{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/cr5n874t0f/manifest","type":"Manifest","label":{"en":["Dr. Paul Brucker"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1991-05-08 (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","Dr. Paul Brucker","family medicine","family physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Dr. Paul Brucker (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/150633/file/277808","type":"Canvas","label":{"en":["Media File 1 of 2 - Brucker_Paul_1991.05.08_-_Side_1.mp3"]},"duration":1931.08288,"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/150633/file/277808/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150633/file/277808/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/277/808/original/Brucker_Paul_1991.05.08_-_Side_1.mp3?1750274061","type":"Audio","format":"audio/mpeg","duration":1931.08288,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150633/file/277808","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150633/file/277808/transcript/81250","type":"AnnotationPage","label":{"en":["Dr. Paul Brucker interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150633/file/277808/transcript/81250/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1: If you could, Paul, think about those times when you first got involved with the idea of family medicine. If you would reflect for a minute about what got you going in this whole idea of family medicine.\n\nWell, I guess, I went to medical school, back in 1957, when I graduated from Penn, was very subspecialty-oriented. And they wanted me to stay there and take a residency in internal medicine. I was terribly upset and I told them that was not where I wanted to go. And I looked around at that time and there really were very few, if any, training programs. And I had spent some time with Ed Pellegrino at the Hunterdon as a medical student. So we were required to take a rotating internship and it subsequently disappeared. And the rotating internship was very much akin, I think, to some of our first years in family practice. And I think when they did away with that as a requirement, it was sort of optional. Although in this state, Pennsylvania was still mandatory, an awful lot of value was lost in training right there. There were literally students who took part 3 of national boards with me who never saw a delivery, who were graduates from some of the New York medical schools. Never saw a baby delivered and they were going into medicine. So I thought, my gosh, where is medicine going? So I took a rotating internship and then I went back and worked with Dr. Pellegrino. And they a, quote, general practice residency. That was in 1959, 1960. And that was a very unique setup at Hunterdon, which subsequently, I think, mainly because of physician greed folded. And the setup was that the specialists were in-hospital doctors used as consultants and were not allowed to practice as private individuals in the community. That the community physicians were family physicians. And Dr. Pellegrino set up the unique referral structure and process that family physicians could admit from their service and take care of the patient exclusively. They could admit and ask for consultation or they could refer the patient. Every patient was rounded on by this band of in-hospital consultants who were teachers at NYU. Then the other thing that he did was got the hospital involved in a lot of community education which was primarily led and sponsored by the family physicians. And he also insisted that they continue with their education. And I thought this was a wonderful model. These physicians were tightly-knit, were very well-paid in the hospital. And the family physicians loved the setup. And they were even talking about, this was in 1960, developing managed care in Hunterdon County. So they were way ahead of their times. But what happened is some of the specialists thought they were not earning a comparable salary to their other friends elsewhere and they decided they were going to go practice in the community – and that place really blew up. And there have been lots of articles about that. It’s kind of a lot revisited but so forth and so on. And a couple of the people, the old guard in there got divorced, died, everything else with all the stress. It was a nasty situation. But Ed Pellegrino was certainly a wonderful mentor for family practice. A real renaissance person. A generalist. You just couldn’t say enough nice things about him then and now. And he packed up and went to Kentucky to start a school and to be chairman of medicine there. Asked me whether I would consider going at that time – and I didn’t know how serious he was about that and I didn’t really want to move away from this area.\n\nWere you in practice at that point?\n\nNo. And then I came back and I took a year of internal medicine. I felt inadequately trained with two years of training and I took another year. So I had three years of training which was equivalent to nothing at that time because there was no board or things of sort. I just put it together. That’s the way you did things. And then I went into a well-established practice which was almost a hundred years old at that time and was a tradition. And those folks had served as preceptors when I was at Penn and I liked them as a business group. So the preceptor at that time was probably the only role model that a medical student had an opportunity to see what family practice, general practice, was the only opportunity. And the hospitals, at that time, were very traditional clinics, which everybody thought that in the bowels of the earth, they were awful. So ambulatory care, continuity of care…in fact, beyond even was really the scourge of the medical profession. That was about 1957, 1958, 1959. And every history, practically every history in the university hospital would have some derogatory remark about the LMD (?). And at times that annoyed me and other times I think it was deserved because some of the things that they were derogatory about were so blatant that the LMD should be criticized. A lot of the times I thought it was very easy to be smug when you had a big system around you and you were somebody in the -- trying to figure out what was going. And, here again, I thought that everybody should know that when you don’t have fancy equipment and laboratory, it’s sort of nice to see what kinds of decisions you’re forced to make in the ambulatory setting – and how to do that. So after I got through with all this, I was sure that I did not want to focus on an organ. I wanted to be involved with families and people and became very aware then and even more convinced now that you cannot take care of people unless you know where they live, how they live, what they do, who are their support systems. And I’m still amazed, when I go through the hospital, that frequently we have no idea what any of the folks do. I mean you can walk through … You know, carpenter – what does that mean? Do they build clocks? Do they carry joints all day? What does it mean? Nobody really cares that much. And I think that that ignorance and not knowing that is one of the big faults of medicine. And the other fault that I thought then and still think is even greater now is that we accepted things in black and white so quickly. An x-ray report, a laboratory result. Anything that was printed we never questioned. I thought we should question a lot of it, but we never questioned it. And I just saw physicians relying less on their senses. History wasn’t very important. Physical exam, no one wanted to teach it because we were so word-related. And I just sort of thought that the whole idea that the physician could use his senses to both diagnose and also to treat. I thought words were probably more therapeutic or more harmful than prescriptions and frequently would tell people, students that I used to have in my office, that what you say is much more important than the prescription drug. And I’ve just seen people wiped out --, seeing patients. So I just got more and more involved that we weren’t training the right kind of person. That the system was directing people the wrong way. \n\nAt that point, you were swimming very hard up the system?\n\nOh, yeah.\n\nWhat was it in you? What was it in your own life and your own experience that made you willing to take that on?\n\nWell, certainly a stimulus to my thinking I was on the right track was I had a son who had major illnesses. I had a son who had a respiratory arrest, maybe a cardiac arrest at eleven months of age, secondary to renal disease, which was not picked up, due to congenital (?) posterior valves. And resuscitated him and took him to the hospital at eleven months of age and was treated as a very anxious, hysterical parent, which I’m sure was. But was told that he had a seizure. And I said, no, I’m sure he didn’t have a seizure and insisted that somebody stay with him while I went home and got cleaned up. And they thought I was hysterical. One of the critical care nurses who was really a friend said, oh, I’ll stay with him. And the same thing happened again. Of course, when that happened he was on an anesthesia machine to breathe for him a little bit. Then the story was not a seizure. And we obviously needed a lot of specialty help at that time. And I was sort of amazed, even more so, how the system worked. One person told us to take my son home and let him die. Another one said that was crazy. And all this was done pre-matter-of-fact, without knowing me, knowing what I wanted. Without talking to me or my wife and things of sort. And finally we took him to New York City to a very good institution and really got even more fragmented. We spent nine or ten months there, I forget, and had lots of surgical procedures and lots of tragedies. So we really appreciated how the system worked. He’s had three transplants since then, from his sister, who had lasted about eight months (?). He’s had five -- surgery after cardiac arrest secondary to MRI. So I’ve sort of been on both sides of the system for … He’s twenty-seven now. And that even went ahead and put more fuel in the fire that I thought we were training the wrong kind of person. And not that these people were bad physicians, but there was a big missing link that somebody would worry about the patient and their family and steer them through this. And the other thing that became apparent to me then, and is even more apparent to me now, that the diagnostician in medicine is disappearing. And I thought that the person who put you on the right track is probably the most important person. And I remember back in the sixties, writing that the most important person in the hospital was the emergency room physician, yet we put the intern in that spot. So I really got revved up about this. I just thought that there was a terribly big missing piece in medicine and that maybe family medicine could fill that slot. \n\nAt that point family medicine still hadn’t become anything as important as …\n\nOh, absolutely. Not until 1969. That’s when the first board exam was given. There were all sorts of rules then about who was eligible for the board. Basically it was almost anybody who did any kind of family practice could qualify – either from training or teaching or hours here or what-have-you. And the first exam I remember taking here in Philadelphia, I think was in 1969, it was an awful exam. And I think everybody would say that construction-wise and everything else. But at least it was an attempt. And movies (?) that were weird, neurological things that nobody could understand. The production was terrible. But it was an exam and we were off. And for the first one, it was probably a very good one. And I was amazed that subsequently how each exam became much better and how sophisticated they are and relevant things of this sort. The other thing is, when I was in practice I used to have students from Penn in my office almost year in and year out. In fact, some of them lived in my house. And I really liked teaching a lot. And I also was very empathetic with these students because they didn’t know what they were missing and they got so turned on when they saw what it was all about. So I really thought isn’t this a shame that this doesn’t exist in a lot of areas because I think there were further fields and people wanted this and certainly medicine needed it. So in 1972, I guess it was, my good friend here, Joe Ella (?), who I had written some papers with and had done some work with about education and continuing development of the physician, convinced me to come down here for an interview. And I said, no, I said I’ll come down for an experience but I’m certainly not interested in changing what I’m doing. And it was an experience. I still remember, somehow logistics got messed up and no one ever called me. The search committee was here but no one told me that they were meeting until the night before. They remembered that they forgot to tell me. And I came. And the school had done a lot of work. I liked the idea and still like the idea that the school did a lot of self-analysis as to whether this was right or wrong. And the state didn’t say we’ll give you $2 million and they didn’t force us to do it and I wasn’t an uninvited guest. I was an invited guest. And I came down and had a wonderful time. Really great folks at that time. And decided this wasn’t for me. And one thing led to another and after six months they kept going. And the more I thought about it, I thought I should put up or shut up because they kept talking about this deficiency in the system. Not that the rest of the system was bad, but something was missing. So I came here in ’73. We had two or three students, I think, out of about 200 plus, at that time, doing the family practice. And it was pretty apparent to me that this was a good decision. I’m concerned now about several things in family practice – and this is a sign of my age. I’m concerned that the clinical emphasis is not as great as it used to be. And I think that really is --. I am concerned that we’re accepting a lot of things that are important but not that important that they should occupy too much time. Like sports medicine, human sexuality, ethnics, medical, legal issues. All those things are important but at the expense of hearing a murmur or picking up a -- or what-have-you. So that I still think this clinical emphasis, to be a good diagnostician, a good manager. And, also, to be able to listen and weigh your words. I am so impressed that we don’t internalize anything anymore as physicians. Part of that is --. Another thing, it’s a lot easier not to. You can have a touch of cancer. Oh, you might have a little bit of cancer. Or we’ll rule cancer out. We’ll get a barium enema (?). Well, I never told a patient that, ever. If they ask me, it could be a tumor or it could be diverticulitum or something else. But why schedule a barium enema next week and tell you it could be a little cancer? And I think this kind of a sensitivity about what we say and what it does to people, we ignore. The other thing is, I think that we really don’t appreciate how much patients, how bright they are and how much they can do and how much they understand. And this eternalistic attitude that they have towards --. And the other thing is, I think that maybe some of the procedural emphasis that’s coming to family medicine is going to get us in the same boat as the rest of the things. And I’m just troubled, as I review articles, how many are procedurally enthusiastic. And you almost feel deficient if you don’t have a pipe to put in every orifice. And I don’t think that’s a strength of family medicine at all. I don’t think it’s a strength of medicine at all. And without sounding malicious, I just wonder whether or not the reward system doesn’t dictate a lot of this. And not only the reward system per se for that,    but the deficiencies of the other reward system. And I really do think that had family practice been more successful back in the early sixties, we would not have HMOs and PPOs today because the family physician would be the manager without turning 10% of the patient dollar over to the HMO, which is basically what we do. And we have a lay person manage. And I think that’s unfortunate. But I think, here again, greed and the fact that we were not willing to manage and we don’t teach management has resulted in this. \n\nDid your sense of what was going to happen in ’68, ’69, when things got going … And I’ve talked to people who said that meetings would be a few people in hotel rooms and things like that…\n\nOh, yeah, they were pretty loose, let me tell you. I think the most powerful force in family practice that certainly I’ve ever met was Nick Pisacano. Nick was probably one of my best friends and I got to know him very well inside and out and still feel he is here. He was just an unbelievable presence who damn the torpedoes, full speed ahead and really did not have to have things perfect. He was a gambler. He knew how to gamble and to take risks. I mean his first exam was a gamble. He said, let’s just turn the damn thing out and get it going. And the other is, Nick was a very unselfish person. And if I heard Nick say it once, Nick would say, what’s good for the patient? Why don’t we devise a system that’s good for the patient and not good for the board and not good for the Academy and not good for the Society of Teachers of Family Medicine. Let’s forget ourselves and design a program that’s best for patient care. And as you well know, Nick was very sympathetic about trying to get medicine … In fact, in 1964 he proposed that family practice be a division of internal medicine. And I’ve seen the letter many a time. And I forgot who was chairman of the board at that time, but they came back to Nick saying they absolutely could not consider that. That was in 1964, five years before the Board of Family Practice was formed. Now I think that Nick, that certainly while he was alive, still thought it was best that the two boards should get together and that there were unique things but there was a lot of common training and issues. And he, maybe not as much as I think … I think generalism will disappear from medical schools if general pediatrics, general medicine and family practice don’t get together. And I think if it disappears from medical schools, there aren’t going to be any training programs. If students don’t see a strong force and an appreciation and powerful role models, we’re going to have more gastroenterologists and cardiologists and that sort. So the generalism in society is just disappearing. Which I think we talk about, you know, it’s income and it’s this and that. I think an important variable is that the generalist is disappearing. Certainly when I look at our basic scientists at a molecular level with a tremendous focus of knowing more than anybody else about a certain organ (?), the students really get the wrong impression about where they should go, what direction they should take. I think that it would be nice to have three generalists teach basic science – which would be more than enough basic science for the students in their level. And I think it would be very nice for students to hear professors say I don’t know and teach them how to use information systems. And I think to bring that back into the schools, it tain’t gonna happen. I think that the idea that the generalist is very acceptable and very valuable has to start much earlier. Even in pre-med probably, but certainly in medical school. The same thing is going on in law. It’s just unbelievable.\n\nOne of the things that was proposed to me many, many years ago was an article that Warren Bennis (?), who I’d heard about and had read things he has written, but he was president, I think, at that point, of the University of Cincinnati. It was in the “New York Times” op-ed section. It was called “Pornography of everyday life.” The title caught my eye. And he was writing about being president of a university, walking through the campus in the spring and seeing somebody chopping down a flowering tree. The students were upset and everybody was upset. They said, who told you to do this? And he said, I’m the president, I’ll find out. So he spent the next three days trying to find out who made the decision. And in reality it was the specialization and compartmentalization of everything, so no one had responsibility. I think that’s the other part that tends to come out when you talk to people who got things going, is this sense of real responsibility … With patient care, yeah. In a sense, for society, for the communities, for things that we’re … And that’s a concern of mine these days, frankly, is that the responsibility … And maybe it’s a reflection of what we discussed in terms of the last decade. But the responsibility of physicians for their patients and to their patients is really something … \n\nAnd to their community.\n\nA much larger sense of the …\n\n…A sense of the greed merger era was a reflection of a lot of things. I mean not just in business. Just put anything together and as long as you profited by it, it’s fine. So I don’t know where family practice is going to go. The OB issue I raised in 1981, I almost got killed. (Laughter.) I wrote a paper which I presented to the RRC about this was our program, we -- about this. And it’s not that I’m against family physicians doing OB at all, but I think the amount of training they have to do OB is inadequate. And the other thing is, I think that many family physicians have to decide whether or not obstetrics is going to overwhelm them and if they want to do it right, there isn’t sufficient time. But I don’t think the OBs do it very well either. And I wrote all this in 1981. I think it was ’81 or ’82, when I was appointed to the RRC, and they were so upset with me. It was just unbelievable how angry they were. That night they had a dinner and everyone was introduced by name and -- and things and my name was never mentioned. I really left an impact on the RRC that ironically, in 1991, they were talking about these very issues. And, here again, part of this was a personal reflection because we almost had an obstetrical tragedy in my family. And had somebody not been able to interfere quickly without finding somebody in the hall or something, we probably would not have that child. So I thought what’s good for the goose is good for the gander. And I’m impressed how many family physicians have obstetricians deliver their children rather than family physicians who know how to do a C-section or delivery. And, again, I think it’s a wonderful field. But I think some of the obstetrics where people had just gone into a busy office and just --. OB has to be a lot better than that. And, here again, that’s where the family physician being very involved in prenatal care. And particularly in some of the … I think family physicians handle diabetes better in pregnancy than anything else. I think there’s a role.\n\nI had an experience … I spent eight months as a GP in the National Health Service in a small town. And the hospital was about thirty minutes away. And I think I did better prenatal care in that system because we did all the prenatal care with a midwife who did home visits and instruction. And I think the level of care, the event was less important than all the things around it that were controlled by me. So I felt …\n\nWhich is basically what the country is screaming about, that that’s the most important part of the process.\n\nThat’s right. The event is a … I mean I enjoy that. On the other hand, what I enjoy more is people I know going through that and seeing them afterwards and so on. That kind of before and after …\n\nAnd watching the impact on the family and taking care of the kids. I think there’s nothing … Nothing gave me more joy than talking to a new mom about her children. And I took care of all of these kids that were delivered by OBs and worked with OBs, but I was in the hospital capturing the baby. So I think that issue is a tremendous one.\n\nYou would have enjoyed the conversation yesterday. It was a day long perinatal (?) discussion and it was very animated. It was the first time where I felt that there were honest disagreements and people were trying to seek some direction. It was good.\n\nIt’s always a very emotional discussion. And unfortunately or fortunately a lot of legal issues are settling in very quickly. And certainly with suits in the northeast where OB or -- related are just absolutely --. A suit for $4 million. So that’s a societal issue that’s certainly affecting the direction. But I just wonder whether or not we started off with a bang and we’ve lost a lot of our zip because we’re changing our course. I sort of sense this. And I don’t know if it’s a depressed state or a jaundiced eye or what-have-you. I think to want to live in a community, be available to provide access and to be a support and to be happy and thrilled with little things. To get somebody from the bed to the bathroom without assistance – that’s just tremendous. Or to help a family arrange for the care of the terminally ill without … Hospice is great, but I think there are many other ways to do this too. It doesn’t seem to give folks as much of a kick as it used to. I think the one thing that I’m proud of is the geriatric issue. I was involved in the whole thing. In fact, I signed the paper for the board, that would be the certificate of -- qualifications. And obviously that was a very heated … God, that was a heated, emotional issue. And basically I don’t think there should be a geriatric specialty. I think it’s crazy to think that somebody goes to you for forty years and when they turn sixty-five, they’re going to find a new doctor. Of course, I think the British model is terrible. It doesn’t work. But I also think that there’s probably a lot about the elderly that we don’t know. I also think we’re a very youth-oriented everything, including medicine, and we haven’t paid a lot of attention to some of these things. And I think geriatrics is probably more of a social issue than any of us appreciate and it needs a lot more than a physician. It needs community resources and family education and so forth and so on. I don’t know when, I guess about ’84 or so, there was pretty good evidence that the American Board of Internal Medicine was going to create a geriatrics specialty. Which, by the way, I think a lot of those folks thought was bad for internal medicine. A lot of the general internists thought this was the worst route they could go. I was pretty sure that we needed another subspecialty in anything like a hole in the head. And finally, basically with Nick, we sort of said, look, if you do that, we’re going to do it. And then that makes good sense to have two training programs in every institution that duplicates and subtracts from everything else. And, finally, I remember in some very heated discussions in some meetings in hotel rooms and things of the sort, at the very last minute, probably about twelve hours before the ABMS voted, we agreed that we would combine efforts. I think that there have been hitches, but I think they’ve worked very well. We do not have another subspecialty in geriatrics.\n\nSide 2: The people I’ve been talking to, it’s been an absolutely remarkable experience. I’ve been spending time with people who have been thirty years in the same community, in different places around the country. I have another tape recorder I take with me. And for me, it’s been the most profound experience to talk to people who are doing what it is that you envisioned being a family doctor is. And I always had, in some ways, a sense of that. And I’m not sure how to make that connection. I sit around with students and residents and, you know, I feel like renting buses and taking the students and parking them in communities and say watch what these people do. Because there’s this incredible, centrifugal kind of thinking and vision. And we’re doing it ourselves. And I’m not sure how much of it is schools and how much of it is our lack of experience. I’m in concrete experience with people who are like that. I mean you had an experience at Hunterdon which I’ve always heard about. And Pete Risilow (?) was down there and Frank Snow (?).\n\nPete was a classmate of mine. He was a fellow resident, yeah.\n\nPete still … And I listen to him differently than I ever did before. He talks about what that is all about. He’s wonderful, he still is. And he’s doing geriatrics and he’s doing it in the way that you were talking about doctors doing. That is he goes walking with the old people. And he’s a wonderful clinician. He’s a great teacher. And what he models is a kind of … He’s very good in his clinical, hard science …\n\nPractice has aged with us. And we don’t teach that. But, certainly, I could join the two other physicians … And we had one that was about forty years older than I. And obviously he was very empathetic and understood the elderly folks and some middle-aged ones. And I got all the young moms and all the kids. And that’s when I was having kids and things of sort. And all those people grew up with me. And as I went through various stages, they stayed with me and things of sort. And it’s interesting how your practice does change tremendously. \n\nAre there things as you think about … You talked about your concern for the training system and perhaps even the perspective, the vision or lack thereof of people who are getting into the discipline now. Do you see twenty years from now that things will change in some other direction?\n\nI don’t know John. I wonder if … And this, again, is a sign of my age. I wonder whether or not people are getting involved sufficiently with patients to really enjoy it and do a good job. And that really does concern me. This concept of protected time being sacrosanct. That at 5:00 that’s it. I mean I think it’s important to have time to yourself and things of sort. But I never … I was in group practice and I never thought that a telephone call at night was that overwhelming. It usually took a couple of minutes to take care of. In fact, I would rather have that than hear from somebody else the next morning for two or three minutes. And the patients appreciated that. And this continuity of my son’s complexity of illnesses, if I could have just found an anchor person, it would have been so much easier. And I was my son’s family physician because there wasn’t any other family physician. So I’m wondering whether or not people are willing to get that involved. And we have a system that sort of scorns that kind of thing. That if you do that, your life will be destroyed. Your family will fall apart. And I think obviously there are extremes to anything. But I know lots of people with protected time whose family has fallen apart and this and that. I think you really have to want to be involved to be a good doctor and be part of their lives. And I think you have to go to funerals. I mean people don’t just die. That has lots of effects. And it’s nice to call somebody up two weeks later or visit them on the way home. Which there is no Blue Cross number for that. There is no remuneration for that. There’s a lot of remuneration but not in terms of dollars and cents. I just wish I could see more of that. I think, by the way … I went to the medical students dance Saturday night and I think there is really fertile ground there. And I think what we’re doing is we’re turning it off. I mean one of the women there, who I think is president of student council, talked to me about how she’s been doing this and that, worrying about the care of the homeless. And she’s doing this after too many hours of lectures. So I think there’s fertile ground, if we stop worrying about whether it’s 8:00 to 5:00 and things of sort, could do this. Volunteerism in medicine has disappeared since Medicaid and Medicare came in. You know, we fought it. Now we’ve accepted it and now it’s controlling us. But there are physicians in surrounding local counties who will not see a Medicaid patient. Just simply will not see them. And, you know, that kind of thinking concerns me.\n\nI’m glad you’re saying that because I sense, and I kept saying it’s a sign of my age, I’ve had discussions with residents who talk about having a personal life and having a professional life as if somehow they’ve claimed that (?). I said, whoever promised that?\n\nYeah, whoever is like that? I mean where did that come from? And the other thing, and with Jerry Casper (?) last night … Somehow being a family physician is not working. And I go to meetings now and still participate in graduate medical education courses and all I hear is how bad it is to be a physician. I don’t hear any interesting cases. I don’t hear any curiosity. I don’t hear any excitement about a new drug. All I hear about is regulation, red tape. And, by the way, I think that’s significant. And if that’s what’s doing it (I don’t think that’s the sole thing) … For God’s sake, let’s lessen it. But there really has been a tremendous in what goes on in medicine. I mean we would never worry about income or insurance or forms or things like that when I used to go to post graduate courses. I mean we would be turned on by advances and thoughts and we would go on and on. We would go in the halls, go on at dinner at night. Now all I hear is there’s a big black cloud over medicine. I don’t know which comes first. But Tom Peoples, who started the Harvard Community Health Plan and is a pediatrician, told me how they had a terrible morale problem in the Boston hospitals with their house staff. And were just fed up basically. Depressed and fed up. And they went and looked into this. Not very scientifically, but they did look into it. And they concluded that it was the attending staff, everything coming in everyday, not talking about the patients or the problems, but talking about this ugly world and the Massachusetts regulation system. And they never saw anybody having a good time. And medicine is fun. So we’ve lost that. I mean there’s just so much down in the mouth stuff about all this other. But it really is fun to take care of a kid that can tickle you or somebody that’s chronically ill and bright. And I have patients still … I saw a lady, ninety-four, last week who made me feel a thousand times better. She gave a lot more to me. She prays for me every night – and I need a lot of prayer. I mean just to hear somebody ninety-four, I really pray for you. I mean, you know, this is just so unselfish. And there are so many giving people out there. So a gentler world and more enthusiasm and more excitement about doing this. I think this is what I learned going with Ed Pellegrino and going out with these doctors in the clinic – and it was fun.\n\nIn a sense, I finally found the people that I’ve been able to talk to. I know this experience has been wonderful, too, because what we’re going to try and do is take what we are hearing and put it together for people.\n\nWell, I’ve talked too much.\n\nNo, it’s been wonderful.\n\nIt’s nice that you were able to come over here.\n\n(End)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150633/file/277808#t=0.0,1931.08288"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150633/file/277807","type":"Canvas","label":{"en":["Media File 2 of 2 - Brucker_Paul_1991.05.08_-_Side_2.mp3"]},"duration":620.34763,"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/150633/file/277807/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150633/file/277807/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/277/807/original/Brucker_Paul_1991.05.08_-_Side_2.mp3?1750274060","type":"Audio","format":"audio/mpeg","duration":620.34763,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150633/file/277807","metadata":[]}]}],"annotations":[]}]}