{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/d50ft8gd76/manifest","type":"Manifest","label":{"en":["Dr. Joe Shackelford"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1989-05-23 (created)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","Dr. Joe Shackelford","family physician","family medicine"]}},{"label":{"en":["Subject"]},"value":{"en":["Dr. Joe Shackelford (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/3180/collection_resources/150921/file/278315","type":"Canvas","label":{"en":["Media File 1 of 2 - Shackelford_Joe_1989.05.23_-_Side_1.mp3"]},"duration":3741.536,"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/3180/collection_resources/150921/file/278315/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150921/file/278315/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/278/315/original/Shackelford_Joe_1989.05.23_-_Side_1.mp3?1750860464","type":"Audio","format":"audio/mpeg","duration":3741.536,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150921/file/278315","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150921/file/278315/transcript/81400","type":"AnnotationPage","label":{"en":["Dr. Joe Shackelford interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150921/file/278315/transcript/81400/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side 1: Dr. Shackleford:  You can go literally anywhere if you’re a GP. I have -- saying please, come help us. I wanted to go to group because I wanted to practice good medicine. I thought if I tried to go and be a solo doc, I’d be so tired that I won’t practice good medicine so I wanted to go in a group. I found a group that paid share and share alike. We had an internist, two surgeons and three GPs. Everybody was paid the same. So there was no reward for doing more, working more to make more money, just work more because you want to work more and there was a young surgeon there who has since become head of the Marshfield Clinic in Wisconsin, big place. And he and I sat down together and said, we want to show that we can practice good medicine in a small town because at that time, your GPs were kind of looked down on as low lifes.\n\nWhat year would that have been?\n\nDr. Shackleford:  Oh, ’60, ’61.\n\nThat was the low point of general practice.\n\nDr. Shackleford:  Oh yeah.\n\nWere you clear in your own mind that you wanted to do general practice from early on?\n\nDr. Shackleford:  I was a surgical intern at Vanderbilt. That year convinced me. I got very tired of hanging over a -- working 16 hours a day so I said to myself, hey, my real strength if I have one, is going and sitting down with patients and talking one-to-one. So I went in the Navy after that and I was in a little tiny base near Charleston and there were about 30, 40 families. We lived 30 miles from anywhere and I really liked that. So I said, I have to do residency because I know so little so I went to Oklahoma because there were only two residencies in the Eastern US then.\n\nIn general practice\n\nDr. Shackleford:  One in Oklahoma and one in Monroe Louisiana. I went there one day, there was a resident there. He said, come up and do a case? I said, what are you doing? I was by this time, I’m in the Navy, a doc. She said, I’m doing a pericardiotomy. I said, who’s going to help you? He said, no one unless you will. If I look over your shoulder? He said, no, you can do anything you want here. So we were watching people sitting in the yard, black people mostly. I thought, no way. So I went to Oklahoma -- was better but you had to work hard. It was all inpatient stuff no outpatient at all. When I went there, I was the only GP resident.\n\nIn the whole place?\n\nDr. Shackleford:  Yes. Everybody else was specialized. But they paid GPs… the legislator passed a law that they pay GP residents $50 a month more. As I went along, I learned that some residents -- that. I didn’t mind, I would too because they work very hard. But I went in and saw a guy who was running a program who was a surgeon who had lots of kids. He was not doing big cases. He -- the job very well, named I. H. Brown. I walked in and he said, hi, what do you want to do? I said, I don’t know, so I wrote down a list He said, fine, I’ll see you in a couple of years and that’s the way it went. I didn’t see him for two years. Right before I left there I spent, let’s see…. 6 months on internal medicine, 3 months of pediatrics, 6 months on surgery at the VA, 3 to 4 months in OB where I delivered lots of kids. Anyway, at the end, all the department heads got together and had a lunch for me, which I was very flattered, it was great. But I was like, what the hell does this mean? They all said, you don’t want to be a GP. Each one said, you want to be a surgeon, you want to be a pediatrician. I said, I made up my mind, I want to be what I want to be. So I went to this little -- because it met my ideal. And it was oh, about 100 miles from my wife’s mother, to whom she was very close, and about 250 miles from my parents, to whom I’m very close. So I thought, that old boy is living right under their skirts and we’ll still be close so we can go. So I said to myself in my naivety, if you can be a good doc, a good husband, a good dad, what else is there? Well, there is a lot more because there are only… I’ve told this -- many times, only 24 hours per day and as time went along I was busier and busier and busier and more people wanted to see me. Finally my wife didn’t like small town. To this day, no. So I knew she wasn’t happy here. The only reason she stayed at all was when the kids started school, all three got in school, she went to work part time for the mental health clinic, which -- there and she worked Tuesday, Wednesday, Thursday for a long time. She got busier and busier and she liked that. But I thought --. In fact one time I took a plane and came to Durham and met with the gal at Watts (?), she’s still there. Older woman, small, Jewish, black hair.\n\nWoman doctor?\n\nDr. Shackleford:  Yes, graying hair. She’s the director of Watts, at the clinic there.\n\nI don’t know.\n\nDr. Shackleford:  They wanted me to come there and there was a guy and two guys who ran the family practice -- and they wanted me to come there. Well, I also went to somewhere in Birmingham, Alabama and I said to myself, hey, this is going to be about the same as I’m doing and I want to stay here because people have become attached to me, which is a real ego trip, you know? I delivered their babies, taken care of their grandma so I decided I’m going to stay. My wife had said early on, hey, I’ll stay but when the kids are grown, I want to go back to school and I said, hey, that sounds fine, let’s do it. So when that time came, I thought she’d forgotten. She hadn’t. She said, I want to go to school. I said, hey, it’s going to be hard after all these years. She said, well I’ll take the GED and do the whole thing. She took that. She was first in her class in nursing and she did fine. I said, we’ll move, maybe we’ll find work and maybe we won’t. So we came here not having a job and I saw Art, he said, hey, you’re ideal, which for him I thought I was.. Then I interviewed with Ed and Botowick (?) and the whole group of people and then -- was ideal. Couldn’t have happened nicer for me. Then after I’d been to work for a few weeks, -- which was a real crusher but real lucky that I had a job. Anyway…\n\nLet me go back to when you chose Paris. You chose Paris because it was in a group practice, it was kind of close enough to both sets of parents. Did you look to a lot of other towns in that particular region or is that the one that really stood out?\n\nDr. Shackleford:  That one stood out because the clinic had been started by three guys who were then middle aged. Two of them are now dead, on the theory that I had that if they practiced good medicine, the place would thrive and they tried to do that. There was a surgeon, an internist and a GP and they were the only place I went which had pay, share and share alike, which I thought was great.\n\nHow big a town was Paris?\n\nDr. Shackleford:  Ten thousand. So I looked at some places but there was something about Paris, the clinic and these three guys that I really admired.\n\nHow many kids did you have when you moved there?\n\nDr. Shackleford:  I had two and two-thirds. One was on the way. Two small kids and one coming.\n\nDr. Shackleford:  \n\nSo your kids were small.\n\nDr. Shackleford:  Oh yeah. We had one born in Charleston, one born about a week after we moved to Oklahoma City in a heat wave and the third one born in Paris about a month after we moved there. We had three small kids.\n\nAnd you settled in this practice of 6 people, is that right?\n\nDr. Shackleford:  Yes.\n\nAs you think back on it, you’ve lived in small towns, you grew up in…\n\nDr. Shackleford:  Grew up in Minneapolis.\n\nI was thinking of you as being outside of Minneapolis.\n\nDr. Shackleford:   No. \n\nSo Jo wasn’t a small town girl and you weren’t a small town boy.\n\nDr. Shackleford:  No.\n\nWhat do you remember in the first years that you were in a sense, not prepared for about small towns?\n\nDr. Shackleford:  I was a little surprised that patients, people would bring up medical things in odd places like the grocery store or church or whatever. Except for going to work, we withdrew.\n\nYou decided to try and create a world of your family and a world of work.\n\nDr. Shackleford:  Right.\n\nWere you fairly successful at that?\n\nDr. Shackleford:  Yeah, pretty much. I’m sure my folks were disappointed I didn’t go to church. I tried for awhile but people would ask me questions at the end of the service so it got --. Finally I got so I didn’t go. I worked so hard, so many long hours that I didn’t have time for anything else. I’d get up early in the morning and go to the hospital and eat breakfast there, before my family was up, make rounds and then go to the office and work the whole day, then come home, eat supper, see the kids and the wife and go back to the hospital and make rounds again. That filled up the day. There wasn’t anything going on at night, it was Paris, it was quiet. By the time I got home, the last few years, I would put on my running gear and go running, which was nice. The phones would ring and I liked it a lot.\n\nWhat you did, I remember when we were talking before about your house and your house was not a place patients ever brought problems to. Was that pretty true? Or did people come knock on your door, call you at home, things like that?\n\nDr. Shackleford:  They could call me but they knew they couldn’t come with medical problems there. My phone always rang. I never took it off the hook. My wife, being a -- gal, never liked -- but I was there. That was my job. I had a few colleagues who had people come to their house. Their wives said, no way. That stopped.\n\nIn the first years you were there, you felt that pretty much, other than having to not go to church anymore or other kinds of activities where people engaged you as a physician in settings that were not medical settings, do you remember consciously doing any other things to organize your life so that you had the things…\n\nDr. Shackleford:  No, it just flowed, there was a lot of work to do.\n\nWhere there kind of expectations of you that the community had that you weren’t aware of until you got there?\n\nDr. Shackleford:  No. I didn’t hear any. I had expectations of myself.\n\nSuch as.\n\nDr. Shackleford:  Not driving a big car, which my senior partner, he loves to drive Cadillac’s. I said Gordon, do you know what it means to people when you come in your Cadillac in --? He said, I like my Cadillac. I said yeah, but that sends the wrong message. That says you’re a big, rich doctor. He didn’t change.\n\nYou didn’t either.\n\nDr. Shackleford:  I didn’t either. He was all right. But I thought, you have to be very profile in the community at that time, which was alright with me because I’m a low profile type person.\n\nBy keeping a low profile, what do you mean?\n\nDr. Shackleford:  I never tried to show off. If I had a few bucks, which we didn’t make much money, we would go out and eat, the wife and I, somewhere else. But I didn’t like the colleagues, which I didn’t have any, thank God, who made a show of money.\n\nWere there conflicts among the colleagues, your partners?\n\nDr. Shackleford:  Occasionally, yes.\n\nAbout what kinds of things, for example?\n\nDr. Shackleford:  There were two that I can remember right off hand. One early on, I hadn’t been there very long. We had meetings once a month, the partnership. The board --  was failing for the third time and one of my partners, one of the seniors said let’s take the money and bail this guy out and I said look, I remember this well because it was a very unusual --, I said, as soon as you start investing money, if you make lots of money, everyone will have a big grin but if you lose money, somebody is going to be angry. I do not think it’s the place of medical facilities to invest group money. So they didn’t.\n\nSo you carried the day.\n\nDr. Shackleford:  Yeah.  Which was amazing. Then several years later, one of the surgeons who -- I like him but lots of people didn’t, said, I’m making more money than anyone here, I’ve got to be paid more. Well, we kind of pooh-pooh’d this because Jerry was always talked at length. You got tired of his talking… kept saying this. So finally I got all the bills from everything and he started for the fourth time, I said, Jerry, shut up for one time, will you? I’m going to tell you who’s making the most money here, it’s not you, it’s me so stop this crap. He did. But even the last couple of years I was there, we went to a different pay where you would make… everybody made X and if you made so much, you made X plus a little more.\n\nLike an incentive plan of some sort.\n\nDr. Shackleford:  That made the surgeons happy. There are only two of them now, one surgeon and two GPs and they don’t do OB. It’s typical of a small town. It’s drying up, which is too bad.\n\nAs you remember it, what was the first kind of point in the time that you were in Paris where you said, maybe I should think about doing something else? Or when you… was there a time that came when you had been there for say, 6, 7, 8 years when you kind of said, well, I’ve done all that, I’ve been successful in all that and begin to get a sense of…\n\nDr. Shackleford:  Well, I’d been there about 5 years but I don’t think I ever said to myself… you always look at it in hindsight. I don’t think I ever said to myself, hey, I’ve done all that, I want to do something else. The only reason I went elsewhere to look was because the workload was becoming so oppressive. The only thing I missed some, I would love to teach. Well, we had kids from the University of Illinois, from Urbana, come down and rotate with us. That was enough to satisfy that, then. That was fun, so I loved teaching. The only thing I thought I could ever do besides practice is teach, either medicine, which I know some or teach in school. I thought about that.\n\nSo you thought about doing that at some point maybe in your life in that community.\n\nDr. Shackleford:  Yes.\n\nWere there any points. You said you got on a plane and flew down here, to Durham. How many years was that into your practice, do you remember? \n\nDr. Shackleford:  About 10, 10 or 12.\n\nWhat was going on around that time? What were the factors that made you look around, get on an airplane?\n\nDr. Shackleford:  A couple of my colleagues said, I’m not going to do OB anymore. I thought, there’s going to come a time I’ll be the only one left, which it got to be that after awhile. I thought, if you can do family practice, you can’t not do OB, so I thought the easiest way is just to bail out. Well, nothing really appealed t o me.\n\nWas it that or was it as you looked around at different things and saw different opportunities and compared that to what your life was like in Paris, that maybe decided there are reasons to stay in that community?\n\nDr. Shackleford:  Yeah, I thought there were. By that time I was a part of that community, medically. I thought people think, probably wrong, but what they think, they need you so I couldn’t leave.\n\nCan you tell me more? Every person that I’ve talked to so far, has at some point gotten to the idea of people needing… they’ve used those words and talked about it and it’s something I’m really struck by. Can you talk more about what that feels like, how that played itself out in your daily life?\n\nDr. Shackleford:  Well, people would come in and tell you things about their life or lives that you knew they wouldn’t tell anyone else. You had a whole bunch of stuff locked up in your head and I thought after awhile, I’m doing something here that really is important to them. You didn’t think of it that much because you were too busy but I’m doing something here that’s really important to the people. I’ve delivered a lot of babies but looking back, anybody could have done that but where were they? They weren’t there so I did that. People appreciated that so I came to feel, probably was good for my ego, that I’m really needed here because I’m doing something that makes a difference in the lives of these people.\n\nWere there ways that you saw that? How did people tell you that? How did you know that was true? Certainly you felt that, the way that they told you things, what they told you about…\n\nDr. Shackleford:  What’s told me since then.\n\nAlways happens.\n\nDr. Shackleford:  Yes. -- my students then, saw I was happy. People would say, I appreciate this, thank you. I always tried to knock myself out to be the kind of person that they could say thank you to because it’s been my observation and I’m sure it’s been yours, that lots of times docs come into the room, they give the patient the impression, you’re lucky I’m here. I’m important. Well, I thought, hey, these are just ordinary people. They do jobs, they don’t want you to come in and be haughty to them. Talk to them, be nice, it doesn’t hurt and it didn’t. And you find people really do appreciate that. And delivering babies, which I loved to do, people knew that because -- I guess, -- well I like to deliver babies.\n\nAs you said, when you started to talk about people needing you, as we all know, that we’re privy to secrets. We’re privy to information that as physicians, probably nobody else has in many cases, in people’s lives.\n\nDr. Shackleford:  Right.\n\nWhen you’re in a small town, it’s one thing to have that kind of information if you’re in a community where you may live here, your practice is there and never the two shall meet. Can you remember some experiences that you might have had about kind of carrying around secrets or having information that might have caused either some difficulties in your life there or might have added to the…\n\nDr. Shackleford:  Never did. I credit my wife with that primarily. Early on, when we were in Charleston, we decided by mutual agreement, nothing was said, that I wouldn’t discuss patients with her and I didn’t and that spilled over. Then when she got into the mental health business, she had clients, is what they call them, we call them patients. She had clients that turned out sometimes to be my patients. She never talked about the fact that they were seeing me. In fact, sometimes when they needed meds or something, she would write me a note. Are you seeing this person? Yes, I’ve been seeing them for some time… I’d been seeing the patient for years and she would say, I didn’t know that. I asked who the doctor was and they said you were. We started that early. When I came home, whatever was on my mind for awhile, I never talked about it at home.\n\nThat’s difficult. I found it’s difficult in a sense that every other job that has a lot of complexity to it, there’s a lot of things that goes on, when you come home and you sit down at the table and I’ve done this for 20 years, Julie would say, what happened today? And I wouldn’t start going through my list of patients but I’d get to a point some time in the conversation where I’d say, boy, really interesting issue or problem, or something that was on my mind, like you said, stayed on your mind, stayed on your mind. But I find, for me anyway, that it’s difficult to carry that around all the time and particularly when there’s a lot of those, I need to talk it through to somebody.\n\nDr. Shackleford:  It’s lucky for me, I think in a way, that I’m an only child because I did this before I was in college, I would talk to the kids who were my classmates and they got to where they’d lean on me. Who do I talk to this about? I couldn’t talk to my folks, they were old and gray, so I learned to deal with it myself. At that age, when I was a teenager, even though college, I prayed a lot, saying help. But I don’t do that as much now. I might need help more but I don’t do that.\n\nSo your family was not a place where you did that and were your partners people who you sat down and talked about things with?\n\nDr. Shackleford:  No, I didn’t because I wasn’t sure if they could all keep their watch (?) up. I thought it’s my thing to deal with alone. Now if I had a problem medically, I might go to a partner and say, look, I have a patient with such and such, what would you do? I would never mention names and the partner would say, me, I would do, or have you thought about, or did you do that? I’d say God dang, why didn’t I think of that? But as far as anything personal, no.\n\nLet me tell you a story. I was watching a video. I don’t know if I told you this but I was watching a video in Denver recently and they were using it as a demonstration of how to train a resident to be… family systems -- and the resident said to the faculty member on tape, now the next person I’m going to see is a young woman and this resident had just moved to town, a small town. It was a small community practice in North Carolina, residency program. She was new there from out of town and she said, yes, there’s a woman I’ve met who I’m friends with, we spend time together and she told me a few weeks ago that she was pregnant and wanted to know if I could recommend an obstetrician. So she said the resident said, what about me? She said, well my friend said, great, can you deliver babies? She said, sure I deliver babies so she said, good, I’ll see you. So that’s who I’m going to see now. As we were watching this, everyone in the audience went, uh-oh, which I thought kind of gets to the heart of what I’m talking to you about, which is that you can’t keep it all tidy, you can’t keep it all in little boxes and stuff like that. What I want to talk about a little bit. But what happened is, then she went in and the videotape showed this young resident talking to this friend of hers and what she found out is that her friend came from a family of manic depressives, her friend’s mother had committed suicide, that her friend had had three therapeutic abortions prior to this particular episode and a number of things about her friend, which are just part of getting a medical history. And you could see her face. I was looking very quickly at the resident’s face and you could see her face start to show what was happening, which is what was happening is, she was getting a patient and losing a friend. Or at least that was my projection. What it gets at is the whole issue, in a lot of situations you can be friends with people but that doesn’t mean you know all about it and it probably means you never will.\n\nDr. Shackleford:  Right.\n\nYou’re the doctor in the town and you have friends who you play bridge with or whatever, go fishing with or something like that and you’re also their doctor, which in small communities, in many cases, is the same. Then you get the opportunity, if you will, the challenge of knowing that person in quite intimate details, secrets of their lives and background and then having to go back and be their friend. Does that ring a bell at all, with the experiences that you had in Paris?\n\nDr. Shackleford:  Never bothered me because in the first place, I would like to -- as a resident, I think you should never try to sell yourself. I think that’s wrong. One of my senior partners Mac --, who’s now dead, said once to me quietly, hey, -- referral never hurts you. I said, what do you mean by that, Mac? He said, if you’re not sure, refer the patient, then they’ll admire you for referring if they find out something you missed, they’ll admire you for that. You’d be amazed. So I took it as my opinion… often times I -- a friend I had in Oklahoma City, he was a surgeon, typical ago but a guy you could like a lot and I do like a lot. He said,  -- I’m the best there is. I said, what’d you do with it? He said, I just hung in there. It got better. Well, it used to bother me, it used to bother all of us, the whole partnership as we got older. Some people were -- and go down --. Hey, we knew better than that but you never did that to people and more and more, as I went along, they gave Mac --. But I handled the friends thing by this technique, one, I’ve never had lots of friends. Not because I don’t like people, I really do love people but I haven’t won a lot of friends because I learned to rely on me early on and so I had very few friends in Paris because one, I didn’t have time and people came through the door wanting something medically, were not my friends. Now that doesn’t mean I wasn’t friendly or I didn’t like them, I did, but they were patients then.\n\nEven though you may have had dinner with them the night before.\n\nDr. Shackleford:  Yes. It didn’t matter to me. I didn’t get into that a lot. The funny part, we had two real good friends in Paris, one who was sitting with me when I first started my teach, the other whom, thank God is now --, she saw me for awhile, I couldn’t get her to lose weight. I couldn’t get her --, she’s diabetic and her kidneys going bad. When I left I said, Margaret, you have to do something, you’re going to be dead in 20 years or 10 or 5, so she did, fortunately --. But they were the only close friends we had. One of my partners and his wife were just here recently. We had a ball but we were never close. They liked different things than we did, than I did.\n\nOne issue was to keep the circle of people you were intimate friends with, people you had…\n\nDr. Shackleford:  Very small.\n\nAre there other things you remember consciously doing about dealing with that kind of knowledge, information?\n\nDr. Shackleford:  No, not really.\n\nSome of this gets to another issue which comes up a lot, as I think about it, is this issue of privacy, which a lot of residents who talked about small towns in some kind of romantic way, talk about living way out in the country so you can be physically removed enough so you don’t have to mix it up with people. Privacy is this big thing. How did you deal with that issue? How did your family deal with that issue?\n\nDr. Shackleford:  Well, we lived in town, we didn’t live in the country, we lived on the edge of town. It never got to be a big issue. A little old lady who lived next door who has died since, by the way, was a patient of mine, so was her husband. We were friendly, I went over and saw her, I delivered for the baby for a gal who lived next door at the same place before them. The biggest kids I’ve ever delivered, 14 pounds.\n\nAt home?\n\nDr. Shackleford:  No, in the hospital, her children were so big, we had a big time. I thought I’d kill the kid. Fortunately, he’s all right. But it was never a problem, really, for me.\n\nYou had enough space, is the vernacular, for you.\n\nDr. Shackleford:  Yes, for me.\n\nHow about for your family?\n\nDr. Shackleford:  Well, first place, my wife didn’t like it there because she thought small town people were snobbish and talked about other people. No matter what I said, hey, people in cities do that same thing. Well, she never accepted that. She didn’t like small towns so she wasn’t a joiner. She didn’t join Junior Women’s Club. The only thing she ever did organization wise had to do with the kids. Like she was a Girl Scout leader for awhile. One of my daughters was in Girl Scouts. People were real nice about respecting your time. I went to all the practices I could, little league, because I had two boys that played and they never asked me… they knew I liked to play baseball, which I did, they never asked me to be a coach or the head of things because they knew what I would say, which is the truth, I’d say I can’t, I’m just too busy, which I was. So they scratched my back while I was scratching theirs.\n\nThey looked out for you.\n\nDr. Shackleford:  Yes, they did.\n\nYou really had that feeling while you were there that people were looking out for you.\n\nDr. Shackleford:  They were. They did, yeah. Because they knew after awhile, I was busy, I wasn’t there to make a financial killing, I was there to take care of them. That’s why I was there.\n\nJust before we leave this whole thing of knowledge, information being power, what you know about people and certainly what you do with what you know about people is a very powerful aspect of human interaction.\n\nDr. Shackleford:  Yes, I suppose it is.\n\nDid you feel, by virtue of having the kind of information that you had, knowing about people the way you knew about them, that you had some kind of special place in that community? That you had a position of status, respect, something like that, that might have been different than the person who lived next door to you?\n\nDr. Shackleford:  Yeah, I always felt like people trusted me because I could be trusted. I thought my own -- was -- trustworthy. So I had no trouble with the power of knowing a lot about a lot of people,. That wasn’t something you used. I wouldn’t know how.\n\nI think that’s what I appreciate from everyone I talk to and I certainly feel this in my own life, the misuse of that kind of power is the most heinous crime that we could ever… it’s the clearest and worst violation of ethical conduct that… \n\nDr. Shackleford:  It certainly is.\n\nIt destroys everything else on what our interactions are built.\n\nDr. Shackleford:  Right.\n\nBut in a small community, there’s not the sense that that’s more possible but you have to be so much more careful. It’s funny. I’m very aware of… I don’t even say whether someone is a patient of mine or not. It’s not anyone else’s business.\n\nDr. Shackleford:  Right.\n\nI don’t say, so and so comes to our practice. If they want to tell them that I’m their doctor, that’s fine, it’s not my responsibility to say I’m their doctor And nothing about them. I had this amazing experience with a young physician in a small town in Northern California who was telling me the story of walking along in this very beautiful community in the wine country and he said, it’s getting more and more difficult for him and he won’t even make eye contacts with his patients on the street. I said, why? He said, because this particular community is a kind of vacation, resort community for the gay population of San Francisco. That a lot of people live there and a lot of people move up there from San Francisco and he feels, whether it’s something that’s really true or not, that if he sees someone and makes eye contact and says hello to them before they say hello to him, that other people around them will see that that person somehow knows him as a doctor and make assumptions about their AIDs status and things like that. Isn’t that devastating? This whole sense of…\n\nDr. Shackleford:  Wow.\n\nThat’s what I said, my God, how do you live in that town?\n\nDr. Shackleford:  Yeah, I couldn’t stand that.\n\nNot very well.\n\nDr. Shackleford:  No, because I was brought up saying hello to everyone. That’s my southern background, hey, how ya doing? It didn’t matter if they were my patient or not. Didn’t matter to me.\n\nDid your kids feel… being the son of the doctor or one of the doctors, I’ve had this sense and I’ve known people… and my dad is not in medicine, nobody in my family is in medicine.\n\nDr. Shackleford:  Right, neither are mine.\n\nWe don’t have that experience personally. Have you ever heard from your kids in any way, that because you were the town doctor that it put them in a little bit different position than it did other kids the same age?\n\nDr. Shackleford:  No. I don’t think so.\n\nDo you have any sense that that would be different?\n\nDr. Shackleford:  They seemed to sense that more was expected fro them but that was fine because more is expected by me and their mom so that’s okay.\n\nDo you remember you wanting them to do something or them wanting to do something and having a discussion about, you really can’t do that? Part of not just, you’re a Shackelford and you’re one of our kids and we have expectations of you but the sense of, if you do this… when we do things in this community people look at us differently?\n\nDr. Shackleford:  No. We never brought that up. If one of my kids would come and say, I want to do this and Mom says I can’t. What I would say is, fine. And they would mope around and say, well…. I’d say, that’s right, you can’t, that isn’t good. You have to come in at","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150921/file/278315#t=0.0,600.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150921/file/278315/transcript/81400/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"tonight. But never because I’m a doctor and your mom is a nurse, never that. It was either right or wrong by its own merit.\n\nOne other thing and this kind of gets back to what you were saying about how you deal with confidentiality, which is, you deal with that… learning to rely on yourself is the way you dealt with that. What about mistakes in a small town? When you think you make a medical mistake of some sort? Can you remember any experiences around that and how that might feel differently? We all hate that. It’s not a question of whether or not it’s okay in some places and not okay in others, but does that affect anything about how you feel if you live in a community that’s that close?\n\nDr. Shackleford:  I don’t think it does.\n\nDo you remember any kind of episodes of situations where you felt like you had erred in some way?\n\nDr. Shackleford:  Sure. I had a man was in the hospital was sick and I didn’t looked at one thing in the lab work that might have made a big difference. He died. I never let myself forget that. But living in a small town didn’t seem to make much difference. I don’t know whether they didn’t know, or what. The gal who lived kitty-corner across the street from us was a school teacher, she had a murmur. They had one child and wanted to have more. So I referred her to a guy at Indiana U to fix her. He fixed her fine but while in the -- up there she had a stroke and she’s a vegetable, still. Eight or ten years, a long time. Hey, what if I hadn’t referred her? What if I’d just let her have the kid? She drove my daughter to school when her legs were broke. She was a real nice person. I never heard --. That bothered me a lot.\n\nDo you think that small towns are more forgiving?\n\nDr. Shackleford:  I was never in a big town. I think they were then. I’m not sure if they would be now or not. Lovely bird, what is that?\n\nScarlet tanager.\n\nDr. Shackleford:  Yeah, rarely ever see them.\n\nLook at those. Or those are red finches. I can’t tell… they’re red finches. Purple finch, they call them.\n\nDr. Shackleford:  Never been there before. How about that? I think medicine has changed a lot in that people are looking for you to make a mistake that they can pounce on. I don’t think they think consciously that, I think it’s subconscious. \n\nDo you think that’s affected small town life too, as far as doctors in small towns?\n\nDr. Shackleford:  Well, probably. I would suppose. My partner was here recently and still practicing. He’s near retirement age, he’s 56, he said, I’m going to retire. I said, why It’s not the same as it used to be. I said, do you really think that? He said, yes, I do.\n\nI’ve heard that from a lot of people. I never thought doctors retired, I always though they just kind of tapered off.\n\nDr. Shackleford:  That’s what I planned to do. I think it has changed. My wife, don’t get it started.\n\nI want to talk to her. I do.\n\nDr. Shackleford:  I have a big lawsuit going now. I gave a gal, 1980, gave her -- because I was scared to death about labor and there were only a few -- then they recalled those. They said, use what you have because they’re going to stop making them because they can be absorbed irregularly. So I gave her -- to start her and she started labor. At one point, her fetal heart dropped down briefly, then I broke her water, she had internal -- and she delivered, APGAR 9.8, which for me was excellent. I never gave 10’s. The kid was in the hospital once, at about 3 years of age, he became obviously CP (?) They’re suing me for a million dollars. -- well, that never would have happened years ago. I told Ernie, I said, look, I’m very, very sorry this kid has CP but I do not think I did anything or ordered anything that -- to that. \n\nDid you know that family pretty well?\n\nDr. Shackleford:  Not real well, enough to say hello. I think things have changed.\n\nDid you talk to them about what you said?\n\nDr. Shackleford:  No.\n\nYou only talk to the lawyers now.\n\nDr. Shackleford:  Oh yes.\n\nPeople would say, what’s going on here? And you saying, this is what I think and this is what you think. Never face-to-face.\n\nDr. Shackleford:  Shortly after I left Paris, I was sued by a guy who never would stop smoking. I begged him, pleaded with him, cussed him out, said everything. Had two carotid bypasses, which there’s all the controversy now. He had coronary trouble, a coronary bypass and then he develops ischemia of his legs. I sent him up to a surgeon -- reconstruction and then his left foot got ischemia. He came in, saw me and his foot was blue, he has no fever, no toxicity. I said, look, you have an appointment to see him in three days. If it gets worse, fever, more pain, go sooner but otherwise, go in three days. Well, he went in and they had to amputate. He sued me for a million dollars. That case never got to court. I said to myself, hey, what the hell is happening? Things aren’t the same as they were. And I feel real, real sorry for my young colleagues, who I think are real idealistic and possess much more knowledge than I had. Psychologically they know and they’re going to go and try to do their idealistic best and be sued. Maybe they can handle that, I don’t know.\n\nNo, they can’t. I’ve been on a couple of situations in the last few years, fortunately not me yet, but where I’ve been responsible for people. It can destroy you. Some of the most moving experiences I’ve ever had have been with colleagues who feel ashamed and apologetic and somehow their image of themselves change forever. People out there are calling them bad doctors. No matter how much you really believe that you’re a good doctor, sometimes people standing there pointing and saying, you’re bad, you’re bad, you’re not good, this went wrong.\n\nDr. Shackleford:  You get to believe that after awhile.\n\nRight. What were the hardest things, as you think about, for you practicing in that town?\n\nDr. Shackleford:  I think the hardest single thing for me was knowing my wife didn’t like this town. She’s a marvelous person but was not cut out to be a doctor’s wife. Never. It was hard for me because I thought, I really, really thought, if you’re a good doctor, a good husband, good father, that’s it. I tried to be all those but I wasn’t. And that was hard to live with. There wasn’t anything for me that was a drawback.\n\nWhat were the things that made you excited about doing what you were doing and made it hard to leave?\n\nDr. Shackleford:  Well, in the first place, I liked to deliver kids --. And I liked to take care of people while I could things for them. I think the excitement came from the fact that you’re doing something that makes a difference. That was exciting.\n\nWhat you’re doing is making a difference is really different in a community like that. At least the sense of what you’re doing is different than it is in a suburb where you kind of go to your office from someplace else…\n\nSide  2: Dr. Shackelford: That’s my father’s phone there.\n\nHow did it get to Minneapolis?\n\nDr. Shackelford:  Well, my dad was in Chicago and got a job with Dun \u0026 Bradstreet when I was very small, they transferred him to Minneapolis. He was a… he is a -- always wanted to go back, so he did, to Mt. Pleasant, which is where they are. They were really loving parents. Neither of them went to college. They wanted me to go. I knew this. They never said, go to college. I wanted to be a doctor for 7 years old on. Why? I don’t know. But I was able to do that and go to college and go to med school, the whole nine years. So I think A, you owe something to someone.\n\nThat feeling of responsibility for and to people is really quite different, I think , than the generational sense. I have no data about that but my sense is that medicine…\n\nDr. Shackelford: That worries me.\n\nIt worries me too. What worries me partly is that that’s the drive behind why you choose medicine as a career, and granted, there are a lot of complexities in the world around spouses and jobs and finances and economics and all that stuff that wasn’t there quite in the same way as when you were starting practice. Still, it’s that feeling of responsibility that will get you go into communities and work for them.\n\nDr. Shackelford: That’s right.\n\nAlso, the lack of feeling of responsibility may keep people from going to small communities or any communities and really serving people A sense of service, medicine is a service profession, if you will, is getting lost and it’s more the medicine is a technical skill, medicine is a trade, medicine is a job but not, medicine is a service profession.\n\nDr. Shackelford:  That’s what it is.\n\nI wish the world would get cleaned up a little bit so it would be clear that that’s what it is again, because I think all of these…\n\nDr. Shackelford: I worry about people not being idealistic enough about that and I worry about my own kids who say, hey, you can’t make any money doing that. I say, hey, who cares? Go do what you want, have fun, you’re going to make enough to eat. People always wonder… one of dad’s friends always teases me every time he sees me, how much money you make now? I finally said, Mr. Johnson, I didn’t go into this field for the money. I don’t like you bringing it up so don’t do it anymore. He never has. But you know, it’s amazing in our present… I never, ever thought about money put up by the practice, it just happened, it just came. Enough, not a lot, but enough to live on.\n\nAnd now it seems like you have to think about that more.\n\nDr. Shackelford:  That’s right. I don’t know why.\n\nAre there any particular characteristics of a doctor who’s likely to be successful in a community like Paris, in contrast to someone who’s probably not?\n\nDr. Shackelford:  Well, I think someone who has a strong sense that they owe something They have a strong sense of responsibility. I think someone who has that, who is married to someone who feels that way too and someone willing to work a lot of hours. Because there’s no way to get out of that, wouldn’t if you could. So I think you have to recognize, I think, that people are the same. People are people. They may be smarter in Chapel Hill than they are in Paris because they have Ph.D.’s, they’ve been to school, but they have the same foibles we do.\n\nLike somebody said, just because somebody’s smart doesn’t mean they’re intelligent.\n\nDr. Shackelford: How true, how true. When I was in Paris, we used to have a meeting once a year in Terra Haute. The medical society is a --, it was supposed to be the oldest medical society east of the Allegheny’s, east of the Rocky’s. Well, a guy -- he gave me his email and asked me one time to write a poem for the -- the foibles of people. I thought he was kidding -- he was really serious. He said, sure I am. So I wrote a poem.\n\nDo you remember it?\n\nDr. Shackelford:  Oh, it’s somewhere in the attic. It had some good parts and parts that were terrible.\n\nLife in general.\n\nDr. Shackelford: Right, exactly But…\n\nReally, if you had to make the same kinds of choices over again…\n\nDr. Shackelford: I’d do it all again. Yeah.\n\nWhy?\n\nDr. Shackelford: Well, because I feel like I did make a difference for awhile, for a short time.\n\nTwenty years is not a short time.\n\nDr. Shackelford: Well, right, 19 years isn’t. Lots of letters I got now, made me feel that more strongly than ever. I would do it all again.\n\nIt’s important to be able to say that for a lot of reasons, but I think the reason you’d choose it, I think you did make a difference. I don’t know anything about Paris, Illinois- but you made a difference around here and that’s been…\n\nDr. Shackelford: I think the same responsibility I feel about teaching is what you should feel about practicing. I think teaching is… have you ever read the Henry Adams thing?\n\nNo.\n\nDr. Shackelford: Have you -- Henry Adams?\n\nNo.\n\nDr. Shackelford: There’s one section where he wanted to be a teacher at Harvard for awhile, he finally resigned. He wrote a page about why he resigned, which I think is marvelous. I gave it to give to all my teacher friends. I think one line he says, “Mothers and fathers give life but teachers do something and impart something that’s going to live for years.” I can’t handle that, I quit, so he did.\n\nThat’s part of what I’m seeing with -- going off to…\n\nDr. Shackleford: Where’s he going, Carlton?\n\nCarlton, yes.\n\nDr. Shackleford:  Good school. Northrop, Minnesota.\n\nThe great north country.\n\nDr. Shackleford:  That’s right.\n\nBut I realize that he’s going to be exposed to people who are going to shape his thinking for the rest of his life.\n\nDr. Shackleford:  That’s right.\n\nWhich I’m happy and excited for him. I’d like to know myself about the students there.\n\nDr. Shackleford:  Well, yeah, it’s like moving -- college, we never know if we ordered the right person. My mother-in-law is a -- and a Democrat -- all that. I told her, -- the biggest mistake that I ever made in my life and I’ve made a few, voting for Richard Nixon. He is the world’s biggest crook. Given that he ran against the world’s second biggest crook, maybe there was one time you think, I’ll stay at home. Well, you can’t stay at home, you have to vote for someone. I became… I told my wife -- who knows how long -- when Lyndon Johnson, although a penny pincher,  ran against Goldwater, I did research pretty thorough and became convinced as time went along that there was no way Goldwater could win so I voted for him. I thought Johnson was a bad man. I still think. And I just finished reading Goldwater’s autobiography -- . Anyway.\n\nI couldn’t vote back then.\n\nDr. Shackleford:  Those were hard votes.\n\nCouldn’t now but I couldn’t then. Have to be 21 to vote now.\n\nDr. Shackleford:  That’s right.\n\nI didn’t vote until ’68 election. Terrible.\n\nDr. Shackleford:  You haven’t had much to vote for, have you?\n\nLook who’s been president during my growing up, Ronald Reagan is going to be the biggest laughing stock for historians in this country forever.\n\nDr. Shackleford:  That’s where we…\n\n(RECORDING ENDS)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150921/file/278315#t=600.0,3741.536"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150921/file/278314","type":"Canvas","label":{"en":["Media File 2 of 2 - Shackelford_Joe_1989.05.23_-_Side_2.mp3"]},"duration":917.696,"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/3180/collection_resources/150921/file/278314/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150921/file/278314/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/278/314/original/Shackelford_Joe_1989.05.23_-_Side_2.mp3?1750860462","type":"Audio","format":"audio/mpeg","duration":917.696,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150921/file/278314","metadata":[]}]}],"annotations":[]}]}