{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/gf0ms3n06w/manifest","type":"Manifest","label":{"en":["Dr. Thomas Wortham"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eThis is an interesting interview, as the first half was self-recorded by Dr. Wortham, and the second half was a standard interview. Dr Wortham spent all of his medical career in Arkansas and was a preceptor for the University of Arkansas Department of Family Medicine for many years. After high school he joined the US Navy (1944), where he was a hospital corpsman, which led to his interest in medical school. He graduated in 1956 and established a small family medicine clinic in a small town in Arkansas, where he spent his career. He did the full range of family medicine (before the specialty was recognized), including the delivery of hundreds of babies. He participated in treating patients in polio and tuberculosis outbreaks, diseases that are rare today. He was instrumental in initiating many changes in his community hospital and served with pride on the Board of the Arkansas Department of Corrections, where he was deeply involved in building the Women's Prison System. In the days before family medicine was a specialty, he included the concept of family medical care in his practice. This provides a good view of the developments in medical care that led to the specialty of family medicine.\u003c/p\u003e (summary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer: The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2010-09 (created)","2010-12-16 (other)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Martha Lauster (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians","Arkansas"]}},{"label":{"en":["Subject"]},"value":{"en":["Thomas Wortham, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"summary":{"en":["\u003cp\u003eThis is an interesting interview, as the first half was self-recorded by Dr. Wortham, and the second half was a standard interview. Dr Wortham spent all of his medical career in Arkansas and was a preceptor for the University of Arkansas Department of Family Medicine for many years. After high school he joined the US Navy (1944), where he was a hospital corpsman, which led to his interest in medical school. He graduated in 1956 and established a small family medicine clinic in a small town in Arkansas, where he spent his career. He did the full range of family medicine (before the specialty was recognized), including the delivery of hundreds of babies. He participated in treating patients in polio and tuberculosis outbreaks, diseases that are rare today. He was instrumental in initiating many changes in his community hospital and served with pride on the Board of the Arkansas Department of Corrections, where he was deeply involved in building the Women's Prison System. In the days before family medicine was a specialty, he included the concept of family medical care in his practice. This provides a good view of the developments in medical care that led to the specialty of family medicine.\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: The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284024","type":"Canvas","label":{"en":["Media File 1 of 3 - Wortham_Thomas_Pt1_10_a.wav"]},"duration":2533.99966,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284024/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284024/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/284/024/original/Wortham_Thomas_Pt1_10_a.wav?1754492247","type":"Audio","format":"audio/wav","duration":2533.99966,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284024","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284024/transcript/82284","type":"AnnotationPage","label":{"en":["Dr. Thomas Wortham interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284024/transcript/82284/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"(Tape 1, Side 1)\n\nGood morning, this is Dr. Tom Wortham, dictating the interview questions provided for me by the Board on the history.  My name is Thomas Henry Wortham.  I’m a physician, M.D. and I currently hold the position of instructor in family medicine at the University of Arkansas Medical Center, Family Medicine Department. \n\nI was born in January 12, 1927 in Waldo, Arkansas, which is a little railroad town and in the quite far south part of this state.  My parents were Daisy Nell Alsobrook-Wortham and Marvin Winston Wortham.  My father was a person who bought real estate to take large oil pipelines across the United States from Florida to California and Texas into New York.  My mother was a family person until her separation and divorce, then she became a secretary, working her way up from the WPA to becoming the executive secretary of the Biochemistry Department at the University of Arkansas Medical Center in Little Rock.  She worked there thirty years and retired from that facility.\n\nI was married until my wife died.  She was Betty Jean Moore-Wortham, who was a registered nurse.  We met while we were precepting in a hospital in north Little Rock.  She, being a nursing student and I was a junior medical student at that time.  We had an immediate recognition that we were meant for each other and we were steadies until her death on December 25, 2009.\n\nOur children were three in number, Thomas, who was born March 1, 1957.  He unfortunately was killed while on vacation in Florida.  A driver, probably intoxicated, hit Thomas while he was on his motorcycle and killed him instantly.  His sweetheart, who was with him was injured seriously but did finally recover.  My second child was an adopted child, Clay Alan Wortham who was born June 13, 1961 and our third child was Jan Ellen Wortham who was born September 9, 1962, who became a nurse anesthetist at one of our local hospitals.\n\nI grew up in a small southern Arkansas town of Magnolia, which is a county seat and was the typical southern town with a courthouse in the middle and a square around it.  The police officers and courts and so on were in this building.  They, of course had schools from elementary through high school.  I finished my high school in three years so that I could enter the military.  In the time of World War II in the 1940s you had the option of enlisting and therefore choosing the service you were going to be in and possibly what sort of an occupation in the service, or just being drafted and generally would be in the infantry.  I wanted to find something related to the hospital work I wanted to do, therefore, enlisted in the Navy prior to my 18th birthday.\n\nI had several people that I considered role models.  First was our family doctor, Dr. John Wilson.  My brother developed diabetes mellitus when he was three years old and of course, in 1930 we just had the discovery of insulin and therefore, he became a very young insulin patient.  I don’t know how in the world Dr. Wilson and my mother managed to treat a three year old Type I diabetic with all the problems they have and nothing to check except urine for sugar because there weren’t blood sugars available.  It is beyond belief to me that she was able to study and learn and figure out how to do things.  Finally she did find a place in Dallas who had some teaching and she and Jim went down there for that.  I remember when they returned they were measuring food, weighing it out and portioning it out and she checked his urine several times a day and gave insulin based on that.  It’s miraculous in my mind that he survived that and she must have been extremely intelligent and perceptive to get that done.  I know in trying to manage very young Type I diabetics, including teenagers, I found it almost impossible until we developed blood sugars to check and the pumps that seem to be the answer for those children.\n\nI became quite proficient in helping my mother take care of Jim.  He developed a lot of low blood sugar reactions taking insulin the way they did and my task was to always have sugared orange juice available and if that didn’t work, to call Dr. Wilson who would come and help us with him.  That was a battle over many years but yet it seemed to always work out.  He had the same problem in school but with teachers and so on he was able to survive that.\n\nI attended elementary school and high school in Magnolia.  I recall one of the most important things that happened in my life, I just kind of got along, didn’t worry much about grades or anything and my English teacher, Mrs. Alacorn, called me in after school one day and got all over me about not reaching my potential.  She reminded me that if I wanted to be a doctor, the first thing I was going to have to do was make very excellent grades or I wouldn’t be able to get into school.  I took that seriously and I think it changed my academic career from that moment on.  I completed my high school in three years so that I could enter the service before my 18th birthday.\n\nThe next page of my life was in the military.  I joined the United States Navy in 1944 and was transferred after the first of the year to Great Lakes Training Center near Chicago.  Of course, taking a bunch of south Arkansas boys who had never seen snow and subjected them to every day of snow and we’d walk the ground so we could march, was quite an experience for us country boys.  My boot camp was interesting.  They worked us hard and we learned to be in the military and march and drill and so on.  One of the more interesting things I encountered, we apparently had an epidemic of strep throat in the barracks and the doctors gave us a sulfa pill every night for a week or so and some didn’t get strep and some did.  I was lucky enough to not get that.\n\nWhen we finished boot camp, those of us going to hospital corps school were transferred to San Diego, California for a course in hospital corps training.  I’m still amazed that an 18 year old kid, never been out of Columbia County, Arkansas could get on troop trains, travel across the country and be dumped out in San Diego in the middle of the night and told to find the base.  Fortunately there were police officers and Naval patrol people who would help us find our way to check into the barracks and start our course in hospital corps school there.\n\nThis was a very interesting course, it was strictly maintained to produce orderlies.  We did learn to do temperatures, blood pressures and so on and the funniest thing that ever happened in my life, I think, is we got a sweet little nurse who was a Captain, I think and it was her task to teach us to give bed baths.  Can you imagine, a group of 17, 18, 19 year old goofy boys with a very pretty young nurse, teaching us to do bed baths.  When she chose a subject, there was great happiness among those not chosen but we were awfully quiet and took good care and good manners because we were afraid we’d be next.  Fortunately we weren’t.\n\nCorps school was interesting and passed quickly.  I found out about Navy discipline.  They told us once to not bring our shorts that we use to exercise after classes were over, but leave them in the barracks.  Later, we were told we could bring the shorts with us and we all did that and one of the captains came around and found all the shorts underneath our desk and made us come in the afternoon after school and we had to pack our bags, all of our belongings, put them on our back and we walked the ground there for two hours for disciplinary purposes.  I always thought that was undeserved but there wasn’t anything to do about it in the service, you just took it.\n\nThen I was sent to the Navy hospital in Normal, Oklahoma, which is where Oklahoma University is.  Stayed there several months, just working as a corpsman on the floor.  I just worked, there wasn’t anything unusual about that.  We were allowed to go on base a lot and we got introduced to 3.2 beer, which was allowed in Oklahoma but no other hard liquor.  I must admit, there’s not much to 3.2 beer and it didn’t do anything significant.  \n\nI was then transferred to a troop carrier.  This service was a matter of running an emergency room for our sickbay for the troops as we took them to the United States to Okinawa or Guam or some other position.  Of course, those trips would take two weeks out and two weeks back and were pretty boring because we didn’t seem to have many epidemics, thank goodness.\n\nI was then fortunate enough to be transferred to the USS Benevolence, which is a 1,000 bed hospital ship, which was one of eight or ten of those we had in the Navy.  We had a sister ship, the USS Hope who was identical to us and we shared a lot of interesting experiences.\n\nThese hospital ships were wonderful.  We didn’t have beds, we had bunks but we had four major operating rooms, all X-ray and laboratory facilities that were available at that time.  I think we had from 12 to 18 doctors depending on the time and that many or more nurses.  Of course our duties were just that of being orderlies.  As the war moved on, we were in San Francisco Bay, preparing to the hospital for the invasion of Japan.  One morning we woke and there was news that some kind of a bomb had been dropped on Japan, which was extremely destructive.  Mr. Truman, our President, got on the radio and asked the Japanese to surrender immediately or they would have to have another bomb dropped on their people to prove that it was serious.  Nothing happened so Mr. Truman dropped a second bomb, this went on Nagasaki after the one on Hiroshima.  Again, monstrous devastation of those communities and thousands and thousands of deaths were startling to the Japanese and they did surrender.  After General MacArthur was appointed to care for that area and the occupation, the surrender papers were signed on the USS Oklahoma and the war was officially over.  We were startled by the speed at which the President dismissed all of reservists who were no longer needed.  From being on the hospital ship for the invasion of Japan, I found myself on a troop train going back to Arkansas so that I could enter the University at Fayetteville to continue my premed work and I was there by September, getting ready to take my year and a half necessary for medical school.\n\nMedical school was difficult, of course, to get in because of the huge numbers of veterans who had come out of the war and were finishing college about the same length of time to go into medical school.  I don’t know how I got in there, but I did.  Our class was one of 1948 and we had an interesting addition to our class.  The first African-American female student was admitted to the University of Arkansas Medical School.  Her name was Edith Irby Jones and she was a petite, very intelligent, vivacious young lady who soon became the class pet.  We had a total of three women in our class, which I think is shocking when now 50% of the classes are women.\n\nMedical school was a very difficult work for us.  That is, we had full time classes, full time labs and lots of tests and lots of homework to do.  I had a roommate who was a student at that time, Dr. Gil Brodman, who lived with my mother and I and we had routine study hours from seven to ten every night and took Saturday night off.  The medical school had parties on some Saturdays, which were mainly dances and were a great deal of fun and often got out of hand.  The police would take care of that, I suspect.\n\nI had no problem with the first two years of medical school and as you know, those are mainly academic and then the junior year we started doing more clinical work, including physicals and so on.  I found I was getting where I wanted to go now, I was seeing patients and learning medicine.  \n\nAt the end of my junior year I had a shock of a lifetime.  X-rays were done of all of us in our junior year and I developed an area of tuberculosis in my right lung.  This was a minimal lesion but yet in those days, with no real treatment, it was difficult to get over.  Unfortunately, my sweetheart also had a small lesion.  We both had to be sent to the Arkansas Tuberculosis Sanatorium in Boonville where she was in the women’s unit and I was in the men’s.  This was quite an experience, of course, in that we had no treatment.  The only thing that was done was you had to be on an excellent diet and an exercise program.  The docs there took me under their wing and I got to make rounds with them and go to all the X-ray conferences and so on, so I really learned a lot about things.  Fortunately, the X-rays did improve and we both were discharged and were able to go back to school, Betty finishing nursing school and I finishing medical school.\n\nAt that point in time, we thought this was the right time for us to get married and it was the best thing I ever did in my life because I put a stable, intelligent, vivacious person who had a great sense of social needs and was a great companion for over 50 years.\n\nI always knew I was going to be a family doctor, that was from reading books in high school about doctoring and watching my brother, who was quite a bit ahead of me in medical school, I got to use his books and so on, so I never wavered from that idea.  The only possibility would be I might not be smart enough, but anyhow, I did get to go.\n\nWhat I was going to do in medicine presented a problem in that the age of specialization had started with internists and surgeons taking the lead.  My professor of medicine wanted me to go into internal medicine and worked on me a lot but I always had that ideal in my mind of taking care of families and being a family doctor.\n\nI must say right away, there was no family practice training.  The medical organization at that time, -- with a number of specialists in large cities, which were growing and becoming more interested in being sure everybody had more training and most people were GPs, we called them, or general practitioners.  These physicians probably had a year of internship before going into practice and probably working with some of the older doctors to learn surgery and other techniques.  The Board of Family Practice did not exist until 1971 when the first testing for family medicine occurred.  I remember there was great controversy about whether this was a good idea or not.  Among us younger doctors, we felt this was a great advancement.  I remember I took a two week review course in Nebraska prior to the test.  I passed the first examination and became a charter member of the American Board of Family Practice.  Unfortunately for the last many years I had to take the test seven times, which ought to be a world’s record, but anyhow, I was able to pass it every time.  This began the change in medicine and family practice as more and more schools, including my school, developed Departments of Family Medicine.  There came great need for preceptorship and other things to help with this training.\n\nWhen I finished my three and a half years of residency, I had a partner, Dr. Jan Crowe who was a medical student with me.  Dr. Crowe had been in practice in Jacksonville, a nearby community to Little Rock.  This area had been chosen for the location of the Little Rock Air Force Base, which is a large military facility, which is still to this day.  Betty and I studied our location to practice, we really wanted to go to Fayetteville, where we loved the area of the University of Arkansas there but this opportunity in Jacksonville was just remarkable and proved to be the correct thing.\n\nWe developed a family medicine clinic with Dr. Crowe and myself and tried to get more doctors and finally did as time went on.  We worked hard, that is, there was no hospital in the community, we had enormous numbers of obstetrical patients who wanted to be delivered.  We had to go to Little Rock to do that and all of our hospital patients had to be at St. Vincent’s or Baptist Medical Center which were a good thirty minutes away from our practice.\n\nJan and I, each morning, before dawn, would go to Little Rock to make rounds and deliver any babies that might be showing up for the afternoon or evening, then go to the office, then one of us would go back in the afternoon to make evening rounds and of course pick up any deliveries that were going on.  We delivered hundreds of babies over the fifteen years and of course it was very difficult for the first few years but then after a time, the citizens in our town began to realize, we’re just going to have to have a hospital.  We had a town that had grown from 3,000 to 30,000 in a short period of time.  I was elected to be the chair of the building committee and we first had to pass a tax to get the Hill-Burton funds to build our hospital and then when that was successful, we were able to build a 20-bed family practice type hospital.  This hospital was organized and I chaired its first medical staff and of course we needed specialists.  That was very hard to obtain in those days because they were all in the larger cities and coming to Jacksonville would be a chore.  After a few years we were able to entice a urologist to come help us and we were able to get him a lab to do his work, then a cardiologist and we had to develop a cath lab for him, so it went that way with more and more specialists and fortunately, better and better care.\n\nWe had developed an intensive coronary care unit when they first began to be popular.  We were able to get some nurses from one of the federal programs to train, physician training and we did fairly well.  Of course, in those days there was not as much invasive work done in intensive care, we were mainly using medications and pain medicine and of course getting the consultants to come see them.\n\nIt was my plan to develop a family medicine clinic, hoping to have nurse practitioners, multiple physicians and social workers.  Unfortunately, with the Medicare program and Medicaid and the reduction of fees, we were never able to afford the social workers, which are vital to such a program.  We did develop a group of six doctors, including one general surgeon, which we found did a wonderful job in taking care of the population.  Of course by that time the hospital had grown and the emergency room was staffed with ER doctors and therefore, some of our load was taken off and we could spend more time in the office.  \n\nOf course, in our particular field it was difficult to be sure you were maintaining an educational program that bore fruit.  We were helped by the University of Arkansas Medical Center with many educational programs and of course they were offered all over the country.  My experience was always good with these.  Each time I had to take the board examination I went to the Board of Family Practice review course in Kansas City and it seemed to help me in passing the test.  It also, I’m sure, helped bring me up to date on many of the things going on.\n\nI feel that our practice, if we could have afforded the social workers and a nurse practitioner, would have began to fit into the mold that the Board had been hoping for, that is, a family home.  That was the style of practice we did practice and of course the addition of preventive medicine, physicals and other helpful things for families, came along.  Our practice evolved into seeing many, many sick people but primarily a lot of physicals and particularly women with their annual examinations and so on.  We found one of the most remarkable things that developed in time was first, the PAP smear.  We had many patients with cancer of the cervix as the years went on and the PAP smear has just wiped that out, or at least the ones we see are very early and easily treatable and cured.  The other thing that’s so remarkable in our practice was the development of immunizations.  I can remember to this moment when we developed the polio vaccine.  Our city and our state had 1,000 cases of polio when I was a junior medical student.  We had iron lungs in our clinics taking over the whole facility because of the need.  The Polio Foundation had to send nurses in from all over the country because we had so many iron lungs and we didn’t have any expertise in that.\n\nI found all of my many years of family practice from ’56 to ’99 to be wonderful.  We worked hard but we developed very close relationships with our families.  I remember a thing that startled me then and now, when I had a retirement party, one of my families brought to the meeting, a family tree, which included grandpa and grandma, father and mother, children and their wives and families, all listed on this tree and I had treated all this bunch of people over the years.  What a fantastic memorial which really surprised and pleased me to death.\n\nI didn’t find terrible disappointments except the challenges that Medicare and Medicaid have produced for family physicians, that is the reimbursement rate is so small that one would have to see a large group of patients to keep your clinic going.  This is a disaster when the primary care for most everyone should be in the family practice office where 80% of the work can be done, but that’s the way it is.\n\nIn trying to go back to think about the people who influenced me the most, there’s no question in my mind that my mother would be number one.  Secondly, my brother because he was leading into medicine and he was an endocrinologist and had severe diabetes.\n\nMy professor of medicine, Dr. Richard Ebert was the best bedside clinician I’ve ever encountered.  I was lucky enough for him to be my attending most of the year I was an internal medicine resident and I can’t imagine how many pearls dropped all over the floor which I was gathering day-by-day.  I understand Dr. Ebert’s brother was a professor of medicine at Harvard and another brother was a professor somewhere, so I sure thing that family contributed to American medicine.  My best friend and biggest role model in the community was Pat Wilson, who was the owner and chairman of the local bank.  Mr. Wilson helped me understand the need for physicians to become involved in the community, in the chamber of commerce, in churches and in libraries and other things that each community needed.  I believe that and served on many, many committees in developing a library for Jacksonville, the hospital for Jacksonville and many other clinical services that were needed.  Nursing homes developed in the area following the development of the hospital.  These all added to the care we could give our patients.\n\nOne thing about family practice, we did have six doctors so we had more and more time off.  My wife and I loved grand opera and were able to then take a week off and go to New York in December to attend the opera.  We were able to do this over probably thirty years and we had a wonderful time and of course the Metropolitan is the outstanding opera house in the world as far as we’re concerned.  We were able to learn a lot about New York and about the various plays and so on, in town so it was a very valuable experience.\n\nI flew airplanes, including a Beach Baron, which was our long time airplane.  The family and I could then travel to places, such as Destin, Florida, which takes you twelve hours to drive but an hour and a half to fly and we could go to the northeast, California, Texas over and over and the children enjoyed the rapid flight and trips to the Six Flags Over Texas and Six Flags Over Missouri and so on.  I would highly recommend aviation to doctors with the full warning that this is a profession to fly airplanes, just like a doctor and you can’t just bully your way through it or you’ll then get in trouble.  I remember the American Academy of Family Physicians became alarmed at the number of physicians who were getting killed flying airplanes and went on an extensive program years ago to try to remind us of the importance of reeducation and flying with our instructors, becoming instrument rated and in every way be a proficient pilot that doesn’t end up with a crash.\n\nDuring my practice days I was lucky enough to be a preceptor for medical students and nurse practitioners.  The school would send these people to us for a month or two, seeing our patients in the office with us and beginning to see what it’s like.  I’m sure that we influenced some people to be family practice doctors but I had several who became great surgeons and other specialists that really helped our community.\n\nThere is no way I can go over the number of committees and other things I was fortunate enough to serve on.  I have included a copy of my curriculum and I’m just going to briefly mention several.  I’m a Senior Staff Member at the Rebsamen Regional Medical Center in Jacksonville and on the staff at the University of Arkansas Medical Center in Little Rock.  I’ve served on the staff of Memorial Hospital in North Little Rock, St. Vincent’s in Little Rock and Baptist.  I served as the original Chairman of the Medical Staff at Rebsamen and developed the policies and procedures.  I developed the intensive and coronary care unit at Rebsamen and served as Director for 25 years.  Of course, part of that was to be a CPR and ACLS instructor trainer for our staff.  I worked as the Chairman of the Executive Committee working with the board of the hospital for over ten years.  We developed the Rebsamen Hospital foundation to add more facilities for our hospital.  The last project I participated in was a $300,000 educational building for the hospital.\n\nI developed the Medical Ethics Committee of our hospital and served as its chair until retirement.  Again, I now serve as an instructor at the UMS Family Practice as primarily a preceptor with three year clinical students.  I was fortunate to serve on the Admissions Committee at the Medical Center for two separate five year terms and found that a challenging and interesting thing since there are so many people who want to go to medical school and so few positions. \n\nI chaired the Founder’s Society of our alumni association and served on this board for over 20 years.  Of course, I’m a life member of the AMA, Arkansas Medical Society and Pulaski County Medical County and Arkansas Academy of Family Physicians. \n\nAs a part of my aviation experience I served as a medical examiner for pilots, both commercial and private and found that to be interesting and stimulating work.\n\nAs the years went by it was clear that our ambulance service was going to have to be fixed and so working with the Mayor and City Council, we developed the Jacksonville Paramedic Ambulance Service, which was a part of the fire department so that we could have the salaries and benefits.\n\nSome of the things that I did I found tremendously interesting and stimulating but the number one thing that I enjoyed the most was serving on the Arkansas Board of Corrections for ten years.  When I went on the board, Governor Rockefeller had just exploded the fact that Arkansas has the worst prison system in the world.  They were inhumane, mainly run by the inmates and it was just a disgrace.  Mr. Rockefeller had passed a new board where politics could not be involved in any way in the prisons and we were able to go ahead and get a commission who was the greatest administrator I’ve ever seen, Terrell Don Hutto came to us from Texas and immediately established an educational program for staff and we immediately went after some medical facilities, which were non-existent.  Our senator, Don McClellan, helped us get several million dollars to build our hospital and admissions center which changed the face of our medical care.  We were able to establish sick bays for each of the units and a small hospital for non-serious offenders and we had a relationship with the Pine Bluff Major Hospital to take all of our really sick inmates which we staffed with correctional officers we could have the prisoners there.\n\nI cannot say enough for what was done in the prison system and the pride I have that when I left the board, all of our units were accredited by the American Correction Association and we had changed from being an awful, punitive, terrible place that hurt people to giving inmates a choice of changing their life or continuing the path they were on.  Hopefully that’s continued.  \n\nOne of the more interesting things while I was on the board, at the first meeting or two I saw in the medical report, a case of tuberculosis.  My eyes popped out of my head and obviously I was very, very concerned.  Dr. Bill Stead, who is an outstanding tuberculosis specialist at the Arkansas Health Department, came down and we reviewed the situation and he set up a program to find cases and to get it stopped.  It took us two years to get everybody tuberculin skin tested, everybody X-rayed, everybody that had had a change of their tuberculin to positive on INH for whatever it was, six months or eight months, whatever the thing was at the time.  After three or four years we never developed problems with abnormal chest X-rays and of course everybody still gets tuberculin skin tested and follow ups.  I consider that a triumph of Dr. Stead.\n\nAnother thing that I found interesting was serving on a bank board.  I did not understand finances or anything of that nature and the thirty years I put on the board of First Arkansas Bank and Trust were very valuable.  Besides that, I got to work closely with my friend, Pat Wilson, who was the best community developer and organizer in the history of the world as far as I’m concerned.\n\nMy medical school has rewarded me for nothing but anyhow, I received a Distinguished Service Award in 1975 from UAMS.  I was considered the outstanding preceptor for our residents in family practice each year.  I was awarded the Distinguished Alumni Award from the Caduceus Club, which is our alumni association, in 2005 and I was awarded membership in the UAMS Medical School Hall of Fame in 2005.\n\nI must say that my choice of family practice and my local community and the years I was able to serve were outstanding fun for me.  My wife enjoyed her community activities and she did the same sort of things in other areas.  She loved Children’s Hospital and worked there for several years, establishing a failure to thrive clinic which is very helpful to patients who need that service.\n\nI think the biggest problems we face in family practice nowadays is really that of medicine.  Anyone who has any brains understands quickly that the problem we have in servicing the American public is the lack of primary care physicians.  If one studies the medical schools around the country, somewhere between 17 and 20% of students go into family medicine.  One of my professors studied that carefully and feels that the problem is financing.  That is, the students have high debts with student loans and loans while in medical school which averages $200,000 for each person.  He says if we would ask a person to go into primary care and serve a smaller community for five years and have their debt rescinded, would be helpful in turned around.  He may be right but something needs to be done to put 50% of medical students graduating into primary care which I include family practice, pediatrics, OB/GYN, gerontology and maybe ER.\n\nI think that the American Board of Family Practice has done an outstanding job in making our service for -- a real profession and has changed the tide from the general practitioner who was a needed person at that time but is out of step with the current medical care.\n\nIt’s been fun going through the past and bringing myself a little bit up to date.  I hope it hasn’t been too boring.\n\n(Tape 2, Side 1  Interviewed December 16, 2010 by Martha H. Lauster, MD): YOU SAID THAT MOST PEOPLE DID A TRANSITIONAL INTERN YEAR AND THAT WAS PRETTY MUCH IT UNLESS THEY SPECIALIZED.  SO THE GPS DID AN INTERN YEAR AND THEN KIND OF ALMOST APPRENTICED THEMSELVES WITH OTHER DOCTORS.  YOU DID THREE AND A HALF YEARS OF RESIDENCY, HOW DID YOUR RESIDENCY FALL OUT?\n\nFirst of all, I have always considered myself a family physician.  It was clear to me from journals and reading that we were heading to a board (?) and we needed to have a formal training program, so I made one.  It wasn’t what we have now but it’s still part of the bus.  We called it -- Intern.  I went to St. Louis City Hospital, which is a big, all emergencies, everything working, St. Louis City, so you saw a zillion patients.  That’s what I needed and we worked the ER a lot.  That was a great thing.  I would have been an internist if I’d… IF YOU’D LISTENED TO YOUR MENTOR YOU WOULD HAVE BEEN, RIGHT?  My mentor and my brother and everybody else.  The academics are still there.  You don’t have to give it up just because you’re a family doctor, you can still be academic.  My year of residency with Dr. Ebert and the rest of that staff was fabulous.  In those days it was white medicine, colored medicine.  It’s awful but that’s the way it was.  The first floor was colored medicine, the fourth floor was white.  I was a resident six months here, six months there.  The beautiful part of it was that I had so much contact with the faculty.  Dr. Ebert, when he was on my service, he could be there at 7:00 in the morning, -- the patients students were going to present to him, he could go read up and be ready for it but he also was dropping pearls all over the floor.  Have you ever been around Dick Ebert?  NO, I HAVEN’T.  It’s a sight.  He’s a great person.  And of course my sweet brother, he’s an endocrinologist with all the diabetics and so on.\n\nTHAT’S AN AMAZING STORY ABOUT YOUR BROTHER.  I CANNOT BELIEVE HE SURVIVED TO ADULTHOOD, MUCH LESS TO GO ON AND BE AN ENDOCRINOLOGIST.\n\nWe had a tough, wonderful mother.  Can you imagine, you’re 28 and you have a three year old in 1929 who develops diabetes.  -- insulin -- so all we had was--.  She had an old family doctor named Wilson, of course he didn’t know what we know, he’s just a family doctor but he knew how to do urine checks and see what the urine checks look like.  Blood sugars were unheard of, so that’s what they did, urine checks four times a day and insulin based on that.  Of course that’s stupid.  IT’S BETTER THAN NOTHING, RIGHT?  My task was, when he developed an insulin reaction through the night, to get sugar in him and call Dr. Wilson and see if Dr. Wilson had any other suggestions.  I was six, I think.  Jim had the wonder of being a genius.  He’s extremely bright so he could study himself.  He figured out how you treat diabetes himself and so he did.  He finished medical school here then went to Duke.  Dr. Hamlin was the Endocrinologist up there, Jim spent three years at Duke then came back out here in Endocrinology.  I had that.\n\nI really like academic medicine.  You do too.  YEAH, I DO.  I love people, I like to get in their skin and listen to them and see what I can do.  What can we do together.  I was supposed to have a year of obstetrics with pediatrics.  I got six months of pediatrics and then one of my classmates absolutely drove me crazy and I had to come to Jacksonville and practice.  He was going crazy, -- over that big vase out there and we needed help so all right, so I didn’t do my OB.  He said, I can handle OB, don’t worry.  YOU GOT ON THE JOB TRAINING WITH OB.  That’s right.  I think we recruited a surgeon to be with us at the time, he did all our sections for us so it all worked out.\n\nSO YOU MADE YOUR OWN RESIDENCY BECAUSE YOU KNEW WHAT YOU WANTED.\n\nThat’s right.  I must say, St. Louis City University (inaudible) I respect them all for that.  Here this crazy kids wants to do about three and a half years of stupid stuff.  Let’s just allow him to do it, just laugh and see what happens.  IT STOOD YOU IN GOOD STEAD.  (inaudible)  I DEFINITELY GOT THAT IMPRESSION FROM LISTENING TO THE TAPE.  My wife would change it.  WHAT WOULD SHE CHANGE?  She wanted to be in Baltimore.  Betty was a wonderful nurse and she worked at Children’s before our children came and when our children went to school, she went back to Children’s.  Her interest was a thing of pride.  She set up that clinic over there at the center and got the protocol all set -- beat a kid.  Three year in come in weighing 16 pounds, you couldn’t believe it but they got that figured out --.  So she worked there pretty much all the time. Betty was extremely talented.  She should have been a doctor.  (inaudible)  We were just fortunate to meet each other.  THAT WAS MIRACULOUS, WASN’T IT?  BOTH IN THE HOSPITAL IN NORTH LITTLE ROCK AT THE SAME TIME.  Yes.  We were both precepting up there/  FATE.  She was also pretty good looking.  GOOD LOOKS NEVER HURT.  Who is that?  And she was, of course, from my hometown.  I was from Magnolia, she’s from Walkerville which was ten miles so it was convenient.  HOW DID YOU ALL AVOID EACH OTHER GROWING UP?  I was two or three years ahead of her.  I finished high school early because I knew I was going to have to go in the service and I wanted my diploma so I was three years ahead of her and when I got out of the Navy I was going to college and she was going to nursing school.  That’s how that all worked out.\n\nYOU MADE SOME COMMENTS ABOUT KIND OF HOW MEDICINE IS GOING.  YOU COMMENTED THAT YOU HAVE TO SEE A LOT OF PATIENTS TO KEEP YOUR PRACTICE OPEN NOW, WHICH IS A DISASTER AND YOU ATTRIBUTED THAT TO THE POOR REIMBURSEMENT FROM MEDICARE AND MEDICAID.  I WONDERED, BACK BEFORE ALL THAT KIND OF SHOOK OUT AND IT WAS FEE FOR SERVICE OR CHICKENS FOR SERVICE OR WHATEVER, HOW MANY PEOPLE DID YOU NEED TO SEE IN A DAY OR HOW MANY PEOPLE WOULD YOU SEE IN A DAY?\n\nBefore Medicare and Medicaid, there were very few insurances, it was cash basis so our charges were pretty slim and therefore they paid cash --.  We didn’t know anything about volume.  The first year I think we made $30,000.  That’s plenty in those days, it was just fine.  My wife was working so we had no need for any more money than that.  That just got better when Medicare and Medicaid just started because their reimbursement was excellent.  I may have said the worst thing that happened, we won’t call it a law, here’s this sweet old lady in with a broken hip and she didn’t have insurance and no money and her family doesn’t have any money so you spend half your life talking your friends into operating on her.  Medicare, all of a sudden she’s a primary patient.  We’d be delighted to see her, doctor.  Of course they paid us pretty much what we were getting and those days, it was a boon.  I’m sure we went from $30,000 to $90,000 a year with Medicare because all those older patients were treated free and paid a substantial rate.  Of course, as you know, as years have g one by that’s been whacked and whacked and whacked.  Primary care docs, family doctors and pediatricians are just getting killed.  I don’t know how many you have to see.  I’ve been out of it long enough that I kind of lost out of the…  my own clinic in Jacksonville still have ten family doctors and nurse practitioners --.  The trend now, doctors quit going to the hospital, which in my mind is a disaster.  The hospital over there is really suffering and probably going to fold.  Ten family physicians and all their practice -- it’s a real problem.  Of course, early on in the hospital work we couldn’t get any help so we all trained ourselves.  I was an intensivist.  I DIDN’T KNOW THAT PART OF YOUR HISTORY BEFORE I LISTENED TO THE TAPE.  We had the first intensive care unit in the state, coronary care unit and of course we could get help them like the federal government gave us a grant to get nurses trained to read the monitors and all that stuff, so we did fine.  They have arrhythmia, diagnose and treat it.  That was fun.  Of course one of our partners was a surgeon, he was well trained and a super good surgeon, excellent.  Good wonderful care of patients so we’d get him to do… he helped us any time we needed it.  So we had a five man family practice and one surgeon for many years.\n\nHOW MANY PEOPLE DO YOU RECKON THAT Y’ALL SAW AS A GROUP IN A YEAR?\n\nOver the years I could see 25 patients a day, easily and be gone and active when the day was over with --.  Those days, the hospital was ten steps.  Come to the office at seven and go make rounds -- by eight, see our first appointment at eight and then by evening, you need to go by the hospital and see maybe one or two of them if something else had happened.  That’s the way we did it, so I’d se 25 patients in the office and five or ten in the hospital each day and most of my partners did that.\n\nWHERE DID THE DELIVERIES FIT IN WITH ALL THAT?  THAT MUST HAVE REALLY CAUSED A WRINKLE.\n\nWe just ran and did it.  In those days, induction was coming on so we did a lot of that on weekends and doctor on call, try to space it into your practice.  Of course, we worked all the time trying to get an OB/GYN doctor out there to take that all off of us.  Finally we did, we got two OB docs and of course our promise to them was, if y’all will come, we’ll quit.  They took over and they did a wonderful job and took that burden off of our back a lot.  If they’d had epidurals I would have never quit because anesthesia was so bad.  We had -- and IV narcotics, that was terrible anesthesia for an obstetrics patient.  Give -- too early they’d stop delivery -- section.  It was awful.  Epidural, no problems, labor right on.  Anyhow, that’s over.  My daughter is a nurse anesthetist in Little Rock and of course they do epidurals by the thousands.  Of course they’re on call for all of that.  They have to do the epidural and you have to stay in the hospital.  There, they’re pretty much on call.  She should have been a doctor.  My daughter is extremely intelligent and I kept urging her.  She got her BS in nursing right away and became an LPN, she worked -- care for years and then she got sick of that and so she went on for three years in nurse anesthesia, came back and has been there ever since.  She should have been a doctor, she’s like you, touchy feely.  SOMETIMES THOUGH IT’S NICE WHEN YOU CAN JUST PUT THEM TO SLEEP.  Well that’s right.\n\nHOW DID YOU MANAGE DRIVING FROM JACKSONVILLE TO LITTLE ROCK BEFORE YOUR HOSPITAL WAS BUILT?\n\nThat was the hardest.  We didn’t have a freeway either so Jan and I would meet at the office at 6:30 and look at our schedules and make any comments for our staff to have ready when we got back and we’d go flying down there and make rounds.  You get in trouble when you got no OB down there in labor so the other guy’s got to take care of all the business.  It’s not good, it was hard on your practice, the patients.  Our staff said, Dr. Wortham is down at St. Vincent with an OB patient, as soon as he gets through we’ll call you in.  They accept that, they don’t mind, they were my last years.  I FOUND THE SAME THING WHEN I WAS IN WISCONSIN AND I WAS DOING A FAIR NUMBER OF DELIVERIES.  IF I WASN’T THERE DELIVERING A BABY EVERYONE WOULD SAY, OH, IT’S A BABY, I FEEL ALL RIGHT.  I thought obstetrics was fun, I don’t like the ruptures and all the complications.  Saw yesterday, one of the residents, had a 24 hour urine -- she didn’t have anything else, she’s going to.  YOU WATCH THAT PROTEIN.\n\nIN LIGHT OF HOW BUSY YOUR EARLY PRACTICE YEARS WERE AND THEN AS YOU KIND OF BUILD REBSAMEN HOSPITAL AND GOT REAL BUSY THERE, HOW DID YOU FIND TIME FOR AS MUCH COMMUNITY INVOLVEMENT AS YOU HAD?  YOU DIDN’T HAVE A LOT OF DOWN TIME IT SOUNDS LIKE.\n\nI did it nights and weekends.  YOU JUST FIT IN WHEREVER YOU COULD.  Yes.  The best thing that ever happened to me in my life was serving ten years on the prison board. It made me a human to go out there and sit down and talk with those people.  You know most of them are lying.  Why?  What happened to this person to change from an active -- citizen to a crook?  In those days, prison was murders and robberies and assaults.  -- murders.  Now it’s all drugs.  We had 1,500 inmates, they have 18,000.  -- Texas was 120,000, California, 118,000  or 120,000.  I don’t know how they feed them.  How do you feed them?  Of course we had wonderful cooperation… you don’t know anything about Governor Rockefeller but the Rockefeller family and he was very unhappy with his life up there so he -- got to know him and he told him to come to Arkansas.  He was rich, he didn’t have to -- so he bought about a third of Petit Jean Mountain and then began getting interested in politics.  Those of us who had any brains wanted him because he was liberal, he was intelligent, he had the right ideas and he had no interest in stealing.  He was the reason I was on that board --.  He would tell you, you get what you want, I’ll handle it.  \n\nAND YOU BASICALLY BUILT THE WOMEN’S PRISON SYSTEM FROM THE DIRT UP.\n\nIt was awful, it was an old chicken house because those were murderers, who cared?  My sweetheart wife got interested, she went there a lot, to the women’s unit and tried to work with them.  We heard of  therapy (?) communities in prisons -- attack therapy kind of stuff.  Two of the board and I were interested in that so we found two families, husband and wives who did TC up north and would come to Arkansas.  That’s the first one we set up was in the women’s unit.  One of them is still working for the prison.  She has a 100 bed drug rehab center in Fayetteville, the old hospital, she has over 100 inmates, all drugs, all young women and of course that’s a group that’s more intelligent than the ordinary prisoner.  Fayetteville, -- where the education up there is a lot better.  She has a great facility -- attack therapy -- you can’t get by anything with them.  It was an important part of my life and of course, it did take away from the family.  We would have a meeting once a month, it was always scheduled on a Saturday because everybody worked.  Just fascinating.  The main thing that was important to us, the fact that we had Governor Rockefeller and -- stayed with us so it was easy to make progress, we could get money.  I remember once I needed a hospital admission area to get inmates away from everybody and study them for a week or two and see if this guy’s going to be a problem.  My good friend, Pat Wilson, who was running the bank in Jacksonville was a good friend of Senator -- and I told Pat, senator, I’ve got to have $3 million for an admission hospital.  If you need it, let’s go see.  He made a point of -- Sunday morning.  He let me have a chance to talk, told him what the problem was, why we needed to have an admission center, why we needed a little 20 bed hospital for acute illnesses --.  Well, you call me Monday, I’ll see what I can do.  Yes sir, senator, what’s your number?  Called him and said, doctor, you’ve got your $3 million, I’ll have it…  I nearly fainted.  Of course, the Senate was a power in those days -- both of them were powers and this was money that hadn’t been spent so be absconded with it.  AT LEAST SOME OF IT WENT FOR A GOOD CAUSE, RIGHT?  Of course, like all good politicians, now doctor, there’s one thing now, I’m going to tell you who the architect is going to be.  Yes sir, senator, we don’t care.  It’s still there.  We built a 20 bed hospital and I got our nurses at Rebsamen to plan it.  I worked with excellent nurses and damned if it wasn’t perfect.  It was fun.\n\nDID YOU EVER DO ANY OF THE MEDICAL WORK THERE?\n\nWe had a terrible tuberculosis problem.  I had to get all involved in that, sit in the board meetings and we had two cases or tuberculosis.  What?  We had two cases of tuberculosis that we had to send down to the medical center.  What?  So that got my attention in a hurry.  Dr. Bill Stead, who was the -- at the health department, I called Bill and told him, I got a problem at this prison, there’s 1,600 people -- students.  He let me come to the office and we sat down and talked about it, here’s our plan.  Of course everybody got tuberculin skin tests.  Bill discovered during our work there a lot of negatives -- could be positive and we did that -- positive X-ray.  It took us three years to get that place cleaned out.  Treated two or three hundred -- it’s been clean ever since.  Of course you know that, TB has retreated in prisons and the nursing homes and that’s what you’ve got to look at.  So that was a great thing for me to see public health in action, working.  YOUR OWN LITTLE EPIDEMIOLOGICAL STUDY.  (Inaudible.)  THAT WAS A TANGIBLE GOOD, EASY TO SEE.\n\nI KNOW THAT MUCH OF WHAT YOU HAVE DONE YOU’VE REALLY, REALLY ENJOYED BUT I WONDERED IF THERE WAS ANYTHING THAT DISAPPOINTED YOU IN YOUR CAREER?\n\nThe hardest thing we had at Rebsamen, we needed some specialty help, couldn’t get it.  We just had to wait until we grew then bring specialists in -- then moved to North Little Rock and now -- we’ve got a freeway, you can get out there in 15 minutes and we have a functioning intensive coronary care unit and cardiologist  -- rewarding.  That was the most disappointing and hardest thing for me was the fact that we couldn’t get help --.  We found people who were kin to us and solved that problem.  BUT IT TOOK SEVERAL YEARS.  The hardest thing, I’m sure it’s the same thing for you -- is patients who can’t pay.  I feel terrible about that.  Do it for free, well, you can’t do that but you just keep doing it.  They need the help.  They need it more than anybody else, usually and there are very few crocks (?) in that group, they’re sick.  The second part of the same thing is medicine, money for their medicine.  I haven’t solved any of that.  I WISH YOU’D GET TO WORK ON IT THOUGH.  Wal-Mart has done better than anybody.  They have solved the problem more than anybody else.  It’s amazing.  Now everybody does it.  BUT THEY HAD TO HAVE A BIG OLD SHOVE BEFORE THEY WERE WILLING TO SUCK IT UP.  I wonder how much Pravastatin they sell?.  I PERSONALLY PROBABLY WROTE A FOOTBALL FIELD’S WORTH OF PRAVASTATIN PRESCRIPTIONS.  Thousands and all needed.  That’s Sam Walton, that’s the way he was.  Getting away from that in Wal-Mart is not his problem because that ain’t the way he saw it.  -- on a football game, TCU Arkansas -- TCU, nice looking couple sitting in front of us, lady in a bun and old country wear and this gentleman was sitting there having a good time, calling the hogs and acting like us.  -- somebody came up, why Mr. Sam, how you doing?  It was Sam Walton.  We followed them out to see what special they were getting, well, nothing, they had a car out there.  NO RED CARPET.  No, nothing.  NO RECEPTION WITH THE TEAM, NOTHING LIKE THAT.  No, nothing.  IT’S FUNNY THEY WERE JUST IN THE STANDS LIKE EVERYBODY ELSE BUT I GUESS THAT’S HOW HE WAS.  Yes, he was a country boy.  The first thing was a five and dime then worked himself up to a dollar store and then he set up his own.  He had to be a genius.  The family has carried on.  That girl developing that wonderful museum -- .  I DON’T KNOW ABOUT THAT.  Alice has been an art collector all her life, she’s got the money and she can do it.  She is building an art museum called Crystal Bridges in Bentonville.  It’s a multi-acre thing.  It’s going to be magnificent.  She’s got all these wonderful paintings that she’s purchased over the years and that will be all open next year.  Arkansas and something like that?  THAT’LL BE WORTH A PILGRIMAGE, FOR SURE.  I’ll be up there.  Of course all those boys have done the same and of course, mama Walton, I think she’s still alive.  They have a foundation -- every year it’s millions they hand out.  Like in Jacksonville, if we had a little community project and we need five, six, eight thousand dollars, we’d go to the Wal-Mart manager and tell them, we really need to have this and he’d see to it we got it, $6,000.  We did that several times.  I KNOW PHILANTHROPY IS STILL PRETTY HIGH ON THEIR LIST AND THEY’RE DOING SOME WORK WITH CHILDREN’S RIGHT NOW, WHICH IS GREAT.  They always have.  That’s Sam.  He must have been a wonderful man.  I’m sure a lot of people knew him well, I didn’t have that opportunity but I’m sure you would be delighted to know him.  NOBODY TELLS UGLY STORIES ABOUT HIM.  Retail merchant taken to a new level, 2,600 stores.  FATHER OF THE BIG BOX STORE.  The labor union don’t like him because he don’t cow tow to them.\n\nON THIS, YOU WROTE AN ANSWER BUT I CAN’T READ IT BECAUSE YOU WRITE LIKE A DOCTOR.  THE QUESTION IS, WHAT WAS THE POSITION THAT YOU ENJOYED THE LEAST IN YOUR CAREER AND WHY?\n\nMoney problems.  WHAT WE JUST TALKED ABOUT.  WHEN PEOPLE COULDN’T PAY, IS THAT WHAT YOU MEANT?  Yes.  I hated it.  My staff would say, don’t pay attention, bring them back.  I couldn’t stand it.  THESE DAYS I THINK WE’RE KIND OF INSULATED FROM IT AT UAMS, ANYWAY, THE MONEY’S ALL SORTED OUT ON THE FRONT END.  IF THEY GET BACK TO SEE ME, THEY HAVE PAID OR THEY HAVE INSURANCE.  -- That’s $368.50, something like that.  You know the patient doesn’t have $3.68 --.  I THINK IT’S GOT TO GET WORSE BEFORE IT CAN GET BETTER BUT I HOLD OUT HOPE THAT IT WILL GET BETTER.  We’ve got the resources.  The main problem is, you can’t convince leaders in Washington what the problem is.  If you talk to them about the need for primary care physicians in this country, they wouldn’t…  That’s the most pressing problem we have.  You’re going to dump 30 million more people in the system that can’t handle them now and the primary care docs can’t do it.  What you want to see is -- Medicare and Medicaid patients.  OH YES, CLINICS ARE ALREADY DOING THAT IN LITTLE ROCK, THAT’S WHY UAMS GETS SO MANY OF THEM BECAUSE A LOT OF OTHER CLINICS SAY NO, CAN’T TAKE ANYMORE.  In this country, 18% of the graduates from medical school go into primary care, which includes pediatrics, gerontology, ER and family practice.  You need 50%.  Our schools last year, 17% graduated and went into primary care.  That’s horrible.  \n\nYOU MADE THE COMMENT ON THE OTHER TAPE THAT A LOT OF PEOPLE MAY BE SUITED TO IT BUT THE DEBT BURDEN IS WHAT KEEPS THEM FROM GOING INTO PRIMARY CARE.  I THINK THAT’S PROBABLY TRUE.\n\nDr. -- wrote about that article about that.  He said his studies over the years, that was the primary problem.  They looked at $200,000 -- and family doctors make $100,000 a year and cardiologists make $1 million.  I like cardiology, it’s just fine so I’ll be a cardiologist.  I think he was right.  The tragedy in our situation -- family practice, is that we do all that hard work and do really good work, I think and -- you’re going to end up telling everybody else -- to Pakistan and India, we need to quit that some way or we can’t get the Arkansas people to come to our program --.  A LOT OF AHACS.  Yes.  IT’S A REALLY TOUGH PROBLEM.  I WISH THAT THERE WAS A REAL CLEAR PATH THAT EVERYBODY COULD KIND OF SEE, THAT WOULD MAKE THINGS A LOT EASIER.  IT’S MURKY.  Dr. Lipzing (?) was saying and we had a program like that but it kind of went away -- Fordyce  and wait for five years, all of your notes are forgiven.  Most of the docs stayed there and they like it and they get their debts paid and all of a sudden everything’s just fine.  I THINK NATIONAL HEALTH SERVICE CORPS, IF I’VE GOT THAT CORRECT, THEY’RE STILL DOING SIMILAR PROGRAMS BUT IT’S USUALLY, AT LEAST WHEN I’VE LOOKED INTO IT, IT’S BEEN, WE’LL PAY OFF $15,000 OF YOUR LOANS PER YEAR THAT YOU’RE HEAR OR $25,000 PER YEAR BUT THERE’S A LIMIT TO HOW MANY YEARS THEY’LL DO IT, MAYBE ONE OR TWO YEARS.  I KNOW THIS SOUNDS RIDICULOUS BUT FOR ME, LOOKING AT IT, I WAS LIKE, I OWE $200,000, PAYING OFF $30,000 OF THAT IS NOT ENOUGH TO MAKE ME LIVE IN FORDYCE.  I AGREE WITH YOU.  Nobody’s listening to that.  I THINK IT’LL KIND OF HAVE TO REACH A CRISIS POINT.  PEOPLE WILL HAVE TO EXPERIENCE FIRST HAND, NOT BEING ABLE TO SEE A PRIMARY DOCTOR OR ALL OF THE EVIDENCE THAT WE HAVE, HAVING ONE PERSON COORDINATING THE CARE REALLY IMPROVES HEALTH OUTCOMES FOR PEOPLE.  I THINK WE’RE GOING TO HAVE TO SEE THE NEGATIVE SIDE OF THAT BEFORE WE EMBRACE WHAT WE KNOW IS TRUE, WHICH IS THAT WHEN PRIMARY CARE RUNS THE SHOW, PEOPLE GET BETTER, BETTER.  That’ll help -- offers.  If you solve that problem they can get appointments --.  That doesn’t work.\n\nYOU ARE A RESIDENT PRECEPTOR AT THE UAMS DEPARTMENT OF FAMILY AND PREVENTIVE MEDICINE, YOU’VE BEEN DOING THAT FOR SEVERAL YEARS.  WHAT WAS OR IS YOUR BIGGEST SATISFACTION IN THAT ROLE?\n\nPretty much all of it.  IT’S PRETTY CLEAR YOU LOVE IT.  We’re down right now, we need two or three preceptors so we’re too busy so we don’t do as well.  Of course number one is interaction with the residents and getting to know them.  There are two or three in this group that are just outstanding, Dr. --, that girl is going to be a great… she’s nuts, she’s kind of like you.  SHE’S FUNNY.  She really is.  She won’t do a year of emergency room.  I wrote her letters from a dozen different places in emergency room or in the outreach program, she had five or six things she wanted to try.  She didn’t get any of them.  They’re crazy, she’s smart.  I think they’re going to hire her in the faculty.  I think she can precept for awhile.  I told Dan, hire her, she’s very intellectual.  VERY GOOD WORK ETHIC ALSO.  Yes, works hard.  I ALWAYS ENJOYED WORKING WITH HER.  I think Dr. -- is a really good doctor.  I DIDN’T GET A CHANCE TO KNOW HIM BEFORE I LEFT THE DEPARTMENT.  He’s first year.  They’re doing fine --  they’re all going to be gone.  LAST YEAR, I THINK WE HAD TWO OF OUR INDIAN RESIDENTS ACTUALLY STAY IN ARKANSAS.  ONE OF THEM WENT TO AN ER SOMEWHERE IN RURAL ARKANSAS, CAN’T REMEMBER WHERE RIGHT NOW BUT THE OTHER ONE ACTUALLY IS WORKING FOR ST. VINCENT’S IN JACKSONVILLE AND REALLY LIKES IT.  SEVERAL YEARS AGO, ONE OF OUR GRADUATES, DO YOU REMEMBER DR. NELEUR, SHEBA NELEUR?  HE’S ACTUALLY AT ST. VINCENT’S EAST RIGHT NOW SO HE’S AT THEIR CHARITY CLINIC.  PEOPLE SAY HE’S DOING A REALLY GOOD JOB.  I just thought the problem was they couldn’t stay.  SOMETIMES THEY CAN.  IT’S ALL VERY MYSTERIOUS.  I DON’T KNOW ANYTHING ABOUT THE VISA PROCESS BUT SOME DO AND I THINK MORE WANT TO.  I STILL WOULD WANT TO SEE MORE OF OUR OWN GRADS STAY WITH US THOUGH, BUT I THINK THE PROGRAM, IT’S JUST HARD BECAUSE IT’S AN OPPOSED PROGRAM.  WE GOT TO FIGHT FOR EVERYTHING WE DO AT THE BIG HOSPITAL.  Kids, I’m sure don’t feel that they’re respected at all --.  I worked as hard as there is.  Family practice out in a community is the hardest job there is.  IT IS.  I HAD A FRIEND WHO TOLD ME ONCE, I THINK ALL THE FAMILY DOCTORS SHOULD JUST GO ON STRIKE BECAUSE AFTER THREE DAYS THE CARDIOLOGISTS WOULD BE CALLING US, BEGGING US TO COME BACK SO WE COULD LISTEN TO THIS INSTEAD OF THEM.  I DON’T THINK I’M ORGANIZED ENOUGH TO DO A STRIKE BUT IT MIGHT BE INTERESTING TO SEE.\n\nDO YOU HAVE ANY DISAPPOINTMENTS THAT HAVE OCCURRED TO YOU OR THAT YOU EXPERIENCED AS A FACULTY PRECEPTOR?\n\nThe only problem I have is we need three more faculty and we’ll be all right.  I’ll have 30 to 40 patients in my side, fortunately a third of them don’t show up so by 1:00 you can finally get through with it, well that’s not any fun, you tend to cut corners you ought not to be cutting.  TEACHING OPPORTUNITIES KIND OF GET LOST IN THAT SCENARIO.  Dan, I’m sure is working hard to try to find faculty who want to do that.  Primary care docs are -- do that.  It’s hard, y’all do hard work.  IT IS HARD.  IT’S HARD BUT IT WAS FUN, I ENJOYED IT.  So many meetings and so many requirements -- .  COMMITTEES, YES, IT’S TIME CONSUMING.\n\nTHIS IS JUST AN EDITORIAL COMMENT THAT I FOUND MYSELF WRITING WHEN I WAS LISTENING TO THE TAPE.  I SAID, ALL OF YOUR COMMUNITY ACTIVITIES MAKE A REAL CASE FOR THE EXISTENCE OF ALL TRUISM.  HOW DID YOU DO IT?  CLEARLY IT FED YOUR SOUL AND KEPT YOU GOING, ALL THIS WORK THAT YOU DID.\n\nI was lucky enough to have a wife that was a grandchild of a minister who was a strong Presbyterian and she converted me from Methodist and that really became an anchor for us.  Presbyterians do a great --, you know what they think and what they believe, which is not --, so that was a lot of help to us --.  The church was the anchor and any excuse you needed, the church wants you to do that.  That’s your task on this earth, to be a volunteer and get everything done that you can that helps people.  Don’t do politics.  NOTE TO SELF, NO POLITICS.  I’M ABOUT AS APOLITICAL AS THEY GET, EXCEPT FOR MY STRONG VIEWS ABOUT PRIMARY CARE.\n\nTHIS IS ONE OF THE QUESTIONS ON THE HANDOUT THAT THEY SENT.  LOOKING BACK OVER YOUR YEARS IN FAMILY MEDICINE, WHAT ARE YOUR FONDEST MEMORIES?  YOU MENTIONED ONE THING THAT JUST WARMED MY HEART, IT WAS WHEN THE FAMILY GAVE YOU THAT FAMILY TREE, THAT MULTIGENERATIONAL FAMILY TREE AND YOU HAD TAKEN CARE OF ALL OF THEM.\n\nThat made me cry.  It was awful.  AND WONDERFUL.  I’ve still got it up in my attic.\n\nWHAT OTHER THINGS DO YOU REMEMBER FONDLY FROM BEING A FAMILY DOCTOR?  I KNOW THERE ARE MILLIONS, PICK A COUPLE HIGHLIGHTS.  Mainly hundreds of people.  It’s funny, when Betty and I retired and moved to Little Rock, I learned right away I couldn’t go to the grocery store in Jacksonville because they’d say, what do you mean, quitting?  You don’t have the right to be doing that to us.  And they meant it.  So I quit going.  THE WHOLE CITY WITH ABANDONMENT ISSUES.  I’m 75 ma’am, I’m supposed to.  SUPPOSED TO GET TO RETIRE AT SOME POINT.  The biggest thing that’s got me nervous right now, I’m so angry with myself, I’m getting ready to take the board again because I’ve got six years and I’ve only done one of those studies.  I’ve got to do another one before the year’s out.  The first one I did on asthma I did fine.  This one on hypertension I’m not doing so fine.  I tried to do one on coronary artery disease and it’s all about intensive care medicines.  I didn’t even know what they were, much less how to use them.  I’ll be 90 years old if I take it again.  I might flunk.  I DOUBT IT.  YOU’VE PASSED IT PLENTY OF TIMES BEFORE.  Seven.  WHICH I JUST THINK IS WONDERFUL.  I should be a charter member.  THEY SHOULD JUST GRANDFATHER YOU IN.  YOU’RE ONE OF THE FATHERS OF FAMILY MEDICINE.\n\nI’M INTERESTED IN THIS QUESTION.  YOU DON’T HAVE TO ANSWER IT IF YOU DON’T WANT TO BUT BECAUSE IT’S MY OWN SORT OF RIFT WITH FAMILY MEDICINE RIGHT NOW, THERE WAS A QUESTION HERE THAT SAID, WHAT WERE YOUR DARKEST DAYS IN FAMILY MEDICINE?  THE MOST DIFFICULT TIMES, BOTH FOR YOU PERSONALLY AND FOR YOUR ORGANIZATION?  DID YOU HAVE ANY DARK DAYS?\n\nOh yes.  The hardest part, during my life I’ve had three doctors who became drug addicts in my clinic.  We missed it for awhile.  It was the nurses that caught it.  Demerol would disappear or they would see the syringes were all gone and they’d come to us.  Dealing with that just kills you because they’re nice people and good doctors that are drug addicts --.  The darkest day of my life, got one of these kids rehabilitated, back to work.  He and I went to the board to get his license and the board treated us like dogs.  I’m just a friend here trying to get this guy… and it was awful.  I’m sure they see so many bad things, everybody’s bad.  I never -- the board so I don’t know.  That was a dark day.  We got him on and unfortunately, ten years later he was dead from sepsis.  We’ve made great progress with drug addiction, haven’t we?  Absolutely zero, it’s like obesity and drug addiction, zero.  IT’S A LOT HARDER NOW TO GET THEM THAN IT USED TO BE.  I THINK IT’S IMPOSSIBLE NOW.  THEY DON’T EVEN TELL US THE SECRET COMBINATION TO THE DRUG CABINET IN THE CLINIC.  I WOULDN’T BE ABLE TO GET DEMEROL IF I HAD TO IN AN EMERGENCY.  I think that’s probably good.  Don’t you think that the pain revolution has made us more tolerant than less?  I AM SO INTERESTED IN HEARING MORE ABOUT WHAT YOU THINK ABOUT THAT BECAUSE WHAT I’M SEEING IN THE LITERATURE RIGHT NOW IS TWO DIFFERENT SCHOOLS OF THOUGHT.  THERE’S THE SCHOOL OF THOUGHT THAT PAIN IS UNDER ASSESSED AND UNDER TREATED AND THAT EVERYBODY WHO HAS PAIN DESERVES TO HAVE IT MANAGED AND THEN THERE’S THE SCHOOL OF THOUGHT THAT SAYS, HERE’S HOW WE’RE GOING TO MANAGE PAIN.  WE’RE GOING TO START WITH TYLENOL AND THEN WE’LL MOVE TO THE NSAIDS AND THEN THEY KIND OF GO DOWN THAT ROAD, WELL, IF YOU HAVE TO USE OPIODS, THIS IS HOW YOU USE THEM AND THIS IS THE WORLD HEALTH ORGANIZATION OPIOD LADDER AND THIS IS WHERE YOU START AND THEN HERE’S THE CONTRACT AND HERE’S HOW YOU DO THE URINE DRUG SCREENS.  IT’S REALLY INTERESTING TO ME BECAUSE WHAT I GET THE FEELING OF IS, A LOT OF US REALLY JUST DON’T WANT TO MANAGE IT BECAUSE IT’S SO DIFFICULT AND THERE’S AN EXPECTATION IN THE UNITED STATES RIGHT NOW THAT NOBODY SHOULD HAVE ANY PAIN AT ANY TIME FOR ANY REASON.  WALKING THE LINE BETWEEN TREATING LEGITIMATE PAIN AND TREATING MAYBE SUPER TETORIAL(?) PAIN, EXISTENTIAL ANGST OR WHATEVER WITH OPIODS.  THAT’S REALLY HARD AND TO DO THAT SEVERAL TIMES A DAY IS EXHAUSTING.  HOW HAS THAT CHANGED SINCE YOU WERE IN PRACTICE?\n\nOf course -- 20 years of practice, we didn’t give narcotics.  You had a kidney stone, we gave you a shot--, that was it.  Back pain wasn’t treated with narcotics, you went to an ET (?) and aspirin, Tylenol and heat.  Sitting in my chair at the med center, seeing what goes by, patient after patient coming in there wanting Xanax, Vicodin, because they have back pain and anxiety.  Don’t tell me that’s right.  Our kids are -- our policy, no narcotics, first visit and the patients can’t get around it, they cry and weep and all kinds of stuff but they can’t get around it because the boss is the boss.  THAT WAS THE GREATEST THING THAT WE DID.  They’d be lined up out the door and down the street.   IT MIGHT NOT BE AWESOME FOR PAIN MANAGEMENT BUT FOR DOCTOR SHOPPER MANAGEMENT IT WAS A BLESSING.  You know what they do now, they see them once and write a prescription --.  AT THE PAIN CLINIC?  YES.  And we’re right back where we were.  BUT THAT’S WHERE WE’RE EMPOWERED TO SAY, YOU KNOW WHAT?  I’VE SEEN YOUR X-RAY AND UNDERSTAND THAT YOU’RE HURTING BUT AT THIS POINT, MY CLINICAL JUDGMENT IS THAT THESE ARE NOT THE MEDICATIONS THAT ARE THE BEST TREATMENT FOR YOU AT THIS TIME AND THEN IF THEY DON’T LIKE THAT THEY GO SOMEWHERE ELSE.  THAT’S A HUGE PART OF PRIMARY CARE RIGHT NOW TOO THAT I THINK IS REALLY WEARING PEOPLE DOWN.  -- chance of getting better.  I think the pain clinics -- make them comfortable, that sounds good but if you make them comfortable and they’re addicted to narcotics, I don’t think --.  My guys ask for that every minute -- their own doctor.  IT’S SUCH A DIFFICULT PROBLEM.  I wish I had even an inkling on that but I don’t.  All I see is work, work, work.\n\nWHAT DO YOU THINK THAT’S ABOUT?  KIND OF OFF TOPIC HERE, BUT WHY DO YOU THINK THAT IN 1962 WHEN YOU WERE IN PRACTICE WE COULD DEAL WITH OUR LOW BACK PAIN FROM OUR LUMBAR SPONDYLOSIS , FROM WHATEVER?  WHY COULD WE DEAL WITH IT THEN BUT WE CAN’T DEAL WITH IT NOW?\n\nBecause we’re just like our residents, -- narcotics.  They didn’t come to you expecting that, therefore the -- treat you with Tylenol, that’s all we have, aspirin and Tylenol and no narcotics because there’s nothing to addict you, it solves the problem.  All the pain management -- they make it legitimate to addict patients.  I’m not sure that’s right.  Problem is, we don’t understand addiction and there’s a part of the brain -- we’ll have to figure it out, just like schizophrenia, -- state hospital, lock them up and let them holler and scream.  Now, take these two pills a day.  So maybe that’ll happen to us with addiction.  I HOPE SO.\n\nDO YOU THINK THERE’S SOMETHING ABOUT THE AMERICAN PSYCHE THAT WE’VE JUST BECOME LESS TOLERANT TO PAIN OVER TIME?\n\nI think we’re more tolerant to addiction.  THAT’S INTERESTING.  I NEVER, NEVER WOULD HAVE THOUGHT OF THAT.  Many, many, many patients, that’s their personality, easy to get on.  First it was alcohol as a teenager, then they get into cocaine, tobacco, whatever.  I don’t understand that.  That’s the problem we have, we can’t comprehend it.  -- alcohol problem is zero.  My daddy was an alcoholic, I saw the destruction it wreaked and I like to have a martini before a good dinner but I wouldn’t want the second one.  Tomorrow night I’m not going to have one because I’m not going to have a big dinner.  Addiction, I don’t understand that.  It’s real.  It’s terrible.\n\nI’VE BEEN LISTENING WITH INTEREST TO THIS WHOLE PATIENT CENTERED MEDICAL HOME DISCUSSION THAT WE’VE BEEN HAVING AT THE CLINIC AND NATIONWIDE AS WELL.  YOU MADE THE STATEMENT IN ONE OF YOUR TAPES THAT DECADES AGO YOU WERE TRYING TO SET UP SOMETHING THAT WAS ESSENTIALLY A PATIENT CENTERED MEDICAL HOME.  YOU WERE GOING TO HAVE ADVANCE PRACTICE NURSES AND SOCIAL WORKERS AND PHYSICIANS ALL WORKING TOGETHER TO TAKE CARE OF PEOPLE.  MY QUESTION TO YOU IS, DO YOU THINK THE PATIENT CENTERED MEDICAL HOME IS JUST A FANCY NAME PUT TO WHAT WE’VE BEEN TRYING TO DO ALL ALONG?\n\nYes.  It extended what you did.  The thing that we could have used in our practice was two social workers, like in our practice at the med center, we need ten.  AND WE DON’T HAVE ONE.  I WISH WE DID.  That’s what the problem was and we couldn’t afford them.  Couldn’t figure out how to pay for them.  Of course, we didn’t have an advanced practice nurse, we had nurse practitioner and we always had some but they wouldn’t stay because -- more money and more responsibility and I don’t blame them.  To me, if we could have had two social workers, a couple nurse practitioners and our doctors and better facilities, we would have had a lot better clinical home.  A medical home, the one issue is they’ve got to provide the care for the patient.  If they call this morning and they’re terribly sick, they need to be seen this morning.  A medical home proves that you’ve got to be available to do that, you or somebody’s got to see the patient.  Or if the nurse practitioner triages up to the doc, that’s fine, just so the patient is cared for.  WHAT THEY NEED WHEN THEY NEED IT.  Yes.  -- answer the phone -- we just do and they ain’t just going away.  THE SYSTEM HAS BECOME LARGE AND UNWIELDY, I THINK.  \n\n(Tape 3, Side 3)\n\nI think the medical home will be an answer but it’s going to be defeated by the fact that nobody’s listening.  NOBODY WANTS TO FUND US ALREADY SO WHY WOULD THEY FUND OUR MEDICAL HOME?  Yes.  THAT’S DISTRESSING TO ME.\n\nTHIS WAS JUST ANOTHER QUESTION THAT CAME UP WHEN I WAS LISTENING TO YOUR TAPE.  DO YOU THINK IT’S EASIER OR HARDER TO BE A FAMILY PHYSICIAN NOW THAN IT WAS IN THE FIFTIES OR THE SEVENTIES OR EVEN THE NINETIES?  OR IS IT JUST DIFFERENT?\n\nIt’s different.  You’re much more powerful, much more able to treat -- with great medicines, great diagnostic tools, great referral sources.  The main thing a primary doc, like Jacksonville, we had a group of cardiologists that we worked with all the time and you had somebody with chest pain, Bill, I’ve got a man with chest pain.  I’ll be over.  A relationship of caring for the patient because they were interested in that.  All that works for us.  I don’t know.  I just think supply and demand is our problem and we need to supply about another zillion doctors, primary care doctors.\n\nWHAT WOULD BE YOUR ADVICE TO A MEDICAL STUDENT WHO CAME TO YOU AND SAID THEY WERE CONSIDERING A CAREER IN FAMILY MEDICINE?  WHAT WOULD YOU SAY TO THEM?\n\nI’d tell them, if I could do it all over again, I’d do it twice.  The reason being, my first -- I like listening to them, I like to deal with them, I enjoy working with them, I enjoy the practice and so when the day’s over with…  JOB WELL DONE.  Job well done.  Try again tomorrow.\n\nKIND OF GETTING BACK TO MY CHANGE IN CAREER PATH, I CAME TO A PLACE WHERE I STARTED TO THINK THAT THE WHOLE CRADLE TO THE GRAVE, MULTIGENERATIONAL MODEL OF FAMILY CARE THAT’S SO CENTRAL TO FAMILY MEDICINE JUST WASN’T POSSIBLE ANYMORE.  THAT’S HOW IT FELT TO ME.  DO YOU THINK IT’S STILL POSSIBLE?\n\nI think if you consider the medical home, those who work there, all this range of specialty that you cooperate with, they know you and they know that you try and do a good job, you’re not going to send junk to them, so that’s the biggest part of a medical home, referral nurses.  If you could do that, I think it’s possible.  By yourself, pediatrics is --.  I gave up on it a long time ago -- they thought that -- send that patient right down to the emergency room, we’ll see it right away and I’ll call you about it.  That fosters that and it’s marvelous for the patient and you.  They can get great care at that place.  You see less and less children all over.  It’s common to see preschool examinations and immunizations -- all the things we do is just routine.  Then gerontology, we’ve got a whole column of Alzheimer’s and all kinds of dementia and we don’t have any way to do anything with except --.  AND IN A FIFTEEN MINUTE OFFICE VISIT IT CAN BE HARD TO EVEN SORT OF ELUCIDATE WHAT ALL THE PROBLEMS REALLY ARE.  I refer all of my gerontology -- evaluation for dementia, then you know what it is.  No, I don’t think you can have a medical home by yourself, I think you need all these people to surround yourself with.  SO CARING FOR FAMILIES ISN’T A ONE MAN JOB ANYMORE, IT TAKES A VILLAGE TO TAKE CARE OF A SICK PERSON.  Come on, Hillary.\n\nHere’s another question I just came up with that probably doesn’t have anything to do with anything. I’ve been thinking about the practice of defensive medicine in primary care because a lot of what I see is people come in and they either get a Z Pack and Prednisone or they get a referral for an MRI or they get sent to Orthopedics for their three-day history of knee pain or something like that. I feel like a lot of that is to save time, possibly, so you can see more people in a day, but more than that, I think it’s defensive. I think we don’t want to miss anything because we might get sued. Is that a product of these times or has it always been like that? \n\nThat’s been much more [    ] the last 20 years and I think that goes with how many lawyers are out there. The lawyers used to be ashamed to sue the doctors, now they don’t care. If they have to sue you for a million, they can. The problem is that you get encouraged to do all of this preventative stuff and you have to keep in your mind, what does she need? Okay, she needs a PAP smear, I don’t know what else she needs, I’ve got to go look it up, where a 65-year-old man needs a whole different thing. I think that’s where a lot of it comes from, we’ve been taught and have pressure to do preventative care, which is magnificent. The best thing that’s ever happened to American medicine is immunizations. Best thing that’s ever happened. I’ve seen children die of diphtheria, whooping cough.  \n\nThing of the past.\n\nPolio.  \n\nYeah, your polio story was fascinating. You had to bring in nurses because there were so many people in the iron lungs.\n\nYes. I remember the last polio I saw, it [    ] one side [    ]. We had a lot more help then, the Health Department had a good health people who would see the polio patients and evaluate [    ] or what. We had a rehabilitation [    ] in Jacksonville, over 100 beds out there where the bowling alley is now. A third of them were on iron lungs. I wish we had respirators, we had iron lungs. [    ] paralyzed legs, can’t do it but you can try. Go home [    ]. We did very little work about the polio vaccine. We knew it was coming, we put it in the paper and we told them that all the doctors and nurses in town would be at the high school at 1:00, Sunday afternoon to give polio shots, $1 a shot. Bring all the family, there’s no child that shouldn’t receive it. A line [    ] Main Street, of course you gave three shots, one and then another month and in three months. Then we got the pill and we did it over again. The population accepts that one immediately.  \n\nBecause they’ve seen the devastation.\n\nYes, they were lined up forever. They waited two hours to get a shot, so what? People are intelligent, people will do what’s right if you give them a chance. That was fun, our nurses had a great time giving the shots. That was [    ] for $1.  \n\nThat’s not much. That’s like our cheapy school physicals. I’ve really enjoyed the story and seeing medicine over a span of time because for me, I haven’t been in it long enough to have anything than more than just a chunk of time and sure, lots of things have changed during that time, but not in such a dramatic way. There’s always been penicillin for me, there’s always been polio vaccine. I’ve never seen diphtheria so I like the chance to hear…\n\nIt was awful. Penicillin [    ] antitoxins [    ] died of heart failure. We were giving DPTs but it just wasn’t accepted [    ] went to doctor [    ] immunizations and then it became so accepted, they’d laugh if your children didn’t get those shots. And shots were inexpensive. The Health Department gave them out for free. At the time you didn’t know it but five years later you knew it, that polio was gone. In Jacksonville, Arkansas, every spring and summer, no swimming, no going to the movies [    ] a good idea, to avoid exposure. Then those shots came out and all of a sudden [    ].  \n\nThat’s wonderful.\n\nIt’s a great scientist that worked so hard on the polio vaccine.  \n\nWonderful things have evolved over time. One thing I think has stayed constant is that…I don’t know if I can say for most of us in family medicine, I guess that’s true, certainly for the people I know in family medicine, the one constant is that we all like to hear the stories, we all like to get to know the individual beyond the context of health or disease, we want to know a little bit about the person and we want to hear their story. That’s a wonderful thing.\n\nRight. Those kids [    ] can’t understand [    ] walking in a room and a patient pours out stuff they didn’t get. Why? I don’t know. I introduce myself, shake hands, what are we doing today? Here it comes.  \n\nThe hidden agenda finally comes out.\n\nIt makes them mad because they don’t understand [    ] it’s not the patient, it’s not them, it’s the situation, not ready to hear it yet. Next visit.  \n\nTakes a little time for some things to come out. I hope that caring and listening tradition is able to be continued.\n\nIs there anything else that you would like for posterity to know about this wonderful life that you’ve had and these decades of time and attention you’ve put into being a family doctor? \n\nNot really. We have made such progress in my life that so many things that left us frustrated and sick are no longer there. So much stuff [    ] far[    ] but yet to the average patient, you’re a miracle worker because of the technology, ultrasound, CT, MRI, all those things have just added so much to our ability. One of the things I always tell a resident, why don’t we do autopsy anymore? Well, we know the diagnosis, we don’t need to open them up. \n\nWe’ve already got the CAT scan, we know what’s going on in there.\n\nAbsolutely. The autopsy told you what the problem was.  \n\nIt was critical.\n\nCPCs were great in those days, they had those [    ] here’s the answer Jim, I’m sorry you didn’t think of it.  \n\nWe did just a few of those when I was in medical school but it wasn’t something regular because at that point it was already not a very common thing.\n\nIt was every week in our school in the ‘50s.  \n\nI read a really good book recently by Sherwin Nuland and it’s called How We Die and it talks about the five most common ways that Americans die and how the body shuts down, basically, but he tells the story about early in his practice and this probably would have been 1960s maybe, he would go to the autopsies for his patients who died because he wanted to learn from it, he wanted to know what went wrong and how to recognize it next time. That thrills me for some reason, that notion, that’s part of our heritage, we learned that way. I kind of wish we still could.\n\nAnd learned a lot of things you didn’t even think about.  \n\nProbably still would, despite all the scans and whatnot.\n\nYou let me know what more we can do.  \n\nI will.\n\nIt was fun.\n\nThank you so much for doing this, I really appreciate it.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284024#t=0.0,2533.99966"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284026","type":"Canvas","label":{"en":["Media File 2 of 3 - Wortham_Thomas_Pt2_10_a.wav"]},"duration":3639.44813,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284026/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284026/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/284/026/original/Wortham_Thomas_Pt2_10_a.wav?1754492650","type":"Audio","format":"audio/wav","duration":3639.44813,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284026","metadata":[]}]}],"annotations":[]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284025","type":"Canvas","label":{"en":["Media File 3 of 3 - Wortham_Thomas_Pt2_10_b.wav"]},"duration":1034.05257,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284025/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284025/content/3/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/284/025/original/Wortham_Thomas_Pt2_10_b.wav?1754492588","type":"Audio","format":"audio/wav","duration":1034.05257,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154865/file/284025","metadata":[]}]}],"annotations":[]}]}