{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/k06ww78q69/manifest","type":"Manifest","label":{"en":["Dr. B. Lewis Barnett"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","family physician"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141822/file/262552","type":"Canvas","label":{"en":["Media File 1 of 2 - Barnett_B_Lewis_Pt_1_92.mp3"]},"duration":3416.34608,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141822/file/262552/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141822/file/262552/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/262/552/original/Barnett_B_Lewis_Pt_1_92.mp3?1739229121","type":"Audio","format":"audio/mpeg","duration":3416.34608,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141822/file/262552","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141822/file/262552/transcript/75743","type":"AnnotationPage","label":{"en":["Barnett Part 1 [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141822/file/262552/transcript/75743/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview William Ventres of B. Lewis Barnett\n\nFebruary 27, 1992\n\nTucson, AZ\n\nQ. - William Ventres\n\nA. - Lew Barnett\n\n_________________________________\n\nQ.  It's February 27, 1992, this is an interview with Lew Barnett.\n\nA.  This is just testing to see if you can hear me.  Are we on now?\n\nQ.  We're on now.\n\nA.  And who-all have you interviewed before?\n\nQ.  Well, I started out interviewing Lynn Carmichael, mostly because he was in Tucson, his son works at the University.  And then I interviewed several people at the STFM meeting. The one that I enjoyed the most, to be honest, was talking with Gene Farley. And then Don Ransom and Miriam Bishop, I hardly went to any meetings, I just interviewed.\n\nA.  Well, those are all familiar names to me because they were all involved in the very beginnings of trying to wake up and revitalize the personal physician. In my case I was a general practitioner who had been practicing in my hometown for 20 years, with the exception of two years that I had to go into the military during the Korean War. When I went back to the country, it was a small town of about 3 or 4,000 people. I was born there and thought I would spend the rest of my life there. I had no intention of ever going into academic medicine. But along about the late 1960s it was obvious that nobody was coming to help us, that I was working harder and harder, seeing far too many patients, over a hundred a day some days, many more than that some days. I'm ashamed to say that I did. I was positive you couldn't do it right, see that many, but you were put in that position. At that time there were no family doctors on any faculty of any medical school, and I wanted somebody to get busy and train some people to come and help me. That was my first thought. But nobody would, did, and specialization was becoming more and more emphasized, and the faculties of medical schools were more and more specialized, and along about 1969 Hiram Curry was at the Medical University of South Carolina, which was my alma mater. He'd been a neurolo-gist, or was a neurologist, but they'd given him the job of being Chairman of the Department of Family Practice because he had had some general practice experience before he went into internal medicine and then into neurology. And he had an interest in trying to turn out a different kind of doctor, a different kind of general practitioner. He felt that general practice would defeat anyone, he just felt that it would be too much for anybody.\n\nQ.  From his own experience.\n\nA.  Yeah, I mean he had had a rough experience with it and he had just determined that this was a chance for him to make some contribution of making it better. Anyway, he started calling me and I – he had remembered me from medical school, we had gone to medical school together, and we had lived in the same house, fraternity house. In fact my name started with a B and his started with a C, and we had been paired – I was one year ahead of him in medical school, so I was his senior and he was my junior, and I was with him when he delivered his first baby out in one of the houses there in Charleston. We used to do home deliveries in the medical school. So he remembered all about that, and then through the years as he became a neurolo-gist I had referred one patient to him, and I think this is the reason he called me. Because it was a patient who had a little 13-year-old boy who developed amnesia and was seen by one of the other doctors in town over the weekend and he forgot his name, he didn't know who he was. And I was out of town. When I came back, the mother asked me to see him and I got a, just an ordinary history and found out that he'd had a rash the week prior, and he wasn't very sick but he'd had retroauricular nodes and a three-day rash and he obviously had had German measles. And he got better and he didn't have to come to the doctor. But on Saturday night he went to a sock [hop] dance and came home and went to bed. At about 2 or 3 o'clock in the morning his father came in drunk and started to fight with his mother and was very abusive to his mother, and so the little fellow woke up the next morning, didn't remember his name, it was Danny, he didn't know who he was. And the physician who saw him sort of said 'this is a conversion reaction' or something, that he was just all upset because of his mother and father being at odds, and gave him some tranquilizer or something. Anyway, when I saw him and I got the history, I figured this might be the only case or the first case of German measles/encephalitis I'd ever seen. But it can happen.\n\nQ.  Might be the last case.\n\nA.  And I never saw another one in 40-some years, I've never seen another one. But anyway I referred the patient to Hiram Curry as a neurolo-gist from my practice in the country. And it turned out that I was right. And Hiram never forgot. And when he started wanting somebody to come back, he wanted Exhibit A, he wanted an example of what the animal was out there that was doing general practice, you know, and he wanted – I always said he wanted one of the animals from the wilderness. And so he started to call and I said no, because I never wanted, I never was, never had it in my head that I would do that.\n\nQ.  You had never...  \n\nA.  Never thought about it. Way back I thought it would be nice if you could teach, but I didn't think that country doctors would ever be allowed to teach in medical schools, so I dismissed it. So I said no about four times that year. And he kept calling, kept calling. And finally he said he would keep on calling until I said yes. And so along about that time they created this American Board of Family Practice that gave an examination. So I decided, well, I'll take that exam and after having been out in practice 20 years I know I won't pass it, so they'll leave me alone. Well, I passed it and so I finally, after nine months of that dialogue, I finally gave up and said, 'well, I will go and stay till somebody better comes along and then I'll come back home.' I had no idea of ever staying. And as we sit here it's been now 22 years, 22 years since I went to Charleston. I was the first family doctor ever to be on their full-time faculty – there. I was given a desk and a chair and he said, 'do your thing, whatever that is.'\n\nQ.  This is Hiram Curry... \n\nA.  This is Hiram Curry says, 'Do your thing, whatever that is.' There were no textbooks, there were no directions, nobody – there was no required time in the curriculum, so I started writing these stories that I just showed you, started – as I saw students and as I – they reminded me of patients and I told them the stories of the patients. And I would jot them down so I would be careful not to use the same patients twice to the same student. So that's how it ever got written down on a piece of paper in the first place. So now it's ended up that they're there as a sample, and I'm glad they are now.\n\nQ.  So this, an aside, you started writing this in the early '70s, recollect - \n\nA.  Yes, yes, this is from the early '70s, those stories are from the early '70s. They were just recollections from the 1950s. And even before that, in medical school, see. I started practicing in 1950 and some of these stories relate back to medical school days, so – some of them were trying to help students understand their own feelings and to know that somebody that long ago had the same feelings was comforting to them, especially in the second year of medical school. Some of the – when you get the sophomore slump, to know that I had the same feelings helped some of them. I kept – well, anyway, we, we started out having elective that we offered, and started out with twelve students in a trailer that was propped up on concrete blocks in a parking lot, very temporary and very tenuous. We didn't think we were there for long. We didn't know how long we would be there. I remember that people would stare at me as I walked through the hall and say, 'Well, who is he and what is he here for? Wonder how many papers he's written?' You know, 'What kind of research does he do?' And of course I didn't fit the mold. And being the first family doc that they had was very intimidating to me and un-comfortable. But I knew that someone needed to do it. And now it seems so long ago, 22 years is a long time. But we had twelve that first session, and it started with talking about real patients and common diseases. I decided that we would lecture on the things that the other specialists did not want to lecture on, that usually were left out, so that article that I gave you about carving an undergraduate curriculum is all about this, what we did at first. Coined the word 'gapology,' you know, do whatever was – filling in the gaps. And then I wanted to make the cadaver live, so I got one of the anatomy professors, who has since gone into family practice, by the way, Dr. Terry Davies, to come over and we together did a thing called 'Diagnostic Anatomy.' He was an anatomy professor, and he was from Wales, and he had a delightful Welsh accent and I was a country doctor from the South with a slow drawl. And we did this together. It was like he was teaching me anatomy in front of the class, and I was teaching him clinical medicine in - [tape paused for tele-phone]. But anyway, the interesting thing was that I got the idea, and this came out as something that I think is, has been worthwhile, and that is that the anatomy professor was refreshing me on the anatomy of the body, and I was refreshing him on clinical affairs to the point where I would say how this patient would look, how they would feel, how they would talk, how they would smell, how they would act, with things like pulmonary edema, and he would tell the class about all the anatomical structures that were affected. And I called this stereo teaching, because there were two voices and there were two persons up in front of the class. And it became so popular, that course, it was an elective - \n\nQ.  This was an elective course for what, third- or fourth-...\n\nA.  And it became so popular that the amphitheater would not hold the students. We started in the trailer, remember. We had now graduated over to the amphitheater, and we had to have two sessions of it to accommodate – just like a minister having two sermons on Sunday, you know. So the dean then eventually said, 'If it's that popular, then we should make it required.' And it became a required course and it was called diagnostic anatomy. So that's in some of this material. That's where we started. And it's always been that the students really wanted to hear what we had to say, and they held us up on their shoulders. And so things went from one thing to another, and I was offered several Chairs back then, because there were just so few available, it wasn't that I was good, it was just that I was scarce. I was a scarce commodity. And one time the dean and the vice president thought that I was going to take a job at another university, I was offered another job – I wasn’t going to take it, I didn't have an idea that I would take it, but they thought I might, so they decided they would offer me a little bit more salary. Salary wasn't very much in those days. My first salary was $30,000 gross - \n\nQ.  A little different these days.\n\nA.  Yeah, a little different now. But they offered me the job of Assistant Dean for Student Affairs on top of my family practice duties. And that was intriguing to me; that was – I liked that idea and I took it. So I became Assistant Dean for Student Affairs. And I used the principles of family medicine in the dean's office at that time. I would make house calls for academic problems for students. I would go to see where they studied, I'd see their spouses, I'd talk to them as a group to see what made the same brain that got them into medical school suddenly go dull. And I found out that the principles of family medicine would even work in the dean's office. And so I stayed there until – for seven years - \n\nQ.  So then you, this is still South Carolina...\n\nA.  Mm-hm. This is all Charleston.\n\nQ.  Okay. And you actually accepted a, really a different role...\n\nA.  On top of. I never moved into the dean's office. I stayed in the family practice department. My office never changed. But they gave – in order to give me another $5,000 income they gave me this other job. They couldn't just do it, so they gave me another job. And so it was so refreshing to me to find that the principles of family medicine could be utilized. Things like house calls. Things like talking to the family. Things like having their spouse come in with them, or things that – are just part of a family doctor's way of life, you can utilize not only in physical illness, but in academic problems. And I get letters still from some of those students who were salvaged. I call it salvaged, there was one down the tube. You know, I still get letters from some of them saying that 'you'd be proud of me, I'm doing this or that.' And they're scattered all over the country. So that's been a blessing to me. I never wanted to be a Chairman. I still don't want to be a Chairman. I never thought I was Chairman material. I never – I have a problem in that when I look in the mirror I don't see very much. I always have never really seen very much. I've always felt extremely ordinary. I have lived long enough to see a lot of extraordinary things happen around a very ordinary man. When we're sitting here right now, I – if I were alone, wouldn't be anything much happening. But the fact that there's one man over in that chair and there's a man over in this chair makes something happen. And I have, I've had a very full life because it's involved other people, and other people have allowed me to be a part of their life. I mean patients, students, children, everybody that I've had anything to do with have sort of helped me I guess have a part in what has gone on around where I was. You know, it's kind of interesting in that when I see, have seen those students or I have seen patients, and I reach out, they reach out to me and I reach back to help. It takes both to complete that transaction. It's not something I do alone or that I, that is singular action on my part. None of life seems singular to me, it seems that it always has involved other people or someone else. I get in the boat and I get one oar, and they get in the boat and they get one oar, and we have to be very careful not to take both oars, either one of us. If you take both oars you wear out, and you burn out quickly. I've seen so many of my peers that seemed to get to the place where they didn't enjoy what they were doing. And somehow medicine has always been my vocation and my avocation. A lot of people ask me if I play golf. No, I don't anymore. I gave, practically gave my clubs away. I see – lots of questions I get asked are not answered in a traditional way because I somehow have been blessed with this capacity to enjoy it enough that I get refueled instead of drained as I'm going through the day. I think there are some times, you get up in the morning and you think, well, everybody you see is going to drain a little bit out of you all day, and you start out the day just draining yourself out. But then again if you expect sometimes that the patient or the students are going to give something back, then you pace yourself. You see, I'm already past 65 and I still don't want to quit. I should probably, I have offered to quit, I wanted to get out of the way for the young folks to come, play through, so to speak, and I offered to do that last fall when – the dean didn't want me to quite do it yet. And so I, I just thought it was important that I didn't, that I wasn't the bottleneck.\n\nQ.  You must still be getting some rejuvenation out of what you do.\n\nA.  Well, apparently, I'd say – I would say yes. I would say, just like I say right now for this particular point in time. See – how would you express it? [tape paused for telephone]. Is it on? I was going to say that, you know, sitting here now, I feel at peace. The fact that you're there in that chair and I'm here in this chair, and that there's something or other in between, even though we'd met what, half an hour, 45 minutes ago, somehow it feels like it's been a long time for me. Somehow it feels okay. Somehow I – even though the phone rang just now – I’m back. Somehow there is a, the capacity to raise present company to top priority so that you can do this and you can forget all else. So that right now you're my top priority. I enjoy that, being in a situation where you can eliminate distractions to the point where that is conveyed to the other person. In other words, there's none of us that doesn't really appreciate being for one brief moment, even if it's just a little bit, placed in a position of top priority.\n\nQ.  You know, I'm kind of thinking back to what I do in practice or what I try to do in practice, and I – and what you're describing is what you may do well in practice.\n\nA.  That's what I think I – that’s why I think that you don't burn out if you're in – and that's intense, but it's not consuming. You don't have to be less intense or less dedicated to be at peace or to be restful or to be feeling pleasure or to be enjoying life or to be mixing your vocation and your avocation. No less intensity is there. In fact it's more, because if we both understand what I'm saying, then we both - \n\n[tape side ends]\n\nA.  I mean if we both understand that you're significant to me, then if I can convey that, then I may possibly become more significant to you. Or I may become more able to help you if we convey all of those things. So that this relationship, something between here and there, something between you and me, is maybe just you. But it doesn't belong to either one of us, this relationship, so it's not a selfish matter. You take away selfishness. You become an unselfish giver, which is pretty well overdrive. It doesn't wear you out like things that, words like duty or job or something I must do, I have to do, or something that I do for money, or for a living, you know, it – you end up with more than a living, you end up with a life. And to me it's just been – all I needed, it's – but going back to the fact that, I think I got off the subject there...\n\nQ.  This has been your life in family practice or general medicine.\n\nA.  Yes, my whole life. I haven't always felt that I was the very best or the very, most significant contributor where I was, but I've given it my best shot. I never thought I would be this long in academia. I never had any intention of being a Chairman. And all of that sort of happened after 1976, when I was suddenly, everything changed because I was, became jaundiced. And the diagnosis at first was carcinoma of the pancreas, and this was 197- about '76, I guess. Turned yellow all of a sudden, and we didn't have MRIs and ultrasounds and CT scans then, so I had to have an exploratory laparotomy. And I sort of went to the operating room with the pre-op diagnosis of possible CA of the pancreas, and it turned out I had 500 gallstones packed in every orifice, and this was 1976, so in all of this and my recuperation, the University of Virginia had asked me to come up and look at their place. They'd been seeking somebody for about a year, and nobody wanted to go there because it was one of those Ivyoid places where they thought family practice would never fly, so nobody wanted the job. So anyway, I had said no already to that before I got sick, and while I was recuperating the search committee chairman called my house and said, 'We were just thinking about you and wondered how you were getting along,' and I said, 'Well, they say I'm going to get well.' I had a couple of bottles of stones stacked in every orifice and 500 – I’m going to get well, so – he said, 'Well, we were just thinking about you, wondering when you were going to feel like coming up and looking at us. You said no without ever coming.' So I laid there and I thought about this whole matter, and it was sort of like you played life out on a screen in front of you, you know, and I said, you know, you've been saying no a lot. You've said no to several places. And you've sort of been afraid to tackle it. So anyway, as I laid there I got the whole feeling that I'd been left here for some cause and been spared for something, and my simple faith and belief system kept plaguing me by saying, you've said no so much, that maybe with the time you've got left, that you didn't think you were going to have, you ought to do something nobody else wanted to do and you ought to go someplace nobody else wants to go. And that happened to be the University of Virginia. And so I've been there ever since. And that makes for 15 years now.  \n\nQ.  Since 1977.\n\nA.  Yeah, yeah. And that's sort of – we met I guess after that.\n\nQ.  Right.\n\nA.  I was just in, I guess, and so much has happened there. So much has happened that I would never dream, we have our own service there now, I just saw the figures, we had 419 admissions this year on our family practice service, we deliver our own babies in the university hospital, we take care of all babies in the nursery, we have our own service, we get promoted on internal medicine at the second-year level, and on pediatrics at the second-year level, promoted to a supervisory capacity, residency. I never would have dreamed all that could have happened. And we, just before starting – we’d done all those electives that we did in Charleston, we've done things similar to that, but now they are going to be required in the first year. That course has been called 'The Doctor, the Patient, and the Illness.' That was in (?) Virginia.\n\nQ.  A stereo course, so to speak.\n\nA.  Because they told me not to call it 'Family Practice' in 1977. Said, 'What are you going to do?' Says, 'Just don't call it 'family practice.'’ And I said, 'Well, just call it 'The Doctor, the Patient, and the Illness.'' And it's ironic, but this year the curriculum committee is initiating a course called 'The Doctor and the Patient,' which is this course. And it's required of all students. And then we'll have a clerkship in primary care this next year, so – so much has happened.\n\nQ.  One thing that I wanted to ask you...\n\nA.  Of course, along the way there's been a lot of national things and that, President of the American Board of Family Practice back in 1980 and '81. I never would have dreamed that a country doctor would have ever done that. It's been a full life when you think about it. When you make me sit down here and think about it, it's been full. What'd you start to say? You were going to ask me something.\n\nQ.  One thing I was, wanted to ask you, and it came again last night, actually, when my – you called and I had to check out with my wife about things and my ten-month-old baby was on my lap actually when you called, I don't know if you could hear, but – and actually when I interviewed in Charlottesville, the residents talked about how on Sunday mornings you and your wife invited everybody over and their families over, and that wasn't common actually in residency then. I wonder where your family fits into the picture of your life? Whether your wife or...\n\nA.  It's been a family affair, actually. They've allowed me to do this, my family has allowed me to do all these crazy things that I've done. I say crazy, they're not crazy, but they're unorthodox.\n\nQ.  Different than what you planned in 1950.\n\nA.  They were not where I headed. [paused for telephone call]. These same people have tickets to the rodeo on Saturday and they're pushing me to go to it.\n\nQ.  Okay. There are lots of different ways that we can work it.\n\nA.  But we can, I can do it before or after. Because I'm going to be here Saturday night. But you probably don't like that idea. [tape fades out, comes back].\n\nQ.  Why don't we finish with this, and then there are lots of different ways, for example, I interviewed Gene by phone a second time. I'd like to meet with you, but I certainly don't want to impose.\n\nA.  That's fine. I'm not sure I'm giving you exactly what you want.\n\nQ.  You're giving me great stuff. What I want is you...\n\nA.  You want soul, you don't want a curriculum vitae.\n\nQ.  That's right.\n\nA.  I didn't bring it, you notice.\n\nQ.  Right. And I'm going to, especially perhaps next time, but in this way I mean I want to – you’re a family doctor, but again this is almost a personal thing in terms of what I saw in 1985, or '84, and...\n\nA.  We had unfinished business. I remember now, since you sit here – it’s almost déjà vu, it's almost like something's come back. I had not thought about it since the...\n\nQ.  And some of those issues are, you know, I remember my wife said, my wife was from Oregon and she said, 'Well, they would invite me to the table and they would be really nice to me. I might not fit in,' she said, but the invitation on Sundays stuck with both of us.\n\nA.  It's still happening. It happened on Sunday. And it may not happen this Sunday because I'm not home, but...\n\nQ.  But I kind of want to know what that, this means to you, or how that's been involved along the way, or...\n\nA.  We bought a house in Charlottesville that was far too big for us. We both came from meager backgrounds, not from wealth, we didn't come from wealth. I still keep a picture on my desk of the little two-bedroom house I was born in. It's not exactly Lincoln's log cabin, but it's not much better. And it was very austere and very (well?), and very – when it rained it leaked, and it was not much. But it still stands and I have a picture of it on my desk, so that when people come into the big house that we live in now, they see the big house but I'm always still seeing the little house. And this whole thing about family medicine, it seems to me we've eliminated the family from a lot of it. And that I wanted to portray to the young people how you can have a successful marriage and a successful family life and yet serve people. And my wife has allowed me to care about sick people. She's allowed me to do a lot of this. And it, if you look at our brochure of residency, it's probably the only brochure of a family practice residency that has the names of the spouses of the faculty, and the names of the children of the faculty in there, and people always say, 'Well, I wonder why that's there?' Well, it's there for a reason, because without – I don't know how I would put out a brochure without my wife's name in it, because she's allowed me to do all of this stuff that's so unorthodox. She's allowed me to spend time with people. When a young person comes to our house at night with a problem, she excuses herself to another part of the house, but she – by her very absence is present with us when we're there, working on a problem. And I often say to whoever I'm talking with, I said, 'Now I hope you understand that Mrs. B is sharing me with you and that's what she intends to do and that's what she wants to do. And that she's in with us, she's the' – so she's been a part of whatever I've done at Virginia, she's been a part of. This Sunday lunch thing started out because she didn't like to entertain the way most of the world entertains, with cocktail parties and all of that, and her way – she was a home economics teacher, and her way of entertaining and showing you hospital-ity is to feed you. And we had a dining room table that was over ten feet long, and that's why we had to buy this old house that was big, because the new houses didn't have a dining room big enough for this table, and that was our mode of entertainment. And to do it on Sunday, people didn't expect the usual. And we would always do it after church. Everybody knows that we usually go to church, and so we eat about 1:15 or 1:30. And so she sets the table every Sunday we're in town, and whoever doesn't have a better offer can come if they'll call us ahead of time so we'll have a plate set. And some people are regular attenders, sometimes bring a dish to add to the pot, and we've never run out of food. I usually slice the meat thick or thin, sort of like the loaves and the fishes. But it's allowed us to have a forum. Say if you were on call and your wife was home alone, she wouldn't have to eat alone. It's not always the resident that comes, it may be the spouse. And it may be the students. It may be medical students. Last Sunday it was about half and half. Students – and the door's always open. The other thing is that the door in, at the office downtown, in the hospital, has a little sign on it that says, 'Please knock, then enter.' That is if the door's shut they can still come in. I think it's extremely important that teachers are accessible to students and that the students feel that accessibility, that they know you mean what you say. That's been my problem, I've not contributed a lot to research as such. My life has been, the emphasis of my life has been on availability, and not being shut up or shut away from people. And I – you can't do everything well. I've just dedicated myself to trying to be access-ible and available and I've managed to enjoy doing that without feeling put upon, which I think – but my wife has contributed tremendously to my feeling of making our home available. We also have a cabin on top of the mountains in North Carolina that's also available. Lot of honeymoons been there. I mean it's – whatever we've got is yours.\n\nQ.  You think you brought this to family medicine or to general practice in the early '50s, or do you think that helped develop those...\n\nA.  Do I think I brought it to...\n\nQ.  Do you think these are just things that are part of your, or...\n\nA.  Well, there are things that I thought I saw missing, I thought the heart and soul of medicine was getting away from us. And I thought that those things were important, that the humanity, that the humane aspects of medical education had somehow been short-changed. And I thought that we needed to infuse medical education with some humanity. And I didn't know much other way to do it. I wasn't sophisticated, I wasn't trained to be an academician, I didn't know what else to do except to be myself. I don't think we can be anybody else, I think we have to be ourselves. I don't think anybody else that you would interview is going to say exactly the same thing, because they have their own modus operandi and their own strengths, and I guess you do the best you can with what you've got. And I don't – but what I did promise was to give everything I had, whatever that was, I was going to give it all. And I'm still around. And I'm still enjoying it. I mean it's a, it's always a gift when I sit down with a new person and I get a chance to meet – you know, when you sit with someone, when I'm sitting here with you and it's almost like I say now, 'What if this is the only time I ever have the opportunity to sit in this, in a room with Bill Ventres in my whole life? What if this is the only time I ever have? It shouldn't be wasted.' It shouldn't be wasted. It should be of some value, somehow, it should be of some value. You hope, you pray, you hope – and it gets mixed up with the metaphysical, in your faith, your belief system. It gets mixed up with science, gets mixed up with art. You mix all of those things together. It's – but it's a vital feeling because it does necessarily profit you always – it usually, if it does any-thing, it stands a chance of being beneficial to the other person. Which makes you, makes you want to keep on, you know, you don't want to give up. It's – I guess if I have any misgivings about all of this, is I just don't know if I've done, I don't know if I've done the best I could do. I mean I wish I could feel that – I’ve tried, but I don't know.  \n\nQ.  I don't know if anybody ever really knows.\n\nA.  Don't guess we ever know.  \n\nQ.  And if there's one thing that I keep hearing over and over again, is, that thing is – I may not include it in what you read, but the theme of Lynn Carmichael saying, you know, 'Am I content? Have I done it? Would I be more content somewhere else?’\n\nA.  Well, I guess I can say I'm at peace, because I suppose if I had it all to do over again, I might do the same thing I did before. That talk I gave last year might give some of the answers to what might have happened if  I had it all to do over again, but it's, I think it's such an important part of medicine and such an important part of life, I mean family medicine, to succeed, is vitally important.  \n\nQ.  I'm going to stop you there, because I'm concerned about your time and... \n\nA.  Yeah, I know, I could spend a lot of time talking. I would enjoy doing it.\n\n[interview ends]","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141822/file/262552#t=0.0,3416.34608"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141822/file/262552/transcript/75742","type":"AnnotationPage","label":{"en":["Barnett Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/141822/file/262552/transcript/75742/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview by William Ventres of B. Lewis Barnett\n\nFebruary 29, 1992\n\nTucson, Arizona\n\nQ. - William Ventres\n\nA. - Lew Barnett\n\n____________________________\n\nA.  Want me to say something now?\n\nQ.  Sure.\n\nA.  This is Leap Year Day, it won't happen for another four years.\n\nQ.  And this is our second interview, it's February 29, 1992, and this is an interview with Lew Barnett. Okay? Did you want to start? I had some questions, but... \n\nA.  Go ahead. I was going to let you talk today.\n\nQ.  Okay. Or at least ask. We finished by, you said there's something vitally important about family medicine, something vitally important that it needs to continue. And that's kind of the way we finished up. And I stopped you at that point. But I was wondering what you felt was so vitally impor-tant, what you were sensing then. Or maybe you've gotten out of the last two days that reaffirmed... \n\nA.  Well, I guess what I was thinking was that so many of the cultural events that have taken place have somehow divided the family structure and have separated the elements of the family. If you go to church anywhere any more, you're separated by age and by sex and so forth, and the organizations and the movements and the cultural events used to be that they were all centered around the family, and the family was strong. The marital bond was strong. And now you find that the institutions of marriage were looser, the family seems to be looser, the age of the powerful father is gone, as we've just been talking about, and so many of the things that we counted on to hold our, to be the glue for society, have been diluted. And the profession of medicine has separated itself out into so many sophisticated specialties, so that even the human body has a doctor for everything except the glue that holds it together. So family medicine to me seems to have an opportunity to address that one thing which I call the glue for society, the family. And hold it together in a way that we never thought as being necessary before. But to me as I get older it just seems that that is becoming more and more necessary, that some group of some – concerned group in this country takes hold of what seems so obvious to me. And through our profession of medicine it seems that we can do it. Does that make sense?\n\nQ.  It makes sense. I'm wondering if, at the same time that family medicine was started, like late '60s, I may be interpreting, but those same cultural events that were working to – destroy may be too hard a word – but working to diminish the power of the family, these things have come together. I'm wondering why you think that they came at the same time. One, at least tacitly talking about strengthening family bonds as you see it at least, and the other cultural force decreasing those bonds. Is that coincidence, or is that nostalgia, or – is family medicine nostalgia?\n\nA.  I hope that it's not all nostalgia, I hope that there are more elements to it than just holding the family, or trying to hold the family together. There are also elements that the generalist physician or the general practitioner of the past was the man who – or the woman who – was more than a doctor in their particular communities. They did not constrict themselves to science. They were active in all aspects of community life. They were citizens of the community rather than of a given profession. I think that this part of the profession was made up of special people all along, and I think that it will have to be said that the future of family medicine will depend upon that same breed of individual who is unselfish and willing to look outside of just the organs that have the disease and look toward the person who has the problem. I suspect, even though we're so different, each individual practitioner is a unique individual. There must be some common bonds. The kind of individual that is attracted to family medicine is still a broadly-interested person in what goes around in his world, his or her world. So I think that there's a certain mission that lies in the heart of individuals who really have a desire to be this kind of physician. It's hard to know what makes each person tick. But I suspect that we all long to have some capacity to make a difference in life and in the human condition, as I like to put it. Just told you a story that sort of does, exemplifies that, that you just don't limit yourself to sickness. You like to be around when there is an absence of sickness, when there are other things going on in the world besides pain and suffering. It's hard for this kind of a doctor to live totally in a world of suffering, 'cause they don't like to see people suffer. Gives them some sense of refreshment to be able to alleviate suffering and then to enjoy the other parts of that person's life besides sickness.  \n\nQ.  I'm wondering if most family doctors walk around with a wide-angle lens.\n\nA.  I wonder, I wonder. I see some young medical students that come in for advice about career decisions, and I see some that have a zoom lens on their camera and I know they wouldn't be happy doing what I've done for all my life. And my place is not to twist everybody's arm into this particular branch of medicine. It's almost as important, or maybe just as important, that I help people understand that they have other than a wide-angle lens, that they have a zoom. 'Cause it doesn't pay to try to influence young people into a way of life that is not congress with their spirit. I think you have to try to feel – and maybe the intuition that family doctors are almost always gifted with can be utilized to help young people decide one way or another. I have often felt that the doctor-patient relationship and the teacher-student relationship, or the mentor-protégé relationship are very similar. That relationship is not owned by either party, but the combination of the two spirits can accomplish more than either one could alone if you have an unselfish motive. I mean if I don't try to control you to speak, but I just try to hear you and to listen to you, and then play it back to you the way I understood you to send it helps you sometimes to understand your own self. And in the doctor-patient relationship, a lot of that I think has to be, I don't know the word, I sometimes make up words, and I – it’s larva-like. I mean there has to be a host sometimes to make the full cycle of a thought. Like sometimes you have to speak enough and say enough and sit with me enough so that I can hear you and I can feel your presence and I can understand your spirit. So that I might be able to help by taking your thought and giving it back. I remember there was an article once upon a time by a rock musician named Peter Townsend, who was what, the Who?\n\nQ.  Sure.\n\nA.  And somebody asked him the question, he says, 'Why do you get up on the platform and 10,000 people will show up? And they'll have a mob scene?' Says, 'Why is it that just – why you? You look so ordinary. Why can you draw so many people to you?' And he says, 'Well, it's very simple. All I do is take what they give me and give it back.' You know, when he was saying – he wrote songs and sang them, says, 'All I do is sing it back to them.' And that's essentially the way I feel about my life. I haven't done anything except I've taken what people have given me and I've tried to give it back. It's not – I doubt if there's so much seminal activity in my life to say that I've created anything or I've invented anything in this movement. I've just tried to observe it, been an observer of the movement of family medicine, to the point where I could recognize the strengths in other people.\n\nQ.  I'm wondering how you reconcile, either at the University of Virginia or before that, that image of yourself or of doctors with what seems to be the general direction of medical education? And maybe I'm wrong... \n\nA.  You mean what it felt like to be in the academic environment to begin with, to find that so much, that there was such a different philosophy there than...\n\nQ.  Well, I don't know if it's changed. It would be interesting for me to know what it felt like when you first started, and then what it is now 22 years later. Maybe it hasn't changed. I have to tell you that one of the things that has been most frustrating for me in talking to folks has been that oftentimes they say that things haven't changed. I mean we've seen the growth of family practice programs, all those kind of structural changes, but the bottom line... \n\nA.  Is it the other people that have not changed, the other depart-ments, the other philosophies?\n\nQ.  I'm not sure what it is.\n\nA.  Well...\n\nQ.  Or the general economic pressures? I'm not sure.\n\nA.  We tend to want to change – someone was asking me last night, one of the younger people was asking me last night, 'What do you think the secret of your particular success was?' And that's assuming that I've had success. He's assuming that I had success. And he says, 'What's the one thing maybe you did different than some other people?' And I had to think very hard, because there's not a whole lot of ready answers for that kind of question-ing. But one of the things that came to mind was the fact that in 1992 you can sit down with me, and I'm probably the same fellow that I was 22 years ago, at least as far as I can tell, I have not lost my romance with medicine, I haven't lost my love for the people, I haven't lost my nostalgia for want-ing to be back where I started in a small country town. I sometimes get lone-some in a crowd, in academic circles, so I don't guess I've joined the legion of ever more rarefied sophistication. If you saw the movie \"Dances With Wolves\" or if you've ever read the book, this Lieutenant Dunbar, who is the man who came out to the frontier, he – the more he went toward the frontier, the more Indian he became. Rather than to change them, he felt more akin to them. But in a sense, the more I've seen of the specialization of medicine, the more tenacious my desire to remain a generalist. It's confirmed my belief that that's – this is where I belong, this is the kind of person I am. I think if it – if you can define your own inward self, then you can allow other people to enjoy being other things and going in other directions, and you can allow for this, the specialization of medicine around you without feeling that you must be like that. In some senses of the word it makes it even more and more necessary that some of us maintain that wide-angle lens, because – when I went to the University of Virginia, it was and still is a very specialized, hard-nosed place. It had a lot of tradition, they still think Mr. Jefferson walks around at night there. And so I used that all through the years, I always said when I've come up against people who don't understand why I'm there, I said, 'Well, you know, to be a true university you have to offer universal education. You have to offer a full menu. You have to have a smorgasbord of everything, if you're going to be a true uni-versity.' And if you're going to do it, you don't want to do it in a mediocre way. And if you want your departments of internal medicine and surgery and all to be good, and if you've decided you want a family medicine department, it's got to have the same quality as every other department. Otherwise it won't belong here. I agreed with everybody up front when I went to the University of Virginia, that a so-so department wasn't needed there because they don't have that mentality there. They don't have room for a whole lot of mediocrity in their own minds. So whenever they became critical of what I was trying to do, I was able to somehow call on their better nature, to say 'help me be as good as you are.' And they've surprised themselves. Now they're proud of it, but 15 years ago it was a tough spot. Most of my friends, and I almost can say all of my friends at that particular time in 1977, said I was a fool to go there. Said don't go there, it'll never happen there. And I guess there's something or other down in my nature that doesn't like to hear that. I mean when somebody tells me it can't happen it makes me want to try harder, to see if it will happen. And that surprises me about myself. I always thought of myself as being quiet and not very aggressive. But I find that I'm still there 15 years later and without some aggressive behavior, I doubt if I would still be there. So some things about myself I haven't under-stood completely. I believe in family medicine so strongly, and I'll do whatever it takes to make it a citizen, a full first-class citizen of the university. Whatever I can do, I'll do. I could retire now, and I offered to retire, as I told you, last fall, and the dean and I sat down and decided that maybe this was not the time. Because so many things are just about to happen, you know, and when you think about the fact that you had – some of these things I've had to wait 15 years to see them happen, and I think the problem sometimes with youth is that you don't have the patience just to stick it out. And I think if the next generation of chairmen are not going to have to wait so long, but some of us that started out 20 years ago had to wait until the timing was right to see things happen. I'm not sure I'm answering the question.\n\nQ.  Yesterday you mentioned a comment about Hiram Curry, and I have no connections to interview Dr. Curry at this point. I was wondering if you could – and I'm kind of changing to a different area – but I was saddened, actually, that you didn't include your comment on tape because it was really a telling comment...\n\nA.  Of what?\n\nQ.  Basically how...\n\nA.  How it happened?\n\nQ.  Well, his perspectives on wanting to destroy general practice and make something new, because it was so trying on him and...\n\nA.  I didn't say that on tape, did I?\n\nQ.  No.\n\nA.  I didn't mean to.\n\nQ.  I wish you had, because it was really an interesting juxtaposition of two – I mean he was actually considered, I don't know him, I never met him, but considered a leader in family medicine.\n\nA.  Oh, absolutely.\n\nQ.  I was wondering – even without that comment, we can talk about it if you want, if...\n\nA.  No.\n\nQ.  Incidentally, if anything that I write up you're going to see.\n\nA.  I can always mark it – no, I would not want to make any negative comment. Because we were very different individuals. I would like to include Hiram Curry in this interview because he was a part of my life, to the extent that if it had not been for Hiram Curry, I probably would still be in the country practicing where I was. Because I did not apply for the job. He was given the job as chairman at, in USC, and he continued to call until I said yes. He shook me loose from the roots. Everybody says, 'Why did you leave family practice – why did you leave your practice?' I didn't con-- I still don't consider the fact that I left it. I believe that there was some reason why Hiram Curry said he would not stop until I said yes. He was a very deter-mined individual. He didn't take no very well. He was a neurologist. But he had the idea that general practice had to be changed. And that you had to include, you couldn't devote your entire time and let it consume you. You needed to learn how to orchestrate your life better so that you could have a life outside of medicine. And that was a noble intention. But in so doing, there is the risk that you give others the impression that you're trying to destroy what they were. And that was general practice. And he had his moments with being misunderstood by the practicing physicians who were general prac-titioners. And I was a general practitioner. So we – as I said, he was re-sponsible for shaking me loose and taking me, bringing me to Charleston. I don't think that could have happened unless I had had a seed somewhere deep down in my soul that said that we needed somebody, and here was Dr. Curry who was a neurologist on the faculty of that school that was given the job as chairman. And somehow that was not exactly what I had thought would be the way to make family practice or general practice a part of the university. So I think – and I've talked to him when he was alive about why he kept on cal-ling and asking me to come, and I always teased him and said, 'You know, I think you just needed Exhibit A, you needed a wild animal from the wilder-ness. And you wanted to put me in a cage.' Which I considered academe to be at the time. I felt that. And then they put a starched white, long white coat on me, which was just like a straitjacket to me there for a while. And then he gave me a big swivel chair, which had a high back, like a judge's seat. And he said, 'Do your thing.' But with no specific instructions. But with the freedom to do just that. So that's when I started writing these, scratching down these little stories that I told the students. And the students then were hungry to see some bona fide, genuine articles. That is to say, somebody who had been ‘out there,’ in quotes. And having been there for 20 years, that's what I had to offer, that's all I had to offer, was what happened out there in real life. A lot of it was very anecdotal, in fact most of it was anecdotal, but it was also, at the same time that it was anecdotal it was true. There was truth to what I had to say. It had not been documented on paper, it had not been published. I had not a single publication. And yet I could walk around with some of this repository of life experiences from other people. That's not all bad, it's not all good. I should have written down a whole lot more in my lifetime. If I have a regret it is that I have not recorded a lot of things about life. They now only come up when other people remind me of what happened. And when I sit with you and you bring out some-thing, something maybe I haven't thought about for a long time, and I say, well, gee, I should have written that down. In the age of tape recorders it's a sin almost not to do it. A lot of other people have contributed more to the literature than I have, and I regret that, because I think I know that some of these principles that are deep down inside, work. And I've tried to share them person-to-person and one-on-one with many people. And I've been blessed to be able to do that.\n\n[tape side ends]\n\nA.  ...one-on-one interaction has been a way of sharing it. And I have seen a lot of those people, a lot of students and residents, who have been much more able to disseminate these principles than I probably could have done. So maybe it wasn't my place to do all that, publishing, maybe it was another generation down the pike. But at the same time I think it was, it's necessary for a lot of us to pass along, pass it on, to those who will listen. And who gets the byline is not the big issue with me. Maybe I needed to have more of the desire for that, but I didn't.\n\nQ.  I want to shift actually even further back. Why did you want to go into general practice to begin with? You said you started in 1950, was that right?\n\nA.  That's right, I started in '50, well, I never dreamed of doing any-thing else. If you have to ask me why I went into medicine, I'm not quite sure but I think that it has to do with an invalid grandmother. She was in bed for 32 years, a very devoted aunt gave her life to take care of her, and she never had a bedsore in 32 years of being in bed. I never saw her out of bed in my lifetime, from the time I was born and I was taken to see her, I grew up getting up to eye level to see her in bed, and then I sort of had an almost innate, inborn feeling that one day I would be a doctor. And my child-like motive was that I was going to come back to that town and I was going to ‘cure,’ in quotes, ‘cure’ that sainted grandmother. She always had a smile, she was at peace with her illness, but yet nobody could do anything for her. It was almost like a helpless feeling that nobody could do that. But by being taken to her bedside so many times, almost weekly, it never occurred to me to be anything else. So that's unusual, I think. But it was really not anything that I could put my finger on other than that. I was delivered at home by a real general practitioner who did everything. He took my tonsils out, he delivered me, I had some kind of a feeling of wanting to emulate him, so those two things, wanting to emulate the physician who delivered you, took care of you, and at the same time thinking he was great, but at the same time realizing he couldn't cure this one person that you loved, showed me that there was room somewhere in the future for somebody else to be a doctor in that town. And I went back to that town, oddly enough. That's where I started. And that was my hometown. And to tell you the truth, that grand-mother, I was her doctor. She lived, she lived to be 77 years old, so she lived long enough for me to be her doctor.\n\nQ.  In bed.\n\nA.  In bed. And I couldn't cure her either. And I remember – I was too late. But she never asked me to. She was easy on me, because she knew I couldn't. And I remember being at her bedside when she breathed her last breath. And I remember laying my head down on her breast with my ear to her pericardium, just to see if I could hear something with my ear that I didn't hear with a stethoscope. Because there was some sort of strange feeling at that moment in life, and at that moment of her death, that made me feel that there was a need for the physician and the patient to be closer to each other. And in a lot of ways, and this is the first time I've ever thought of this, I haven't ever really realized why I did that. But all of my life ever since then, it seemed to me to be important that the physician and the patient aren't afraid to be close to each other. Technology and procedures and instrumentation and machines and huge steps forward in science have seemed to me to have increased the risk of losing this particular closeness. Now I think you can make a mistake by becoming overinvolved and becoming misunderstood, but I think we have to be courageous enough to risk reaching out and reaching toward and touching. Because to me that's different than all the other science that we have to offer. Just, to me it seems to be one of the hard things to put in print. And we almost seem afraid to say it, and I'm not sure why. I'm not sure why we appear sometimes and are perceived to be ashamed of that. I don't know whether it's change and expectations, whether the patients just don't expect it anymore, or whether we are just in our culture and society we are afraid to be misunderstood. I believe that we must try to teach young people to be very professional. I know the word profession means to profess to know. So many words, so many words in the English language come from Latin and other languages, and I've often wondered, you know, why we call our, the people we serve, patients rather than customers. There's a difference between what everybody else does in the world and what we as professionals in medicine do. And when you say patient, it comes from the word patior, pati, which means to suffer, or to bear something. So what we're really dealing with is a human being that is bearing something and is suffering. Which makes us, it sets us apart, and it makes, it seems to me it makes for a greater need than just being a customer or a client. But maybe not. You know, this is a – and then when you think of the word compassion itself, it comes from the same root, you know. Compatior, to suffer with, or to bear together. Dr. Ed Pellegrino brought that to my attention many years ago, and I've never forgotten it. Said, 'That's where the words come from,' and it makes this profession different. [tape paused]. Why we call them patients? I learned that from a person who was not a family doctor, you know? So I think that there are elements of this spirit in all of the disciplines of medicine, so I don't think it's something that we as family doctors have a corner on the market. I don't think we do, but I think, I think it's what I see as one of the important things about our being in the universities is that we need to exemplify that spirit and not be so selfish with it that we only want it contained within one discipline of medicine, that we have some obligation to reinfuse this caring spirit to the whole medical community. So in that respect I have a very wide-angle lens on my camera. Because I feel that we have obligations far and beyond family medicine.\n\nQ.  It was interesting, in that first article that was reprinted in John Geyman's book, that was a direct statement to that, that we're not doing this just to recruit students.\n\nA.  That's been a begin – I brought that article because I wanted you to see how close, what I feel today still reflects what I felt then. And when I answered last night about what is it about you that made you a success, it was the fact that I hadn't lost the mud on my shoes. I still feel very much the same way I felt when I came in, except that I have been allowed to share with a lot of young people those thoughts. And I also now understand better why others differ. I mean I understand that there are honest and good people of all persuasions that differ with me yet they're just as intent and just as honorable. They're just different. But there's room for all of us. And this one common bond should be I think that – and I don't like to use the word should – but one common bond of those exemplary physicians in all disciplines seems to me to be that quality of the caring and the courage to be different in their own group. I mean I think we need to be courageous enough to have to have the guts enough to stick up for what you believe, whatever that is. And that's what I've tried to do. I believe that everybody should try to do that, and I don't expect everybody to agree with me anymore. I think maybe the one difference, big difference is, that when I first started maybe I wanted everybody to agree with me. Now I don't demand that.  \n\nQ.  You know, you mentioned customer and patient. Has your, I mean I sense maybe I know the answer, but has your image of what a doctor does or what a general practitioner or family doctor or exemplary person in any field, has that image changed of the role, since you were in your practice or even in the last, since you entered academics?\n\nA.  Well, I guess there's a fear that we're changing, because of all of the restraints and the litigious society we live in and the regulations and the governmental interest in our profession, has caused us to be different. I'm sure I couldn't start back into practice like I did in 1950, with $63.65 in my pocket. That couldn't be done any more. Nobody would tackle it anymore. I see young people now going into building buildings to a quarter of a mil-lion dollars, some of them. It boggles my mind. I mean I know that it's changing. And malpractice insurance – you would not even think it to be true if I told you what my last premium, when I left practice in 1950 [sic] was $54 a year. And I was delivering babies and doing everything. It was, you got so much reduction each year for good behavior. If you didn't get sued, and I had gone 20 years without a suit, so therefore I was paying just a pittance, I mean I – but now, even...\n\nQ.  That's about 5 minutes' worth.\n\nA.  Being chairman of a department and doing much less than I did in the way of patient care, I pay thousands and thousands more than that. And so yes, everything has changed in that sense, and I suppose it's made the dollar mark such a vital part of survival that it's distasteful to me. I started out in practice, $2 for an office call, $3 for a house call, $50 for delivering a baby at home, prenatal care and all with a 6 weeks checkup, $10 extra for circumcision if it was a boy. That's where I started. So you can see how the questions you ask me in 1992, I have to process through all of that back experience before I can come up with any decent answer. You know, it's – we must live in 1992, and we must somehow be able to try to inspire young people to do this thing which is honorable to do with all of the confusion that society has put on us. You can only hope that pendulums swing so far and then begin to swing back. I hope that will be the case. That's why I think a lot of young people are being attracted to the Third World now, because there's some of the same romance in the Third World now that was where I started in this country. And yet there are places in this country that are just as needy as the Third World, but something is wrong with the system, that distracts young people away from those needy places. You know, it's hard to do the kind deed any more, just because you want to do a kind deed without filling out a whole bunch of papers and forms. It's hard to say, 'No, I don't want to – you need the money worse than I do, you keep it.' You wouldn't dare do that, cause you fill out a paper for everybody, and you have to have an insurance clerk for every kind of insurance, and you have to have more – you have more overhead. You see, so the more it costs you, the more you have to charge the patient. And that's distasteful to me.\n\nQ.  You talked about the pendulum, you know, you hoped the pendulum swings back at some point.\n\nA.  Not being reactionary, but I'm probably saying that I think the pendulum has swung too far.\n\nQ.  My sense is that in the late '60s and early '70s, when family practice – when you entered academia, that pendulum was in a different place. And I was wondering what forces supported that at the time, either in medicine or in the greater society, what supported, that pendulum...\n\nA.  I think the people had a strong voice at that particular point in time. The people got the attention of their legislators and the politicians, and there was money made available to establish programs and that's how it happened that medical schools allowed us in. I don't think they did it of their own volition, and so there's a mixed bunch of precipitating factors back in those, the timing was right. The numbers of general practitioners being turned out by medical schools was dwindling to such an extent that we were dying on the vine out there. I was seeing over a hundred patients a day and I could get no help. I even went back to the medical school and said, 'Why, what can I do to help some of these young people.' And I remember being told by the president of my university, he says, 'I couldn't pay you enough to pay your insurance premiums if you came back here, because you haven't cloaked yourself with authority.' He says, 'You would have to go someplace and get some credentials before I could even offer you a job to come back on this faculty.' And it was many years later, when I was given an opportunity to go back, I never thought I would have an opportunity. I thought somebody else would do it. And for a long time I thought somebody else would be better to do it. And when I went to Charleston I told Dr. Curry that I would come and stay till somebody better came along, and then I would go back home. I intended fully to go back home. Now I guess it has become home. It's hard now to imagine not being here, I've been here so long, been in it so long. But the thing I still enjoy most is sitting down one-on-one with a patient and being able to hear what they say and being able to figure out what's wrong with them, and to do all that in the context of their family life.  \n\nQ.  Think things are different from a patient perspective? Let's say even in the community, where you grew up and where you practiced. (?) in the '60s where they perhaps had a voice, or were they – had more of a voice?\n\nA.  I think they've kind of sold out, they've kind of given up. I think they're becoming satisfied with the anonymous doctor seeing an anonymous patient. I think this personal interaction is probably not as much a premium as it used to be, but I think if they ever got a taste of it – see we have a generation of people growing up now that don't remember, don't know all about this. Don't know what it was like. It's sort of nostalgic and romantic-sounding. They all look back at Marcus Welby and say, 'Well, he only had one patient a week.' You know, and they think that was what it was like. That wasn't what it was like. But I'm encouraged, because there are still young people who have the same feelings that I had, and they're still going to make the future more nearly simulate what was, what was in the past. It will be a different, a different brand, but it's going to have the same basic, innate, caring qualities that we remember. And I, I have a lot of faith in the young people that I see. It's going to be hard, it's going to be tough with all of the things that have come along. We didn't have all the problems that they will have. But they've got a lot of courage. The same ones that want to go to the Third World are going to somehow wake up to the fact that there are those needy spots right here under their nose. And they're going to get hold of their legislators and they're going to get hold of the people, and together they can make it happen. They did it once, in the 1970s, it's just sort of cooled off now for awhile. And I just think it's going to come back.  \n\nQ.  You've talked about a lot of different things. Have there been other aspects of your work, or of your recollections or of your hopes for the future that you had thought I would ask about, or wanted to bring up?\n\nA.  No, I guess I didn't know, I on purpose didn't bring you a CV, because I didn't want – I mean there are lots of things on there that I've done, and maybe as an afterthought it might be good for me to go back home and look at it, to see if there's any basic things we've left out.\n\nQ.  My interest in this actually has not been what you have done, it's what those things have meant to you, and so I try not to...\n\nA.  So that's why I didn't bring it.\n\nQ.  Right. And sometimes the littlest things that you can't even put on your CV.\n\nA.  Oh, yeah. Well, I guess that I am extremely grateful for being, having been allowed to be a part of this whole effort. I've had a full life, when I think about it. I enjoy seeing young people outdistance me, and I'm so thankful for that kind of, I guess I don't feel whipped by my ego, which I guess I should be very thankful for. I think it would be terrible if that had really – if two things, if the ego and the want for wealth had ruled my life, I believe I wouldn't be at peace. But I feel at peace, and I'm grateful for that feeling of peace. I'm grateful that I can sit here with you and I can say of the two people in this room, which one has the greatest potential, and I can say with honesty you do, you know. I can feel that. And you say, ah, maybe you disagree, but I can say potential to me means future. 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