst because we were going to a part of the world that was not the most settled and I knew that there was the possibility that there could be some issues that come up while we were there. But watching Tracy interact with the kids her age in the Republic of Georgia was just…when she sat down and was reading Mark Twain to the fifth graders in a couple of the schools. I don’t know how many pencils she hauled in her suitcase because they don’t have pencils, they don’t have paper. Just the very basics that we take for granted. It helped shape her life as a youngster and she took the lessons learned from that trip and got involved with all kinds of things in leadership. She went on a Global Youth Leadership program in Europe for ten days. They took 200 kids from the United States and 200 kids from around the world and put them together for a ten-day conference. And she came back from that ready to bear [?] just about. But you know the people who complain about our medical system need some time to go to a country that has less, like the Republic of Georgia. When you go to a major city hospital, like in Tbilisi, they have one microscope that looked like it was a hundred years old. You go to the central supply and there’s one or two items on a shelf. No pharmacy. You have to bring your drugs from the street pharmacy. It just brings it home how fortunate we are even as screwed up as our medical system is and the issues we have with it, it’s still so much better than many places in the world. We could be a lot better and the money that goes to waste could fund a lot of these countries. I just wish more people had the opportunity to do something like that because it is an eye-opener. Tracy was ten years old when she took that trip. But there are things that we talk about like it happened yesterday. And she was really fortunate to be able to take that trip. In fact, she decided that she wants to make her career in not-for-profit working somewhere in the health field. That’s her goal. So we’ll see where she ends up.\n\n    \n\nI have the great pleasure of going back a second time and seeing all of our translators again and seeing the ministers of health again. So I know how important it is. And to be able to go back to the same country and still see the good results of the initial one, which was you. I, too, have taken my youngest daughter. She went to Moldova with me. And then Dick went back to the Republic of Georgia with me. So at least they now understand my passion.\n\nAre there any last thoughts you would like to add to this? We are toward the end and I thought perhaps you would like to share any future thoughts on future generations?\n\nI look at us as a specialty of opportunity. I don’t regret one minute. I’ve never had the chance to be bored in my practice. I’ve never in almost forty years had two days the same except being busy. I never worry about am I going to have enough patients to see. I worry more about am I going to have enough slots for everybody that needs to be seen, be seen. About seven years ago I went to open access scheduling and my patients love it. And it take a lot of pressure off me because I can come to work in the morning and look at a schedule that’s 90% open. And by","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153021/file/281650#t=660.0,4200.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/153021/file/281650/transcript/81606/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"in the morning, I’m looking at a schedule that’s completely full. So I don’t worry day-to-day about am I going to see enough.\n\nI think the thing that’s kept me energized has been my association with the schools and the athletes. My practice has aged as I have and I have patients every day who come in and have been with me since day one. And they’re all worried I’m going to retire. And I say well, I am going to retire but I’ll leave you in good hands, don’t worry about that. And Teri says I have no doubt that you can retire. But you’re never going to give up the kids. You’ll have to figure out how you’re going to be able to continue that because you’re never going to give that up. And she’s probably right. I don’t like standing the rain. But if it’s raining at the game, I still go.\n\nNo, I don’t like standing in the rain. It’s too cold here. I’m going back home tomorrow. No, actually I’m going to Tom Stern’s memorial tomorrow.\n\nWell, this has been a distinct pleasure for me.  \n\nThank you Sandy. It’s been fun for me too. It brings back memories of some really very special times. And unfortunately there’s only so many spots for family docs to do the things that I’ve done and have the opportunity to rub elbows with some of the brightest and best family docs around the country. And it makes your job so much easier when you…I could go to virtually every major city in the country and stay with somebody that I’ve met during my journey through the Board and be on a first-name basis. And you know, that’s what makes us special, I think, as family docs.\n\nAnd it is very special. In Florida it’s somewhat difficult to find a good one. But I have managed to do so with a husband and wife team who only take eight patients a day. That’s how much time they spend. They obviously do not make any money.  \n\nIf in hindsight you think of other things you would like to add to this, just let Don know and we’ll set up some more time. It is going to be transcribed but not right away. You will get a copy of it. As you listen to it, if you wish to do so, and you think oh, I forgot to do this, just let me know and we will come back for another recording session. You have a great day. And if you see Tracy, you tell her hello for me?  \n\nI sure will.  \n\nAnd have a very happy holiday.  \n\nYou too Sandy. Nice talking to you.   \n\nNice talking to you, too. 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