{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/ns0ks6md0f/manifest","type":"Manifest","label":{"en":["Dr. Thomas Stern"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer: The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2003-01-26 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["video interview"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Dan Ostergaard (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["video file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians"]}},{"label":{"en":["Subject"]},"value":{"en":["Thomas L. Stern, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/295/886/small/STERN-OSTERGAARD%282003%29.mp4_1761150294.jpg?1761150295","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162457/file/295886","type":"Canvas","label":{"en":["Media File 1 of 1 - STERN-OSTERGAARD_(2003).mp4"]},"duration":1994.993,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/295/886/small/STERN-OSTERGAARD%282003%29.mp4_1761150294.jpg?1761150295","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162457/file/295886/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162457/file/295886/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/886/original/STERN-OSTERGAARD_%282003%29.mp4?1761150293","type":"Video","format":"video/mp4","duration":1994.993,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162457/file/295886","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162457/file/295886/transcript/85523","type":"AnnotationPage","label":{"en":["Dr. Thomas Stern interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162457/file/295886/transcript/85523/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"I’m Dr. Dan Ostergaard of the American Academy of Family Physicians, currently serving as AAFP Vice President for International and Interprofessional Activities.  It’s my honor today to interview Dr. Tom Stern for the Family Practice Archives of the AAFP Foundation.  Dr. Stern has been a leader in our specialty through his entire career and is the architect of many of our most important advances.  Today is Sunday, January 26, 2003, we’re in Scottsdale, Arizona, and we are at the Westin Hotel which is quite close to the winter home of Tom and Glad Stern.  It’s my special pleasure to do this interview of Tom Stern because he has been my colleague, my mentor, my boss, and my friend for over thirty years.   \n\nFrom a rural general practice in Oregon to the “mother house” of family practice in Kansas City, it’s quite a journey.  Describe the metamorphosis of this rural GP to a leader in our entire specialty.\n\nWell I guess I started out as a corpsman in the Navy during World War II and they sent me to Willamette University and then I went to Oregon Health Sciences University and practiced in a small town in Oregon – Sherwood, south of Portland about 25 miles.  And after eight years in rural practice I moved to Manhattan Beach, California, and practiced in the middle of the aerospace industry, at which time I was president of the California chapter of the Academy, dedicated to the Academy from almost the time I first went into practice.  And started a residency program in 1969 at Santa Monica Hospital and we were very successful in attracting residents.  So that was the beginning of the career.     \n\nNineteen sixty-nine was really the first year in which we as a specialty had formal residencies, so Santa Monica Hospital must have been one of the very first ones? \n\nYep, # 22.\n\nNumber 22 huh?  Number 22.  Okay from Santa Monica then at some point you made a decision to go to Kansas City to join the Academy staff.  How much time elapsed between your arrival in California and your departure to Kansas City?\n\nI was in California fourteen years but most of those years were in practice.  Actually, the Santa Monica program started in 1969 and I moved to Kansas City in January of ’74.  So it was about five years.    \n\nMarcus Welby, MD, a term that people over 40 know, people under 40 may not know.  Marcus Welby, MD still the standard of medical TV shows.  What was your role?\n\nI was the Technical Adviser.  It’s kind of a period of my life that was a fun part of my life.  Did it for five years.  The – my job was to work with the writers and in production part of the program.  They asked me once to appear on camera and I said “No.”  They wanted me to appear as a crusty old family practitioner running a residency program.\n\nYou would have done well in that role!\n\nWell, it was true and I was afraid to do that.\n\nI remember in the Welby show at one point it became a family practice residency preceptorship site or had something to do with our residencies.  What was that? \n\nActually that’s how I happened to get the job of Technical Adviser is that the Academy had wanted the show to show and demonstrate a residency program and Bill DeLay, who at that time was public relations of the Academy, talked to David Victor who was Executive Producer of the show and asked him to do this and David Victor said “Where could I see one of these residency programs?” and he said “Well, go to Santa Monica Hospital, I’ll arrange an appointment” and that’s the way I met David Victor and that’s how it all got started. \n\nRobert Young.  Robert Young was Marcus Welby.  Did you know Robert Young?  What was he like?\n\nRobert Young was a great guy.  He has a reputation of being an alcoholic.  He was depressive and he suffered depression and he used alcohol to get over that, but he never missed a day’s work.  He was a religious man.  He was married to the same woman for over 60 years.  He had wonderful kids and he was a charming fellow.  We knew him quite well.  In fact, when we retired to Florida he came down and spent our 40th wedding anniversary with us – he and Betty.  We had a wonderful time together.  He’s a great guy. \n\nBack in that time, in southern California, you talked about Santa Monica Residency, but also you were instrumental in, and had a certain amount of difficulty in, cracking the ivory tower.  What about the deans of the medical schools at that point relative to our specialty?\n\nYou know it’s a most interesting tale because Bill Rogers, who was the Executive Director of the California Academy, and I, visited Dean Sherman Mellinkoff at UCLA for three years running, offering the services of general practitioners in teaching roles.  And every year Dr. Mellinkoff said “What have you got? What can you show us that we don’t already know?”  And we tried to answer the question to no avail and he literally expelled us from the office.  I finally got an appointment at UCLA by Lester Breslow in Public Health.  I was in the Department of Social and something Health, and it was a non-clinical appointment.  My level of appointment was Lecturer which is about as – is as low as you can get. \n\nWell your tenacity is appreciated because from those rejections to being in almost every medical school in the country, we’ve come a long way, I guess. \n\nWell, you know, after I went to Kansas City, and you know very well because you and I worked together for many years, we spent a lot of time romancing the deans of a lot of medical schools with what we had to offer.         \n\nEven to the point of having “Dean’s meetings.” \n\nYes we did. \n\nGet a fancy hotel and see if the deans will come. \n\nYeah. \n\nDid they?  I can’t remember.\n\nA few.  I remember one in Boston, we had, we tried to get Harvard and Yale and B[oston].U. and so forth…I think we had three.  But it didn’t hurt. \n\nIn the nurturing of practitioners into academics, there were some initials which you used back then.  SOTS.  TDCs.  Now what are SOTS and what are TDCs?\n\nSOTS was the Symposium on Teaching Skills.  Actually it was preceded by the TDCs, which were the Teacher Development Conferences, and you know very well because we went together, all around the country, with a band of people who were teaching at that time, and we’d go to a city and we’d invite general practitioners to come in for a day’s experience with us, and listening to us lecture about what teaching was all about, not to be afraid of medical students or residents, and we recruited people to come from practice into teaching.  And then the Symposia on Teaching Skills was pretty much the same thing.  We’d start out on a Tuesday morning and we’d go to some city, and the next day another city, the next day another city, and we’d take three or four faculty members from around the country and we had a wonderful time doing it if you can remember because it was meeting so many logical, nice family doctors who wanted to participate and that was one of the thrills.  And many of them said “We don’t need anything on teaching, just send them to us, we’ll train ‘em.”  But we managed to convince them that a formal atmosphere probably be a little better.\n\nYou had a certain way of convincing people that their naiveté about this was probably inappropriate and you did a good job in that teaching. \n\nWell first of all I told them, “Never tell a medical student ‘I’m learning more from you than you’re learning from me.’”  And secondly, there was nothing to fear.  So that was what we really tried to instill in these folks. \n\nAnother initial important to your entire effort in graduate medical education was RAP, Residency Assistance Program.  What was the Residency Assistance Program?\n\nWell, RAP came from my discomfort in being a consultant to developing programs or programs that had been gigged by the Residency Review Committee.  They’d been turned down or they’d been put on probation and it was my job to go out and visit these programs and try to help them get organized to a point where they produced a quality residency.  I spent a lot of time going to these programs that were in trouble.  Finally I said to Roger Tusken, who was the Executive VP of the Academy at that time, “Roger, I’ve got to visit some programs that are functional and doing well or my mental health is going to be disturbed.”  And so he said “Go ahead.”  So with that in mind I recognized that these good programs had things to offer but they also needed help, and what we tried to do was to create a program that was entirely elective on the part of the residencies, for us to provide consultation for quality.  And we established a set of guidelines, RAP Guidelines, and I’m very proud to say that the RAP Guidelines later became the basis for the change in the “Essentials.”  We trained our visitors, our consultants that went to the programs, we had meetings for the consultants where we worked together to improve our consultation skills.  I think all in all it was unique, different, and I was thrilled with the success of what we did.  And it was confidential.  There was no possibility of it being another level of accreditation.  It was purely for the program’s own health. \n\nActually, the program, or at least the essentials of the RAP Program have now been emulated by some of the other specialties, so the legacy goes actually beyond family practice, and particularly that part of the legacy which was that a consultation should be sought not only in the time of crisis, but in the time of looking forward to quality enhancement. \n\nExactly, and there was a great concern among the program directors that this would be another level of authority.  And I can remember when I first introduced this in the Program Directors Workshop in 1975 as a concept, some guy in the back of the room yelled “You Nazi!”  Well it was a little hard to take at that point, but they came around. \n\nYour contributions extended to the world of continuing medical education.  In fact, you even coined a term “enduring materials.”  Perhaps the most enduring of the enduring materials is the Home Study Self-Assessment Program.  What was Home Study, what is Home Study? \n\nWell, Home Study Self-Assessment came as a result of the Board of Directors of the Academy telling the Commission on Education to create an annual examination that family physicians could take in their own office that could be voluntary and be educational.  This was sort of in copying what Internal Medicine was doing.  And I thought about that for awhile and I decided that it was far better to have a program over a six-year period which coincided with our need for recertification and accompany that with a series of questions and answers that would provide validation for the person who took the course, and the questions and answers be returned to the student.  The program consisted of a monograph and an audiotape, and from the beginning family physicians found it very helpful.  And initially we had all kinds of specialists write the monograph, but we gradually shifted that over to the point where family physicians wrote the variety of the monograph, and that was the greatest thrill, to me.\n\nAnd that still persists.  That blends into another area in which you have been a pioneer, and that is international family medicine, and the reason I mention that in the context of Home Study is because you may not know it, but the Home Study monographs actually form the basis for the curricula for family medicine in many countries of the world.  In international stuff you were one of the signatories to the creation of the International Center of Family Medicine.  What’s ICFM? \n\nThe International Center for Family Medicine for the Americas, Spain, and Portugal was a group that was created by a group of us: Don Rice in Canada, myself and others from the United States, Nick Pisacano and you, and I don’t remember all of the people, and people from Mexico, Venezuela, Buenos Aires, and so forth. \n\nAnd particularly Julio Ceitlin.\n\nAnd particularly Julio Ceitlin who was the Executive Director and the stimulator of this organization.  It was, you know at that time we had an organization called WONCA that’s still a very, very potent organization, but they didn’t appeal to the Spanish-speaking peoples.  And so ICFM was created to appeal to the Spanish-speaking peoples and those speaking Portuguese, which is somewhat like Spanish.\n\nWorld Organization of Family Doctors, now the acronym doesn’t quite fit, but WONCA means World Organization of Family Doctors, and in 2004 it is likely that those countries which constitute ICFM, from the time in which you were doing this, will indeed join WONCA as a Spanish-speaking element of the World Organization of Family Doctors.\n\nWell that’s very good to hear because we don’t need two organizations, and I think that will enhance family practice all over the world. \n\nLet’s go on to another phase of your career in Kansas City and that’s with what was the Family Health Foundation of America at the beginning of that but is now the AAFP Foundation, and specifically something which I know you created and that was the very specific attention to the corporate members, to working with the industry people as part of the Foundation. \n\nWhen I retired from the Academy in 1983, the thought of not working scared me half to death.  So, I became a consultant to the Family Health Foundation and developed this program of corporate membership, and it worked so well because the pharmaceutical industry, the instrument industry, other purveyors of products to family physicians, were anxious to become contributors to the Foundation.  We went to their offices, told them what our program was, traveled around the country.  Sandy Panther joined me, who is now the Executive Director, EVP of the Foundation, joined me at that time and we traveled the country together promoting this corporate membership.  And now, I think it’s a very significant part of the funding of the American Academy of Family Physicians Foundation.                                      \n\n \n\nYou actually may not have kept track of the years, but it’s the twentieth anniversary now of the corporate part of …\n\nIs that right?  I had no idea.\n\nYeah, right now, so that’s neat.  We’ve kind of gone through your career a little bit and it’s not as though we’re done here, but in retirement, one of your multiple retirements, you wrote a book.  The book that was published and distributed in hundreds of thousands of copies.  What’s the name of it? \n\nIt’s called House Calls: Recollections of a Family Physician and it’s a book from the heart.  I tried to show what it was like to be a family doctor in the rural countryside and in the city and I think I stressed the fact that I really enjoyed being with my patients.  And I missed that when I left them, that patients became a part of my own family.  And I think the book has been successful because so many family doctors who were GPs in the old days pick it up and read it and say “My gosh, that’s what I did.” \n\nRight.  Well the book is full of vignettes which are filled with empathy and all of the things which we cherish in family practice and in general practitioners, but it also had a lot of humor.  A lot of humor occurred in those days in practice.  Tell us about that.\n\nWell, my whole approach toward life has always been to have a little fun.  Even though I seem to have developed a rather stern mien.  People have said that… \n\nIt’s only your name.\n\n…but I’ve tried to show a sense of humor in the book.\n\nLet me throw out a few names and get your initial reaction to hearing the name.  The first one I’ll preface a little bit by a phrase: They were the grandfather and the godfather.  Now you were the grandfather.  Was Nick Pisacano the godfather? \n\nWell, Nick was one of the greatest men I’ve ever known.  I loved him dearly. Glad and I went with Nick and Virginia Leigh on their honeymoon.  I went as a consultant. \n\nWent on their honeymoon?   \n\nOn their honeymoon. \n\nThis is unusual. \n\nWell, we were good friends. \n\nApparently.\n\nHe did more for family practice I think than any other single person in the history of our specialty.  That’s my take on Nick Pisacano. \n\nThere was a non-physician among us in those days who’s still with us, Marian Bishop. \n\nOh, Marian Bishop.  I’m devoted to Marian Bishop.  I remember her as the Society of Teachers of Family Medicine president, as the only non-physician chairman of a department of family practice, and successful, completely successful.  A person who was warm, intelligent, and promoted family practice – I’m honored to say that I’m the possessor of the Marian Bishop Award and it hangs very proudly in my study. \n\nThere’s a name that people, most people in family practice may not remember, and I’m going to throw that name out simply cause it goes way back to the early days of interaction with the American Medical Association and it’s Council on Medical Education.  Dr. Bill Ruhe. \n\nBill Ruhe.  Bill Ruhe was the head of education for the AMA.  He was instrumental in helping us get family practice started.  But nevertheless, the AMA was a bit standoffish in their attitude toward, including us in the family, on an equal basis with everybody else.  My fondest memory of Bill Ruhe is having him come to our house for dinner along with the chairman of the ACGME, the Accreditation Council for Graduate Medical Education, a fellow who was dean at Alabama, and we sat over drinks and dinner and I think spent an evening that wouldn’t have – that we couldn’t have spent any other way – getting both of them involved in to family practice.  In fact, Dean Pittman from Alabama called me a month or two ago just to see how I was getting along, and our friendship has gone on that long.\n\nOne more name, and I’ll throw that name out, is a past president of the AAFP because, as you pointed out, you were president of the California Academy, but when you go to the Academy staff, you forfeit future political involvement, but you’ve known all the presidents: Jack Stelmach.\n\nWell, Jack was my family doctor.  Jack was president of everything at one time or another.  He had a happy disposition, he was intelligent, he brought people together. \n\nFrom your current vantage point, what should family medicine have done differently, what should the specialty have done differently?  What good could have come if we would have done something else? \n\nWell, I think that there’s been an unreal desire on the part of the leadership to remain pure.  Pure family physicians without any other attractions.  We have got special certification in sports medicine, and in… \n\nGeriatrics.\n\n…geriatrics.  I think we could have extended ourselves into other areas.  Emergency medicine.  At the time the board of emergency medicine was being formed, I lobbied extensively and failed to have it become a part of family practice.  And at the time, I thought that emergency physicians would burn out, want to go into practice, and I thought that by having a family practice base, they’d have a clinical home to return to.  I think we’ve missed some opportunities in that way.  Perhaps in OB special certification and some of the areas that we now are left out of a little bit, in hospital care and special procedures, that we could have enhanced our opportunities for our members. \n\nThere are those who say then though that we might have been a jack-of-all-trades, master-of-none, you’ve heard that.\n\nWell, I’ve heard, you know, that’s what we are anyway.  I think that the concern is that we not become little pediatricians, little OBs, and I’m not talking about that.  I’m just talking about the ability to do some of the procedures that we’ve been excluded from. \n\nWe’ve talked a lot about the history of family practice and your role, and now there is a whole activity underway called the Future of Family Medicine Project where family physicians and others are getting together to figure out where we should go in the future.  What advice would you have to those framers of our future? \n\nWell, of course the main thing is to attract medical students into family practice residencies.  In the beginning, when we formed the residency at Santa Monica, and the others were in those early days, we were contra-organization, we were off the record, so we were not just internists, we were not just surgeons.  But later the medical schools gathered us in and we became departments of family practice in medical schools and we began to emulate the other departments.  We no longer were seen as something entirely different, something that was special to students.  And so I think we lost some interest in those, because of that.  Now, how do we recoup that interest?  Well, I’m not sure I can tell you any more than the dozens of people that are working on it at the Academy and the Society of Teachers today.  But I guess it’s the humanistic qualities of family practice that have to be stressed in an age where there’s more interest in how much time one practices, how much money one makes, how much credibility they have with their peers.  And so we have to work in that direction.  I think we have to be leaders in continuing medical education, that constantly being taught by other specialties, going to meetings where we get the leaders of internal medicine and the other single specialties, speaking to us, should be – we should be doing it ourselves.  The pharmaceutical industry, I believe, is one of the sponsors of continuing medical education, and their attitude is: “Let’s get the guy who’s written the most papers on the subject.”  Well, being a good teacher and reading the literature and speaking from their own particular vantage point, I believe has a great deal toward giving credibility to family practice. \n\nYou addressed as part of the answer to that question, I guess what could be described as, we were at that time a counterculture movement.\n\nYeah, I couldn’t say the word, the counterculture.\n\nWell, we’re probably not counterculture now but we still I think can foster in people the desire to meet the needs of people in the way in which you just described.\n\nYes and I think the generation that’s coming along has shown that they are willing to become involved in being with people, they’re people-oriented.  And we’ve got to convey that, that this is the specialty that does that for them. \n\nWe’ve talked a bit about the things about which you should be remembered, your contributions are legion, but one of the things we haven’t mentioned is the Thomas L. Stern, MD Lectureship in family medicine.  That I did want to mention, but what else would you like to be remembered for?\n\nWell Dan, the lectureship is one where the theme is quality in graduate medical education, and through the RAP program and through consultations I think I spent most of my career trying to promote quality in graduate medical education, and that’s what I’d like to be remembered for. \n\nI think that’s too limiting, because you’ve already described your efforts at quality in graduate education, continuing education, international family medicine, thanks for all you’ve done for us. \n\nThank you.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162457/file/295886#t=0.0,1994.993"}]}]}]}