{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/mc8rb6z402/manifest","type":"Manifest","label":{"en":["Dr. Donald Ransom "]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1991-11-19 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. William Ventres (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","family medicine","family physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Donald Ransom, PhD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003e This is a series of two interviews six months apart in 1991.Dr. Ransom is a PhD who became involved in the early days of family medicine and was instrumental in designing and developing the concept of the family in family medicine. He was the product of graduate studies in psychology and sociology at Harvard and the University of California at Berkeley. He helped create, as a graduate student, a family medicine pathway at the University of California San Francisco. In 1971 he attended the Society of Teachers of Family Medicine (STFM) annual meeting, where discussions with other participants led him to write an article for JAMA asking where the family was in family medicine. He subsequently chaired the STFM Task Force on the Family in Family Medicine and helped initiate an annual conference on the subject. The interviews covered in great depth the concepts of family medicine and detailed his journey and his thinking. He championed research on the subject and is one of the true pioneers and leaders of this concept. His wealth of history and his efforts make this an important document in this arena. \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"]}}],"summary":{"en":["\u003cp\u003e\u0026nbsp;This is a series of two interviews six months apart in 1991.Dr. Ransom is a PhD who became involved in the early days of family medicine and was instrumental in designing and developing the concept of the family in family medicine. He was the product of graduate studies in psychology and sociology at Harvard and the University of California at Berkeley. He helped create, as a graduate student, a family medicine pathway at the University of California San Francisco. In 1971 he attended the Society of Teachers of Family Medicine (STFM) annual meeting, where discussions with other participants led him to write an article for JAMA asking where the family was in family medicine. He subsequently chaired the STFM Task Force on the Family in Family Medicine and helped initiate an annual conference on the subject. The interviews covered in great depth the concepts of family medicine and detailed his journey and his thinking. He championed research on the subject and is one of the true pioneers and leaders of this concept. His wealth of history and his efforts make this an important document in this arena.\u0026nbsp;\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/153756/file/282870","type":"Canvas","label":{"en":["Media File 1 of 4 - Ransom_Donald_Pt1_91_a.wav"]},"duration":1914.98806,"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/153756/file/282870/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282870/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/282/870/original/Ransom_Donald_Pt1_91_a.wav?1752683493","type":"Audio","format":"audio/wav","duration":1914.98806,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282870","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282870/transcript/81717","type":"AnnotationPage","label":{"en":["Dr. Don Ransom Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282870/transcript/81717/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview by William Ventres of Don Ransom\n\nNovember 19, 1991\n\nSanta Rosa/Tucson (telephone)\n\nQ. - William Ventres\n\nA. - Don Ransom\n\n_____________________________________\n\nQ.  This is a telephone interview with Don Ransom, Don is in Santa Rosa, California, I'm in Tucson.  The date is November 19, 1991, it's","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282870#t=0.0,630.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282870/transcript/81717/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"a.m.\n\n[pause]  How are you?\n\nA.  Pretty good, just getting over a bad flu head cold thing, but I think I can get my head in the right place and talk.\n\nQ.  Okay.  I'm actually not too sure where to start, I read through all your things, and it's really very interesting what you--\n\nA.  Yeah, I couldn't even remember what I was thinking yesterday getting ready what I had sent you and what I hadn't.  I saw some things, and I said, 'Hey, what's this doing?' and I think I pulled a few things out figuring that I had sent enough, and then I thought, 'Well, why didn't I send him this?'  But I think you have more than enough.\n\nQ.  Okay.  That's right.  Well, let me just ask you this, and you said you thought over it a little bit, and as you know, my interviewing style is pretty nondirective, which is kind of what, I want you to take the direction so to speak in some of these issues.  What kind of things did you think about yesterday that you thought you might want to bring up, or general directions and we can incorporate those into--I do have some specific ideas or thoughts I want to ask you about, but was there anything yesterday that you wanted to bring up?\n\nA.  Well, there was only one thing that I thought of in relation to my remark, which was the, you know, the forest and the trees issue, really trying to kind of get things down to some kind of, you know, what's really important here or what did I find interesting, or what contribution did I make or did I think (??) just like me made, and I had this--it's not a new idea, and it comes through in the writings, but it's here and there and it's scattered, but  I just felt like one of the things that's been real interesting, that has been more, I've been more aware of lately because I've been doing more Balint work than family systems work, and that is that--and it goes together with, why have I always, you know, had such a strong identification with Lynn Carmichael?\n\nQ.  Right.\n\nA.  And I think it's kind of dawned on me that from the very beginning there were these two streams, at least, two main streams of people in family practice, in the modern movement, and the minority stream is the one that Lynn represented, and that I really tried to strengthen.  The majority stream, and they were both important and they're complementary, and it wasn't really one versus the other, although sometimes it came out like that.  And the one was, those who came in to fill the primary care gap and to be superdocs, you know, to really be the people who really saw the discipline as one of synthesis and you needed all the specialists to help you learn all these particular things up to a certain point in their own area, and then you kind of put it together and you were a jack of all trades.  But that tradition emphasized much more procedural competence and just being able to be all things to all people, but really didn't have much insight into being a new kind of physician, a personal physician.  And didn't really--wasn't very personally self-reflective, although maybe they had those inclinations, too.  But that never was part of the agenda or part of the training or no time was spent drawing that, building that side of their personality, let's say.  And then there--the other flow that I identify most with Lynn and Ian McWhinney--well, Ian is sort of the true synthesis, but--is the person who really wants to be, you know, is the point of entry, anybody can come into the door, all comers are welcome, but the idea is not that I can solve all your problems but that, you know, I'll be with you, whatever is wrong with you.  I'll help you with it if I can, I'll find somebody, we'll really get to the root of what's going on, I'm going to be your personal physician, your advocate.  I want to understand you, I want to help you be a healthy person.  And had this idea of a new kind of physician, you know, that the system had gone crazy and we were producing people, you know, who were, couldn't connect to people, relate to people, couldn't use the history to really make diagnoses, couldn't think on their feet, couldn't get to the bottom of what's wrong with people because they were following these protocols and trying to do a little bit what the internist did and the surgeon did and the pediatrician did and the psychiatrist did, and never really put it together.  And secondly, you know, that stream of folks really thought about it, was soul-searching all the time and asking themselves questions and wanting to think about patients and symbolic meaning of symptom presentations, and group interaction and that kind of stuff, and realized that that was intellectually challenging and personally challenging, and made it a main part of the agenda of becoming a physician.  And I was thinking, you know, over the years, that's what I feel I've really tried to link up with.  And I've always had trouble with behavioral scientists who got, went in with protocols and behavior mod approaches on how to treat this and how to do that, and you know, could come up with answers to somebody and say, 'Well, I've got this person and what's the treatment for depression?'\n\nQ.  I see.\n\nA.  And rather, you know, much more concerned with trying to sort of open up the whole thing and get to the bottom of what's going on, try different approaches, think about, you know, your own role in it.  And now--and so what I see happening is that you know, there were two kinds of behavioral scientists, too, and as time has gone on it seems like those that were more interested in growth reflection, physician stress and well-being, really learning to talk with people instead of using cookbook approaches, have kind of grown.  And the result of that has been that even people who were sort of the superdoc types have been encouraged to think about what they're doing, it's drawn them out, they've been going to resident support groups, they've--you know, been doing Balint demonstration groups at national meetings and even some of the old-timers are getting in there and really getting interested.  And it's really helped to kind of bring out, foster that side of the whole personality of the practice.  And of the specialty.  And there was one little--I realized after reading, I don't know if I even sent it to you, it was a piece that I did that John Frey had sent me, a task force report on behavioral sciences and family practice, and I had some problems with it, and I wrote a little critique.\n\nQ.  Right, it was in, there was a pro and a con actually.\n\nA.  Yeah.\n\nQ.  \"Perceptions of Behavioral Sciences:  A Quiet Revolution Going On.\"\n\nA.  Right, did I send you that one?\n\nQ.  Yep.\n\nA.  Yeah, well, good, I must have had two copies of that, and there was a pile of stuff left over from what I didn't send you.  But I was reading that that I realized that, that that was sort of a, that sort of jumped out at me, that you know, at the time I wrote that I wasn't even aware, exactly, as to the larger picture, as much as I am now.  So anyway, that's just the only (??) thought I had prepared ahead of time, and I may have even touched on some of that on our first interview, you know, I can't remember from one thing to the next any more.\n\nQ.  Well, where are we now in terms of this new kind of practice or new kind of family doc?  You mentioned people are coming in, but do we realize that?  Where are we?\n\nA.  Well, I think we're in a very interesting and critical kind of juncture.  I think I'm encouraged by what I see as a kind of a--I don't want to say consciousness-raising, 'cause it sounds too California-ish--but a sense of awareness into that potential of the personal physician and of the importance of meaning in the doctor-patient relationship and a self-reflection, and I'm really encouraged by the renewed interest in Balint seminars.  And with that I realize that what's really very good about that is not just that it's--there's a side to it that's not obvious, that's really, I think, going to make a big difference, and that is that Balint training is almost like procedure training.  You can almost draw an analogy to doing a flexible sigmoidoscope exam and learning how to do it.  That it's a way of thinking about a problem, of coming to understand, of coming up with alternatives that is extremely practical.  And it's the best method we have for helping family doctors get on their feet with problem patients and difficult situations.  And also to reduce their--I'll put it the other way--to reduce their lack of happiness, or to increase their sense of satisfaction and reduce the risk of burnout from day-to-day practice.  And so a lot of the things that people use drive them crazy and that kind of thing, I think there's a technique to sort of getting a handle on that, feel better about that, and all you're doing is the best you can, that it's a very difficult business, to do family practice, and I think that's kind of growing.  At the same time, on the other side, is this terrible larger issue in the economic system and the economics of health care and managed health care systems and pressures on time.\n\nQ.  Right.  A very big competing interest.\n\nA.  It's kind of almost an alien force that is real and has to be coped with, but it has no direct connection to the doctor-patient relationship, or what's the best way to practice medicine, or what's good for patients, what's good for doctors.  It's a very, it's kind of, it makes the doctor's skill a commodity.  And it turns the practice of medicine into a, you know, a consumer/provider kind of metaphor, and it looks at the whole thing as a business.  And while it isn't--there is an economic aspect to it that can't be denied, it's kind of gone so far that way that it's setting parameters that make it very difficult for some of these more hopeful [helpful?] things to continue to evolve.  So I'm not sure how it's going to go, but if, you know, I think internally things look good, it's just the external environment isn't going to really overpower what's going on, it could be very hopeful.\n\nQ.  I'm going to challenge you here a little bit, though, because two things, two thoughts come to mind, both things that you'd written.  I don't know exactly how to ask the question, but one was that you sent me the information on George Silvers, the article you wrote on Silvers' demonstration project.\n\nA.  Oh, yeah.\n\nQ.  And that was a, that was an HMO kind of model in a sense.  It was a much more elaborate, it was managed care but it was kind of comprehensive management rather than just medical management.  And the other thing that just comes to mind is that you say that internally we're doing well, but a lot of the rhetoric now is still the same stuff that it sounds like they talked about in 1971, you know, we're here to serve the underserved, we're the best primary care specialist around, nothing new.\n\nA.  Well, I still think those are--that's fine rhetoric and I, you know, I think that's--my hope is that those two will become more synthesized.  You know, a real good example of where that synthesis is difficult is San Francisco General.  They're not very interested in Balint training, you know, they really see that as sort of fluff and middle-class stuff.  They're there, you know, they're there to serve the poor and the underserved and the ethnic minorities, and they want to make sure that the care of the underserved is in the department mission statement.  And got into some, a bit of a hassle at the faculty meeting about whether, you know, that should be in the mission statement or that was just background, and they're very adamant that, you know, that the dean should know that and the world should know that, and that that's really what family practice in their mind is about is serving the underdog and taking care of people whom nobody else will take care of and go into places where there are no doctors.  And I still think that's fine, I think that's sort of a challenge in its--there are lots of ways to work on that problem besides just using family doctors, but I still think that's fine--but I think, what I hope will happen will be that that set of goals will start to become integrated with the other set of goals so that the two will come together.  You know, I may be too optimistic.  But back to the Silvers, to the LaGuardia thing, my reading of that and the little bit of discussion, and I never have talked to Silver, unfortunately--\n\nQ.  He's still alive, isn't he?  He's at Yale.\n\nA.  He's still alive, yeah.  Is that it was a very progressive, very creative idea and the reason it failed wasn't so much because of the HMO side of it, but in a way because they, in a multispecialty effort to be a family health-providing service, the specialists could never work together, they never could get it integrated.  They never knew who was in charge, (??), they couldn't really collaborate very well, they weren't used to working that way, and they were competitive and territorial and it was kind of like Balint's theme of (occlusion) of anonymity is that, you know, the internist was supposed to be in charge but then it might be the psychiatrist or the pediatrician.\n\nQ.  Right.\n\nA.  And in Silver's writing, it's obvious he has no notion whatsoever about family practice.  And my thought was that, you know, if there had been family physicians available then, and you know, that they were trained more as they're trained now and they had built that whole first experiment around family doctors, how might it have gone.  And it might have been a whole different story.  I don't know.  And so in some ways, you know, that's possible to do nowadays, but the economics I think are so much worse than they were then that there may not be enough margin in the whole system to do it right to start with.  I don't know.  \n\nQ.  (??) interested general comment that I would have as well is that I was able to talk to some people that were involved in getting HMOs going in Minnesota quite some time ago.  And whereas now we talk about HMOs in terms of you know, cost containment and managed care, managed almost as an economically managed--at that time I think they really did have a different vision of what it was.  It was really, it was kind of quality care provided to a group of people.  I mean they didn't talk so much about finances.\n\nA.  That's right.\n\nQ.  It was more the philosophical aspects of what managed or what HMOs could do, a maintenance organization, health maintenance.  And I think we lose sight of that and now we see them as cost containment modules.\n\nA.  You know, and I wonder about, you know, what really happened in that evolution, you know, the dollars did get tighter, but what else went on?  The people who really got in positions of management were Harvard business graduates and also there's this universal, sort of horrible law that I don't know if anybody's even formalized, but it's--you know, whenever the situation is ambiguous or complex, people always tend to go towards solutions which are concrete and justifiable to their peers.  And so you begin to kind of concretize things.  And go more for that economic metaphor, that bottom line metaphor, and you think you can manage things and control things if you can just a handle on certain kinds of costs.  And there's this fantasy that that's the solution.  And so things just kind of drift that way unless there's strong, creative leadership somewhere that just keeps it from doing that.  It's almost like water seeking it's lowest level.  \n\nQ.  Right.\n\nA.  I think that a lot of that's what went on.\n\nQ.  Okay.  I'd like to change a little bit here.  I want you to talk a little bit about what you're training in psychology was like.  You talked about training with Bateson, some other guys that I don't know, Weekland(?) and Haley and--what were the key things that really interested you about your training or that really got you going?\n\nA.  Well, I was really unusual in that, you know, I really have to think about my training now in a whole, the whole picture.  'Cause when I was an undergraduate at Harvard, I was very influenced early by, I was a social relations major in the start and I did a lot of work with John Whiting who was a psychoanalytic anthropologist, a yearlong tutorial and I really got interested in that kind of interdisciplinary approach.  And then, the same year was Robert White, who taught a course on the history of lives(?), which got me very interested in the kind of ideographic, autobiographical approach to psychoanalytic and theory and just looking at how life evolves over--a person evolves over a lifetime.  And so I had that grounding, and then very late I got interested in social structure and personality and, there was a guy there named Ellis Inkliss(?) who had an interesting way of trying to take things as far as they would go at the cultural and social level and then crank it down to the family and community level and then go down to the individual personal level to kind of squeeze as much understanding as you could out of a situation.  And I switched my application at the very end from psychology at Berkeley to sociology at Berkeley.  And so when I got to Berkeley I ended up in a training program that really wasn't like the Inkliss stuff, it was on socialization and personality, but it was very boring.  Everybody was expected to do their dissertation out of data already collected in the Berkeley and Oakland growth studies.  And I had had it with that very quickly and switched back into psychology.  And--but I was kind of full of a social imagination and kind of into, you know, anti-psychoanalytic at that time, and really looking at the context of people's lives.  So in that I was a kind of a rebel in the department, and they were primarily psychoanalytically oriented and I--\n\nQ.  Is that what you mean by social imagination, the context of people's lives, or--I'm not sure what that means.\n\nA.  Well, that, you know, I had always felt that psychoanalytic theory kind of brands the victim in a way, that people were the cause of their own misfortune because of their internal hangups.  And that they needed to get insight and just grow up and gain maturity, and that they needed analysis to do it.  And that reality didn't matter much.  And I never believed that, so I kind of, you know, kept my ties up with the sociology department.  And I had an interesting arrangement, that if I agreed to stay on as a sociology graduate student one more year I could keep my training money, even though I was in the psych department.  And it was during that year, where I was just a transitional student in both departments, that the guy whose training program I was leaving went on sabbatical, and the person that came in to take his place, Henry Lennard, knew, happened to know Bateson and Weekland and Jackson and Haley, and Norman Bell and all of these interesting people in the family, early family system stuff.  And it was working with him and taking the seminar with him that I got introduced to all these folks, and so even I kind of went through graduate school as a psychologist and did my clinical training and my assistant training, all of that stuff, and my therapy training, and had very traditional supervisors, the research I was doing and the seminars I was taking, you know, were with--on the sociology of health and sociology of mental illness and cultural illness and family systems stuff.  And I was lucky to have at the same time, family therapy was just starting to happen, and one of the earliest people in the field happened to work in Berkeley, and we managed to get him involved in some stuff in the department and to be supervisor, and I worked with him, and that was Chuck Follweiler(?).  So I was, you know, probably the first generation of graduate students who could be trained in individual approaches and family approaches at the same time.\n\nQ.  Okay.\n\nA.  And those that came before were really steeped in the individual tradition, those, some of those who came after rejected it and just really got into family stuff.  But I was kind of lucky in that sense, in that, and that was when, it was during that time I met Carlos Luffsky(?) and ended up doing the book on the double bind with him about Bateson's work--\n\nQ.  Who is this Carlos?\n\nA.  Carlos Luffsky is an Argentinian immigrant who used to spend 6 months every other year at MRI in the early days with the Bateson group.\n\nQ.  MRI is--\n\nA.  Mental Research Institute in Palo Alto, where Bateson and Jackson and Haley and Weakland first worked, that was their institute.  And he had read my thesis and liked it and invited me to do a book with him, and his English wasn't so great, so I--he was a smart guy and I enjoyed working with him, so we did that, and it was--also, he then, when we--I was on the committee that planned and started the Family Practice Residency Program at the General in--it opened in '72.  And he seemed like a natural person to bring on as their head behavioral scientist.  So he went to work there.\n\nQ.  Oh, really.\n\nA.  I was working at the department part-time there, and it was over a couple of years that we put together the book called The Double Bind:  The Foundation of a Communicational Approach to the Family.  And he, and it was, we made trips to, down to Gorda on the Big Sur to visit Bateson and talk with him, day at a time.  And when we were doing our double bind book.  And that was when I got to know Bateson a little bit more, and then at the same time I kept up my ties with a guy named Henry Lennard, a family medical sociologist, who had lots of grant money, and he would have Halley and Weakland and--come up regularly from Palo Alto to visit with us to look at our tapes of families that we would make.  And whenever anybody was in town for a meeting he'd have them over, and so I got to know all the people in the family therapy movement over a couple of years.  And I was heavily influenced by that in the early days, so that when I got into family--it was about this time I was already working in family practice, too.  It was a time when Lennard's money was running out and I was just finishing graduate school and I ended up getting the job and so I was, you know, thinking, boy, if this insight was good for psychiatry and mental health, it's going to be great, even more important for general medicine.  So that was kind of the platform that I entered the picture.  And that was the frame of mind I had when I wrote that piece I sent you that was in JAMA in '72.  \n\nQ.  Right.  You know that piece, reading it now, two things came to mind.  One, it's kind of angry--\n\nA.  Oh, yeah.\n\nQ.  And two is that, I don't know if you've changed much--I guess, I guess I wanted to ask, you know, where your anger came from outside of what we talked about internally, if there was something outside as well, outside in the community that, you know, that stimulated you to be kind of an angry guy about this.\n\nA.  Well, I was real angry.  I think it was partly disappointment that when I went to my first STFM meeting, you know, I thought I was going to find a bunch of comrades.\n\nQ.  Right.\n\nA.  And I think we talked about this a little bit.\n\nQ.  That's it, we mainly talked about that internal kind of disillusionment.  But I was wondering if there was something else, from the outside, if it was, you know, something in the community, or something, the social times or the--\n\nA.  Well, I identified I think strongly with the '60s.\n\nQ.  I don't know if you were living in Haight-Asbury at the time.\n\nA.  I think I was.  I think I actually was living right down the hill from the Medical Center until I moved back to Berkeley in '72 for a couple of years, and I was--you know, there were a lot of cross-currents.  But I think, you know, it's hard to say.  I think some, there might have been some extra baggage in that paper aside from thinking of some of the guys that were really pushing the stuff, were, I don't know, thinking that they were selling a phony bill of goods or something like that.  But it, I had a real turning point, and I may have told you about it.  A lot of that anger, or partly I think it's aging, maturity, whatever, but back in, must have been around '76, '78, two things happened.  I think I may have told you this story of running for the board and losing the election.\n\nQ.  That's right.\n\nA.  And then when they formed the task force on the family, in family medicine, and I didn't get appointed to it, I realized, you know, I was angry about it, and I--but then I realized, hey, you know, this is partly me.  These folks are seeing me as an outside, as a critic, as somebody who isn't going to be helpful but just going to cause trouble.\n\nQ.  A provocateur, perhaps?\n\nA.  Yeah.  And I realized, that, you know, I didn't want to be--\n\n[tape side ends]\n\nA.  So that, you know, and think of the impact of some of these things.  So that, along with just, you know, getting some of it out of my system, I think may have been--'cause I don't feel that anger now.  \n\nQ.  Do you think, though, that some of that anger was part of the, you know, living in Haight-Asbury or the greater times, or the--I'm not even sure, I was a young kid.\n\nA.  Maybe a little bit, I don't connect with that too much when we talk about it.  I think, I think some of it, and I don't know if we touched on this too, was that, in one position I had and my own program until Frank Dornfester(?) arrived.  And I think--did we get into that in the interview?\n\nQ.  Just a little bit, mostly about how Frank has really changed the program.\n\nA.  That I was, in a way, using the larger stage of writing and the whole field to act out, as a stage to express my anger and frustration with my own program, that I couldn't deal with locally, 'cause I would have my ass in a sling.   And so when--or any of that, I think the test of that idea is that when Frank came and had the opposite view, a lot of the fire went out of my guts.  \n\nQ.  Right, you mentioned that.\n\nA.  I no longer had that foil.  In fact, the challenge was, the shoe was on the other foot.  It was like, 'You've been saying a lot of things and you've got a lot of these ideas, Ransom, let's see what you can do for us here locally.'  Instead of, you know, 'You can say all this stuff nationally, just don't do anything here locally.'  Which is the way it was before.\n\nQ.  Don, you mentioned in that article, used the term family in a broad sense, I've got it here, the term family, you probably know it by heart, I don't know, \"the term family is used in the broadest sense to describe any group of intimates with a history and a future.\"  And I've heard through the grapevine that you and Herb Vanderbilt were the people that really defined that.  You made that up, or you took that at least from somewhere and put it into this audience.\n\nA.  Yeah, I don't think I invented that phrase, but I can tell you I have searched my library to find who said it first and can't find it.  But that definition of the family really did stick.  It made a big impression on a lot of people as a way to think about this.  And I--I remember for a long time it got traced back and quoted to me and I felt a little bit sheepish about it, but I think that in a way that was the way the family was thought of by a whole bunch of people in the early family therapy movement.  It wasn't taken literally, but it was taken more as the social environment that was relevant, and you know, I thought that was a real essential part of the whole piece because otherwise--that was where Lynn and I worked out our differences, because he was adamant that the family literally was not the focus of practice and that the relationship was to the person and the, family practice was for everybody and you shouldn't just see families.  And I agree with all of that.  And what I was trying to do was just say that it's these, it's this whole sphere, this middle, middle-sized set of influences between what goes on inside the skin and the head and what goes in the community and the ecology, the larger ecology, that we haven't looked at that makes a big difference in people's health and illness.  And the success of care, and that is a relevant scope for family practice.  That's fuzzy, but I think it's still right on.\n\nQ.  Mm-hm.  And so you moved away, it sounds like, from what other people, or maybe in the concern that people weren't talking so much about what family was in family medicine, and that's why you came up with your article.  But you know, you moved away from pretty traditional concepts of what family is, and I think that some people still think.\n\nA.  Well, they weren't talking about family in any way--\n\nQ.  Right.\n\nA.  --literally or metaphorically.\n\nQ.  You know, it seems to me that people have taken the definition of family since that time in different ways.  I was talking with a family therapist, maybe you know him, Dael Waxman, he's an M.D.--\n\nA.  Yeah, I know him a little bit.\n\nQ.  He went through this training at Rochester and he said they do a lot of kind of normative training--\"This is what families are.\"\n\nA.  Yeah.\n\nQ.  And we should work to get them back to that state.  And I mean that's, that's almost not what you're talking about.\n\nA.  No, I have trouble with that.  And I have trouble, in a way, you know, on the one hand I know that families are different than other kinds of primary groups.  Blood is thicker than water, there's something different about family ties.  Even though there's so many different family forms in our society and there's, you know, the fantasy of the nuclear family is just one of a variety of arrangements.  But even with all the arrangement there's something, there's lots of juice there.  And the person that I was most influenced by in thinking about it was R.D. Lang, you know, where the thing that's so crucial about a family is that people identify so strongly with each other that they really do think that the behavior of one is almost like them acting themselves.  It's such a reflection on them, and they feel so identified and bounded with them, that they will commit great crimes to control their people in the families to keep from acting a certain way.  And people will go to any lengths at times and they'll do things for each other because it feels like their own survival and their own life, their own value depends on it.  So it's a powerful force.  And the other line of thinking that influenced me that, that I use more than I used to but I still have some trouble with his (??) theory in family, intergenerational theory, where they really stress the family emotional system and then it's almost a biological image for them.  And that's to some degree, you know, what Dale, some of Dale's training touched on that and some other things too, but there's this idea that families work a certain way and that [if] they don't function that way, they're pathological and you kind of turn them back to working that way.\n\nQ.  Right.\n\nA.  And I've never, you know, that's sort of--it's hard, I've always had a terrible time teaching and never expressly taught the family part very well because I can't teach that way.  Just doesn't--everything that you can say that way you can make exceptions for.  And so it seems to me if that's the case, then it's not important to teach.  It's important to teach you something at a little higher level about just that it's, that it is there.  And that each person has a story, each person has some kind of family background.  They have an internal family, perhaps an external one still, and that they, that this may play some role in who they are and how they think about themselves, what they think about health, and even if it isn't that immediately relevant to presenting a problem, it's relevant to who they are as a person.  And to get to know that person in some sort of essential way quickly as a family physician, you'll want to find out about that.  And that people like it when you're interested in that.  \n\nQ.  And that does fit your relatively loose definition.\n\nA.  That's it, yeah.  \n\nQ.  Okay.  You talked about teaching, and I'm going to move on a little bit to that initial course that you had on family health and illness.\n\nA.  Yeah.\n\nQ.  I got, I had your article on the basic course in family medicine, which was more about the philosophy and goals and structure.\n\nA.  Yeah, I sent that just out of historical interest, that was that course way back.\n\nQ.  Right.  I guess two things come to mind, is one, what did it mean to you to be this, I think in the first interview you talked like you were the first person in the country teaching a course on family health and illness.  And what kind of things did you take into that and gain from that?  And secondly, what kind of influence did Herb Van der Berg have on you as a psychiatrist?  I understand he was interested in family medicine and the development, and that he died relatively early.\n\nA.  Yeah.\n\nQ.  I was just wondering about those two things.\n\nA.  Well, you know, I--when I was planning that course and I wrote a lot of places and just--I went to the library and I looked in medical school catalogues and I actually wrote to maybe 40 people that I thought might be teaching a course similar, and there were people teaching stuff, social workers and people here (??).  I don't think I was really the first, but I really kind of put a bunch of things together in a way.  And I really tried to do with that course, the course has always kind of been an extension of my real values and purposes, you know, it was--I always taught it with a family doctor, I invited all students, not those just going into family practice, I tried to tell them that whatever specialty they would go into they would be well-served by having, you know, kind of an imagination, you know, stimulated about who people are and what affects them and I wanted them to go out into homes and interview families about their health history and their health plan, and if they could have an ideal health plan how would it be, and did they like their doctor, and just basic stuff.  Which the students loved.  And that course actually, since I talked to you, I was about to teach it for the 23rd year in a row, and we didn't have enough students to do it this year.  And there are lots of other opportunities now in the department and the school to do preceptorships and to work in community clinics and to get some of these ideas so that it's kind of like not nearly what it used to be in terms of its uniqueness, which is good.  It's kind of become obsolete, in a way.  So it's good to be part of that, and I never tired teaching of that, 'cause I always started out with the students' own story, who they were, what their experience with health care was, a little bit about their family, and it was endlessly fascinating because no two people were the same, and each entering class different and I never got bored teaching that course.  And I felt kind of sad that it's now--but now I'm going to be doing similar things, and we've just been given the responsibility for, and a person who taught with me in my course is now the course head of Introduction to Clinical Medicine in the first year for everybody.  So I'm going to work with her and we're going to bring a lot of these ideas and techniques into that course.  So it's really going to be more work and a bigger stage than I had before, but my course is history.\n\nQ.  Okay.\n\nA.  But the early, Van der Vort(?) was an interesting guy.  He really, he was a psychiatrist who really believed in the family practice model.  And he really knew there was something to all this, and was a tremendous source of support.  He was the only physician for several years, back in '69, '70, '71, '72, and the only real physician in the family practice pathway.  And it was kind of him and me for several years until David Sonwald(?) was hired and really--Bob Masid(?) was brought in in '72 to direct the residency program at the General from his practice in the Valley.  And he taught in the course and he was involved, but he was, you know, swamped with San Francisco General stuff.\n\nQ.  And he's in New York now, isn't he, or--\n\nA.  Yeah, he's been at Montefiore for a number of years.  He's a real interesting guy.  He's somebody you might want to talk to.  In fact I was thinking, is McWhinney one of the people you--\n\nQ.  John Frey interviewed him. \n\nA.  Uh-huh.  And how about Lou Barnett?\n\nQ.  I wrote to him and he wasn't at last year's STFM meeting, so by chance I haven't interviewed him.\n\nA.  'Cause I was thinking of people that you, you know, that I really thought were interesting characters, who could really tell a story and of course McWhinney's obvious, but Barnett is one and Bob Massett(?) is another.\n\nQ.  Okay.\n\nA.  So, but Van der Vort really, you know, was the only advocate.  And he was a psychiatrist.  And he would fight with the chairman and he would try and get more family practice recognition and get our courses supported and get preceptors involved who were family physicians.  And then by historical accident, he got saddled with--I guess he wanted to do it, but--the human sexuality program.  Human sexuality course that was required for everybody in the first year, started a sex therapy clinic, that was very pioneering and kind of got swallowed up by that.  And getting that supported and getting himself recognized in the academic series, which he never was able to do, really with so much stress on him I think the combination did him in.  But it was--he was sort of the, you know, he was sort of the protector of family practice and of me in those early years when I was controversial and we were just getting started.  You know, not much understanding of what we were all about.  \n\nQ.  And then you talked about how you and John Geyman would also go down--sounds like John Geyman was also somewhat of a--\n\nA.  Well, Geyman was involved in Santa Rosa, from '69 he'd drive down to the city and he'd hassle the chairman all the time, he was a strong personality and so was our chairman, Bob Credet(?), and it was clear Geyman wasn't going to get anywhere with him.  But he saw that I was real interested, and we would--he invited me to Santa Rosa, and we would take the--we made three or four trips, well, maybe two or three trips that we took to MRI, 'cause Geyman was really wanting to know all about this stuff.  He was really wanting to find out as much as he could and get it set up right.  And I think in those early days I'm not sure he ever really did understand some parts of it, but his heart was in the right place.  But I think Geyman could see that family practice that you see in those days wasn't going to take off, and that was one reason why he went from Santa Rosa to--\n\nQ.  Utah, I think.\n\nA.  Utah.  \n\nQ.  You said in those early days that you watched a lot of family doctors.\n\nA.  Right.\n\nQ.  What were the kinds of things that you learned?\n\nA.  Well, I guess I--one of the things I learned was that I could watch a family doctor for almost 2 minutes and tell, is he talking the language I'm interested in or not?\n\nQ.  Probably patients too.\n\nA.  Yeah, and that--he, it wasn't necessary to have any rap about it, to be able to talk about it reflectively, to say, you know, I'm doing it for this reason or that reason.  That some family doctors really knew how to connect with people and get to the bottom of things and have a real conversation, and some couldn't.  Some were just sort of playing doctor.  And that really struck me.  And I learned that and I also learned that in a way, it made me think that the theory is really an afterthought.  People do what intuitively they think they ought to be doing.  And then somebody else invents an explanation for it.  It isn't the theory that drives anything.  The theory's a caboose.  And then I also learned the tremendous variety of ways people organize their practice and their lives and what they focus on and what they emphasize.  The others had no idea, you didn't know what you were getting into when you walked into a doctor's office.  It was, you know, and I would go to surgery with them and I'd go to, when they assisted, and I tried to learn that side of things too.  But one of the things that I did learn, that still sticks with me and I've written about it and I still bring up in meetings, is that there's a lot of family doctors out there who are a tremendous research who aren't being used for teaching residents in particular and students get to see them more.  And that is that it's still rare for a resident to be able to work in the room, shoulder to shoulder with an experienced family doctor to really get a sense of how somebody who's good at it, who's been doing it for a while, does it.  You can't--I think unless you, it's like an apprentice thing, unless you can work literally with somebody in the heat of the moment in their office and hear them talk and watch them touch the patient, you can't internalize it, you can't introject them, you can't swallow their style and try it in practice, because you can't experience it.  And that's a whole different thing from going outside and saying, 'I just saw this woman and she had this (??) and have them give you a consultation.'  Totally different.  And I think residents get that in the hospital when they work with specialists at the bedside and when they do surgeries, they--and so what they do is they still internalize specialists, 'cause those are the emotionally charged moments and they're really right there with them and they see how they act and then they just--that's the role model that they internalize and they do.  And they don't get to internalize family doctors.  Unless it's sometimes in the hospital like with a complicated delivery or something.  And I think that's still a tremendous weakness in the training.\n\nQ.  You mentioned oh, at one time, that--maybe it's putting a couple of things together--in training this new kind of doctor, you mentioned watching (??), you just mentioned it, and I actually have the article, I think you'd talked about--you talked about these Canadian doctors working hand in hand with the faculty.\n\nA.  Oh, yeah, my visit up there to McMasters.\n\nQ.  Right.  What other kinds of things do we need to do now, and maybe it's changed, but what kind of things do we need to do now to develop the training of this kind of doctor?  Or what other kinds of things?  You know, we've grown, I look back on all these interviews and I kind of find myself feeling like I'm just one of these unreconstructed general practitioners, because my training was pretty--sadly, I look back at it--because my training was pretty conventional.\n\nA.  Well, you know, I think it's a real problem.  I think that, you know, my suggestions would be modest and would be, try to be realistic and try and do those things within the context of what residents actually have to do and where they have to work when they're trained to get some of these kind of experiences.  'Cause if you really look at it, the experience of being a resident, you know, you go into a, generally a public hospital, and see people who nobody else wants to see, who have the worst problems in the county, so you have the least experienced people seeing them, and you've got a lot of time in the hospital, you know, the hospital needs the residents to survive, and you get good training in emergency, you know, a person comes in, you work him up, and you really feel like you've saved their lives and get them in the outpatient center and you try to get their diabetes managed and you're seeing the kids and delivering the babies and doing all this stuff, but the demands on a resident in that environment just to play their role in the system are so powerful, that to kind of create the kind of learning opportunities to develop this other side are very difficult.  Even with the best of intentions.  And I think it's remarkable that the residents get through all that and still maintain a certain sense of idealism and a certain sense of still wanting to be interested in people and carve out their own kind of practice later instead of just going to work for Kaiser and taking the easy way out.  So that, you know, I'm real sympathetic with the difficulties, even though, you know, I've always complained of we need to do this and need to do that, I'm certainly aware of how hard it is, and what an incredibly difficult job it is to train a family doctor.  And that I'm not--you know, that--the Canadian example was, now I see it more clearly since I've been working more with some Canadians family docs, around this Calgary group and the work they've been doing trying to get their research and family stuff going and things like that.  It's such a different medical system and it's set up so differently that it's easier from the start to get some of these kinds of experiences set up right.  And you know, their training period is shorter and they want to make it longer and they can't do a lot of what they want to do.  \n\nQ.  But to bring it back to here, what would be your recommendations for here?\n\nA.  Well, I guess I'd want to try to create opportunities for the faculty and the residents to practice together more in the outpatient setting.  And I'd want to create opportunities for residents to actually spend some time in the offices of experienced family doctors with them, even a month.  I've seen people turn around in the third year when they've gone out and spent a week or two just going in the room and sitting through an afternoon of seeing patients with a family doctor.  And a lot of residents are not initially very interested, and they want to do things themselves, they don't want to be passive, they don't want to watch.  But some of them struggle and say, you know, they often kind of get in the middle of things and they still wonder, well, I'm doing all this stuff but what is a family doctor, anyway?  And what's so unique about this?  And I just have to learn all this stuff, don't I?  And they kind of have this lack of a sense of identity and self-regard.  You know, if they could see somebody who's kind of achieved that work, you know, it suddenly comes together for them in a way that nothing else, no kind of teaching can put it together.  So I'd want to encourage that.  And the other thing I've always pushed and I don't push it as much now because it's just swimming upstream, is that I've always felt that--and it's family practice training should be more like graduate school and less like, you know, rotating internships.  And that more time for seminars, more time for reflection, more time to think.  For example, an ideal model to learn is intensive case presentation and case supervision, where you take a real difficult medical case or even, you know, emotional case, and you get three or four residents and you'd go into that case in some detail and have a seminar where they could present their own cases and be followed with them and then be given ideas about what they can do and what they can do next and what's really going on.  I think that that kind of thing fosters the kind of model I'm interested in.  But it's so difficult to do.  It's labor-intensive, it takes time, you can't get the schedule set up to get more than two people together in the same time and the same place 2 weeks in a row.  They're hassled by things, they don't have much time to read.  It's--I've really come to respective Maslov(?)'s hierarchy of needs idea.  You know, that any given person, he's got all these things and that they're in a real situation of trying to survive and they've got to take care of first things first, and when the resident's just trying to get through a day and get through a year and cope, and we're trying to feed him this hifalutin' ideology of family practice and this biopsychosocial stuff.  It's so far down the list on what's needed to survive that they're not interested, and I don't blame them.  And furthermore, they're not being treated in that kind of respectful, personally interested, holistic way by their resident program, their training programs and certainly by the hospitals that employ them.  So how can they in turn treat their patients that way?  So it's a tough environment to train this new kind of physician.\n\nQ.  What kind of--kind of on the flip side--where do you think research, or you mentioned research just when you were talking, and what kind of directions or goals should people doing research in this, to be this new family, new kind of physician, what directions should they take?  It's a little bit different question, but--\n\nA.  Well, it's a real challenge to do this, to look into this systematically.  I think it's wide open.  I think anybody interested in any part of this, the state of the art is so primitive in studying this stuff, any kind of work that looks at the natural history of a doctor-patient relationship or you know, turning points in the care of people, if you make certain kinds of approaches in interventions early, does it make any difference, you know, over a period of time in how people take care of themselves--you know, it's just--looking at common problems and their management, but including within that the fuzzier variables of who the person is and what they're environment's like and you know, what--whether the doctor chose any intervention besides the straight medical stuff, that kind of thing.\n\nQ.  Okay.\n\nA.  Nothing that earth-shakingly new, but it just, there's not much being done.\n\nQ.  I'm not sure we do it all that well, either.\n\nA.  Yeah.\n\nQ.  People are--\n\n[tape side ends]\n\nQ.  A lot of people I'm talking to aren't of your kind of generational core.  You're a little bit younger.\n\nA.  Yeah.\n\nQ.  You know, Lynn is probably 65, my guess is you're in your late 40s or mid- to late 40s.\n\nA.  48.  Yeah.\n\nQ.  I was just wondering if you had any thoughts or reflecting back on identifying with other people in the movement or maybe new residency graduates in the family practice programs, people in the first programs, just some reflection on kind of your generational involvement with the development of family practice and family medicine.\n\nA.  Yeah.  Well, you know, when it comes to that kind of thing I identify real strongly with John Frey and Barry Ingerbretson(?) and I see myself in their generation.  They might be a couple of years younger than me, and you know, the young Turks that kind of came out who didn't start the field, who didn't come out of practice, who didn't have the political clout and the courage to create it, but who kind of, were just beginning, but beginning early.  And I sort of, in a way I guess I'm the oldest second generation person.  'Cause I, you know, I think of Lynn and Lee Blanchard and even John Geyman, who was pretty young when he started.  You know, as the older generation, as the people I looked up to as the elders, the people who started and I was the upstart that kind of got in and wanted to get into the field.  And so I kind of look to them as the leaders, and I think of myself as sort of like the newcomer, but I--it just, I just happened to get to be the newcomer early.  And you know, there are a few people around like John and Barry and you know, who were--can remember what it was like in the beginning and what the original issues were and who carried really important values forward.  And--but what--and they're now in positions of leadership, but what worries me is what is the next generation of leaders, kind of, who are they and you know, who are the young Turks now and what are their vision?  And I think of people, you know, kind of like Mark Manuel at Oklahoma, you know, fellowship-trained, just out a couple of years, people like you know, I don't know, how old are you?\n\nQ.  Oh, I'm 33.\n\nA.  Yeah, so you're pretty young still.  You know, who are really interested in the field, who identify with it, who want to work within it, who have a vision of it.  How's there going to be room, you know, I mean like you got the old guards hanging on and you got the middle people, you know, still--you know, how to make room and how to let new leadership and new ideas come along, people that, you know, are attuned to the times now and economic issues but still who kind of have that sense of historical continuity.  And who still see the specialty and the field as evolving.  I think about that at times, you know, I still go to the STFM meetings and I look for the new voices, and I don't see too many of them.  \n\nQ.  Yeah, well, I actually had the opportunity to talk to John a little bit about that, and maybe he sees more at North Carolina, his viewpoint is that they're doing a lot of, they're buying in, you know, they're doing kind of clinical epidemiology and things that are respected within the medical field.  And that's kind of where he sees a lot of the people in North Carolina that are fellowship-trained, that are becoming faculty, that are--they're really interested in being involved, but it's involved in a medical sense.  It's kind of a preserving this hierarchy again and being at the top and respected.\n\nA.  Right, well, I think that's going to be the norm, but there's still, you know, a few people around.  There's a guy named Calvin Chin, I think he's at Cincinnati now, who trained with Parkerson, Tom Campbell's an interesting guy, who know the demands of achieving acceptance and academic respectability and what the issues are and mainstream, you know, academic family medicine, but at the same time still have a cutting edge, you know, a kind of a sense of individuality, uniqueness about where to go and what the field's up to.  So I know John gets a little discouraged at times.  \n\nQ.  Just as a comment--you mentioned three folks, this Mark--none of whom I know, Tom Campbell I know only through Dael, and Calvin Chin.  Are there other folks?  The last issue--I shouldn't say the last issue--the last of these I think is going to be something like \"Voices From Family Medicine Toward the 21st Century,\" and I want to interview some of the younger folks.  I talked to them, Betsy Naumberg in Rochester, and Janet Townsend in New York, and I was wondering if there are any others that you would add to this that would really be--\n\nQ.  Well, Janet's kind of in between.  I almost identify her with me.\n\nA.  Okay.\n\nQ.  But she's been around working hard for quite a while.  But she--but yeah, I think Tom Campbell's somebody you should talk with, and Calvin Chin was out here about a month and I really got to talk to him, and I think he was at North Carolina, and then he, got a fellowship with George Parkerson--\n\nQ.  At Duke?\n\nA.  Yeah, at Duke.  And then I think he's, may have taken his first job in Cincinnati with, I'm not sure, but I really found him interesting, 'cause he's interested in the research, he's interested in family stuff, yet he's a real well-trained researcher.  Wants to be a clinician--kind of, still wanting to put it all together, still having a sense of that energy.  Let me see, I'll think about it, the younger folks that really jump--oh, David Stoller, who just took a position in Eau Claire, Wisconsin.\n\nQ.  Okay.\n\nA.  And is reachable there or through Gene Farley.  He was a family systems medicine fellow with me.  He went to Western Reserve and was a resident in Santa Rosa, stayed on a year and did a fellowship, then went up the coast and did a real intense rural doc thing up on the Mendocino Coast, where he and another person were the only docs for like a long way.  Did that for 4-5 years, and just kind of started to get burned out with it, but kept connections with teaching, and would go to Amelia Island and decided he wanted to go into academic medicine and narrowed down to whether he'd go to Oregon or go to Wisconsin, and went to Wisconsin.  But a very creative, very thoughtful, strong sense of family doctoring is and very articulate.  I met him on my first or second visit to Western Reserve when Dalley(?) was there when I went out there to do some stuff when he still an undergraduate.\n\nQ.  There was one person that I had talked to last year, I didn't interview him but David Lockstercamp(?), he was at San Francisco.\n\nA.  Oh, yeah, interesting guy.  Very interesting guy.  \n\nQ.  Little bit too smart for me.\n\nA.  You would enjoy him because he does what you do.\n\nQ.  I'm sorry?\n\nA.  He does a lot what you do, which is you know, loves to talk--does narrative histories.\n\nQ.  Oh, really?\n\nA.  Yeah.  In fact I just critiqued a manuscript of his, on his fellowship here.  He interviewed several physicians, went out to their offices and really hung out with some experienced docs and tried to capture the essence of what was going on, and was really struggling with ways to write it up.  And just before he went back to Maine he--I encouraged him to go ahead and send us what he had, and I have a little Friday morning study group, we read each other's manuscripts and--\n\nQ.  Oh, really?\n\nA.  --yeah, it's a wonderful hour-a-week kind of faculty development thing that the program gives us.  Again, one of those things that's quietly sheltered and supported by Frank (Dornfester).  And occasionally we have visitors, and he sent his manuscript up and we all read it and when he came we had a lot of feedback for him.  But it was really creative, very good stuff, good writer, good thinker, he's read all the people who try to do narrative history stuff, from Fortunate Man(?) to John McPhee.  And--\n\nQ.  Robert Coles, maybe.\n\nA.  Yeah.\n\nQ.  Studs Terkel.  \n\nA.  Yeah, you know, so he's an aficionado that you'd enjoy.\n\nQ.  I think David has a master's in anthropology.  I think he did that before he went to medical school.  I may be wrong, but--\n\nA.  Ah, could be.\n\nQ.  Anyway, there was also someone, oh, he works for a--he went through the Salinas program, who did some interviewing of people, and I'm blanking on his name.  Mark--no, Peter Rabinowitz.\n\nA.  Oh, yeah.  Interesting.  Yeah, I don't know him, but he did some interesting work.\n\nQ.  And maybe David's following in people, their footsteps, so to speak.  You mentioned that these people are, you know, these folks, Calvin Chin, have some energy and kind of a renewed energy.  I guess this is a more personal question because the way our interview, our last interview in Philadelphia ended was you talking about how, you mentioned again today that 4-5 years ago, kind of the guts went out of you to do some of this stuff.\n\nA.  Yeah.\n\nQ.  And I guess in a, both in a personal sense but in a general sense, where's your energy nowadays and where's the energy of the field nowadays?  Or, after a kind of a, you know how people are always talking about, nobody's going into family medicine, nobody's going into family practice, we're having a hard time, that was kind of the theme of a lot of people talking at this meeting.  Has the energy gone out of everybody?  Or many people?  Are we at a low point of energy?\n\nA.  Yeah, well, first thing, I think the swing has gone back the other way as far as the numbers go, things look promising.  UC and the stuff we're hearing locally in the last year or two is, or at least, you know, that might be changing, but I don't know, I've been putting so much time into my research lately that it's kind of like swallowed me up and I have less available for family practice at large and--but I just find since Philadelphia, you know, since we talked, the program here has fallen on rough times, and I just found myself getting much more involved in the program and with the faculty and with the residents and with teaching and kind of getting back into it, just because it needed some boost.  And just getting back into it again has gotten me, you know, some renewed energy.\n\nQ.  Doing the local stuff.\n\nA.  Yeah, you know, just getting immersed in it again, going in the office with the residents, thinking about what they're dealing with, looking at what's going on, with Kaiser and the local, you know, thinking about issues, thinking about practice.  They have a particularly interesting situation in Santa Rosa because last July we admitted 13 residents and 12 are women.\n\nQ.  Oh, my.\n\nA.  And it's really created a different feeling in the environment, but also some flack from the old graduates.  Some of them are bitterly complaining and thinking that the program's going to hell in a handbasket.  There have been these community tensions vis-a-vis the program for the first time.  So it's just kind of, getting involved in the local stuff has gotten me interested and trying to get away from the computer and the writing and get back into some of that.\n\nQ.  Well, good.\n\nA.  And then the more I do the Balint training and the workshops, we just did another one at Western STFM in San Diego, extremely interesting, very successful, well-received, just an incredible example.  The guy came from Watts, from the Martin Luther King Center, and after we'd been going on for about an hour he finally spoke up and he says, 'Look,' he said, 'You know, I'm really interested in this.'  He said, 'I got problems I need to deal with but most of my residents are foreign medical graduates and then dealing with patients who are all black and some Chicano, that they don't understand the first thing about the culture.  And I can barely keep the program going.  How can I--and yet I think this ought to be good for them.  How can I sell them on this?'  And I was thinking, 'My, this is a challenge.'  You know, how to expand this method and bring in the cultural stuff and show it can be a practical help to these foreign graduates who don't know the first thing about what's going on when they see people, and how to support them at the same time as clue them in on what might be going on, and what better mechanism than the Balint process.  Rather than have these trains pass in the night and the health center every day.  And stuff like that.\n\nQ.  These are engaging you again.\n\nA.  Yeah.\n\nQ.  Good.  Well, that's great.  \n\nA.  Yeah, no I feel very much, you know, alive and well and ready to--\n\nQ.  Great.  Except for your flu.\n\nA.  --I'm going to be on the platform with Lynn and Gayle and Marian, one of the theme days about reflecting on behavioral science in the last 20 years, something like that.  I haven't got the details yet but I was real pleased and honored to get that invitation.  So yeah.\n\nQ.  Well, that's great.  I mean--anything else you want to talk about.\n\nA.  Oh, I think we covered a lot of good stuff.\n\nQ.  And actually I, you know, I went through it, the initial interview, and I kind of wanted to piece together some things and that's why I hit on different topics, but--I have a couple of things off a little ways, if you don't mind.  You mentioned 13 or 12 women in your program, out of 13, outside of Marian Bishop, were there any other women involved back in the early 70s?  It would be nice to have somebody, but--\n\nA.  Gee.\n\nQ.  No one really identifies anybody.\n\nA.  Not in the early days.  She was such a strong--she was a real exception.  \n\nQ.  I mean it's okay, if that's the way it was, that's the way it was.\n\nA.  The way I remember it, yeah.\n\nQ.  Okay.  Second thing is, D(?) training, are there programs that, you see a need for programs that either you folks have in the Bay area--my father-in-law and mother-in-law, parents-in-law live in the Bay area, and are there CME programs in Balint training that--\n\nA.  I don't think so, I think, you know, this Balint society spun out of the society's interest and it's been going in its second year, and we've been doing these workshops and they've got a newsletter and--but I don't think there's any--that's something we had talked about, and we're going to meet next Tuesday night again and go into things and I'll--but I don't think there's anything like on a scheduled, catalogued, continuing available basis on that yet.\n\nQ.  Okay.  Third thing is just kind of a personal reflection.  I actually was really sad after I read your first transcript here, and it had a lot to do with two things, one, I was kind of sad--I'm encouraged now that you say that you're getting back into things, the way the interview ended was that you know, you're not sure where you're going and that was sad.  After a lot of energy--\n\nA.  Yeah.\n\nQ.  --that you'd put into it.  And the tape--right ended is that you'd said all you had to say, finally, and then we ended up talking, again it was off the tape, but I certainly hope that--it sounds like you got more to say at St. Louis, but also that you may say things in different ways or you may say new things, but I hope that you haven't, that you're feeling that you've not run out of things to say.\n\nA.  Yeah, well, thank you, and you know I realized--just one sec [tape paused?] I realized, you know, in a way, even though I felt as if I'd said all I had to say, I--I didn't really say it in a forum or in places where a lot of people got it.  You know, I was really thinking about, you know, a lot of the writing I did was tucked away in those random notes or here and there, and I didn't write that much for Family Medicine and I could have done more there and JAMA, and so I'm thinking a lot of that stuff is still, could be sharpened and needs to be said and could be said in a better place and a little bit different way, not as if it's just recycling or autoplagiarism, but just--I really kind of felt bad in a way that a lot of energy had gone into the thing and it hadn't really been put in the right place.  So I thought a little bit about that.  And then I, you know, I just think there's a lull here, you know, that there's sort of stuff stirring and going on, and then--I don't know where my head was at when we talked last, but--\n\nQ.  Well, you know, I also have talked to John, I get to share with John mostly through this BitNet system.  I don't know if you're familiar with it, but I mean his point is that, you know, a lot of people that become involved with family medicine were in their early to mid-40s, perhaps where both you and he are, the kind of, ah, wondering what they're doing, Gale Stephens, I mean they weren't in their 30s, with few exceptions, they were people who had been in practice for a while.  Gene Farley had been in practice for 7 or 8 years, and before that he was, you know, did a residency and another internship, you know, lots of stuff, and he was probably 42 when he got going.  And Carmichael had been in practice for a long time.\n\nA.  Right.\n\nQ.  And it's not like they're (??), and John talks about that, in terms of you know, we get to a point where we, you know, have to reconnoiter, and then get back into things.\n\nA.  Right.\n\nQ.  So I hope you do.\n\nA.  Yeah, good, well thanks.\n\nQ.  The other sad part was more personal, actually, is that I really wonder if what I do is family practice or family medicine.  It's--I think I do, I use your infelicitous term lightly, ecological medicine, I mean I think--I work in a community health center and it's both saddening but it's also kind of empowering for me.  It's saddening in that half my practice is in Spanish, and I speak poor Spanish, but I do it.  But I also think that, you know, I gave a talk where--to a group of medical students where I really characterized what I do as sometimes veterinary medicine, but I really am sad that I said that, because after reading what you and actually I just finished Lynn's the final transcript that's going to go to press, what you had said, and it made me really minimize what I do, because even though I can't speak I really think that I can care.\n\nA.  Yeah.\n\nQ.  And I mean that's what we're talking about in a big sense, and I--\n\nA.  It is, it really is.\n\nQ.  And I may not, you know, I may not do it all that well, some patients won't like the way I do it, other patients will.  But I--and this is really, I guess the issue is that I hold out hope that I can grow as well and develop in my own field, and--\n\nA.  I'm sure, I mean just based on our little bit of contact and our interview, that, you know, I feel you're such a thoughtful and caring person, I was secure with you and comfortable and open, and you can see it, just kind of really me talking, and you know, I'm sure when you're like that with your patients and you just getting to work with them, trying to take care of business, that you certainly are a family physician.\n\nQ.  Yeah, but when you're in the lobby waiting half an hour behind--I'm a half an hour behind, it's a different matter.\n\nA.  But that's the part that I've come to really respect in a way, is that there are real constraints, and there is this hierarchy of needs, and you have to work within that and do the best you can under the circumstances, and if you don't, then you just really do burn out.  You just absolutely get totally bummed.\n\nQ.  Or I think you look at it as kind of a factory.  And a lot of people work at factories their whole lives.  And this is a well-paid factory.  I know that seems kind of sad--\n\nA.  (?) got to fight against.\n\nQ.  I mean, in a curious way, and probably this is why I wanted to do this, is that all this has been kind of therapy for me in terms of finding out what my role is.\n\nA.  Oh, I'll bet.\n\nQ.  And I mean I think I looked at that after finishing, I learned other things in my residency, and I had other values held up.  People like Ron Pust and Larry Moher, whom you may not know, really caring people--they didn't hold up values of talking to family, but they certainly held up family values of caring for underserved people, and that there's a--I don't mean in a religious sense--but there's a certain mission, and I learned those things and I think I've integrated those into my practice, but this is a, these are some new values to hold up as well, that have been really challenging to me.  Certainly a little bit saddening, but also maybe that's where the challenge comes, is to incorporate them.  Maybe I already do them somewhat, but recognizing them, you know, in my own practice.\n\nA.  Probably more than you think.\n\n[end of interview; tape continues re logistics, etc.]","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282870#t=630.0,1914.98806"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282869","type":"Canvas","label":{"en":["Media File 2 of 4 - Ransom_Donald_Pt1_91_b.wav"]},"duration":1927.37021,"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/153756/file/282869/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282869/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/282/869/original/Ransom_Donald_Pt1_91_b.wav?1752683494","type":"Audio","format":"audio/wav","duration":1927.37021,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282869","metadata":[]}]}],"annotations":[]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282871","type":"Canvas","label":{"en":["Media File 3 of 4 - Ransom_Donald_Pt2_91_a.wav"]},"duration":1866.90343,"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/153756/file/282871/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282871/content/3/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/282/871/original/Ransom_Donald_Pt2_91_a.wav?1752683494","type":"Audio","format":"audio/wav","duration":1866.90343,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282871","metadata":[]}]}],"annotations":[]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282868","type":"Canvas","label":{"en":["Media File 4 of 4 - Ransom_Donald_Pt2_91_b.wav"]},"duration":1866.90343,"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/153756/file/282868/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282868/content/4/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/282/868/original/Ransom_Donald_Pt2_91_b.wav?1752683493","type":"Audio","format":"audio/wav","duration":1866.90343,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/153756/file/282868","metadata":[]}]}],"annotations":[]}]}