{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/qf8jd4rq28/manifest","type":"Manifest","label":{"en":["Dr. Jeffrey Beckwith"]},"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":["2020-05-27 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["oral history"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Becky Purkaple (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family  physician","American Academy of Family Physicians"]}},{"label":{"en":["Subject"]},"value":{"en":["Jeffrey Beckwith, 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/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162460/file/295890","type":"Canvas","label":{"en":["Media File 1 of 1 - BECKWITH_JEFFREY_(5-27-20).m4a"]},"duration":3477.37397,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162460/file/295890/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162460/file/295890/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/890/original/BECKWITH_JEFFREY_%285-27-20%29.m4a?1761151501","type":"Audio","format":"audio/mp3","duration":3477.37397,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162460/file/295890","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162460/file/295890/transcript/85526","type":"AnnotationPage","label":{"en":["Dr. Beckwith Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162460/file/295890/transcript/85526/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Jeffrey Beckwith (JB) Oral History Interview\n\nThis oral history was taken on May 27th, 2020 at an outdoor table at Crema and Bloom in Springfield, OR. There are sounds in the background of the street and movement in and out of the establishment. Becky Purkaple (BP) recorded and transcribed the interview. \n\nMy name is Jeffrey D Beckwith born 4/24/45 in Seattle. And wandered around the country following my dad as he changed jobs. He was in printing—first he ran a linotype, which I don’t know if you know, those big machines each time you press a key a block of lead comes down and inserts into a plug. So, you type a way and create a template for a newspaper, for example. It was called a linotype, a big noisy machine. But he worked his way up—he was an awful hard worker—and he got his way into being a foreman and a manager and got hired by different companies. So, I lived in Seattle for 7 years and Binghamton, New York fir 4 years, La Grange, IL for several year, Indiana for two years, and then I graduated and went to college at Carlton college.\n\nAfter college, I did not know what to do. I had been a good student grade-wise and so on. So, I went into medicine not knowing a damn thing about it. (laughs) My only knowledge of medicine was that I had had a few girlfriends whose dads were doctors and they were pretty cool guys. One of them was a surgeon who, uh, I was invited over to eat dinner at their house and I had a smudge of dirt in my hair and he hypnotized me and removed the dirt and I did not feel a thing. So that was impressive.\n\nBut anyway, I went to school not knowing a whole lot about medicine. Got through school; still didn’t know what I wanted to do. Most people, they go and they find that they like nephrology or like this and that and their career path was pretty much open, but I never really fell in love with anything. So, the option was to be a generalist or graduate—I graduated in 1971—the newer name for generalist was family physician. That was really taking off. You may have done research to know exactly what year they started doing family practice residency?\n\nBP: I believe, 1969\n\n \n\nJB: They became popular. One claim to fame I have was that I was quoted in Times magazine about how family practice was where it was all happening. (Laughs) The reason I got quoted was that my brother worked for Time magazine following politics and so on so he worked that quote into the article that he knew was coming. So anyway, I did a rotating internship, an old name for a general internship at Bronson Medical Hospital in Kalamazoo, MI. And, uh, sort of traditionally rotate through internal medicine and surgeon and so on and then did two years at the University of Colorado in Boulder, Rose Memorial if you know Colorado. At Bronson, it was the home of one of the big drug companies, and I can’t remember which one. We toured their factory once and they had an old display about how they bragged about their pills, that their pills could not be hammered through wood like their competitor’s pills. You think they would be better at dissolving and doing some good in the body. But this company, Eli Lily maybe? I don’t know, got going in the early 20th century which was a time of great quackery.  \n\n Medicine did not get scientific until the 20s. Somebody I read said that your chances were more likely to be benefited vs. harmed in 1928. And so, goat glands were only part of the problem. It was not a scientific background. Early in the 20th century, Johns Hopkins had a famous surgeon Dr. Halstead and the whole idea of medical schools creating a culture of competence and confidence was just coming into play in the 20th century. Halstead taught or trained many surgeons who became heads of surgery at other medical schools. Halstead was a jerk and had a poor temper and a bad human being—also a cocaine addict. And he would periodically try to wean himself off cocaine but he would get very irritable. He threw instruments and would curse at the nurses so he taught surgeons to be jerks basically and that is one thing I have seen in my career. The tolerance for that sort of behavior has disappeared. And so, but that was not until late in the 20th century but it was not until the late 20th century that surgeons were disciplined and fired on occasion. \n\nI was subjected to the culture of medical school which was fairly abusive emotionally—if not by residents or attendings then by residents and other medical students who would…if you hadn’t read the most recent journals, you were shamed and this that and the other. In medical school, I remember being drilled by a surgeon as to the cause of peptic ulcers. Of course, I said stress and this that and the other. This was before helicobacter was found to be. That is a wonderful story too, because that guy, was Australian I believe, was not accepted. His ideas were not accepted for years. Even swallowed some of his own bug to get himself sick with ulcers to prove it was helicobacter. It is a wonderful story, but uh, again in medical school never was drawn to one thing. Sort of did like the different ideas—I disliked hospital medicines, codes, things like that. We had a medicine that was thrown in during a code, Levophed. Remember that one? Vasopressor of some sort. In our internship, people would joke “Levophed, that mean’s leave ‘em dead.” Yep. But got through rotating internship and went to Denver and two more years in family practice and joined the health service in family practice in rural Montano, Superior, Montana for several years and then moved to Springfield. Looking back, I do not think I was really well trained.  Partly because of the culture of medicine which looked down upon family practice at that time and partially my own temperament and shyness and inability to get what I needed so anyway, my practice life started learning on the job primarily. \n\nSo, I graduate medical school in 1974, wait a minute—missing a few years, my timing is off. In Chicago, in medical school, I started medical school in ‘67 and graduated in ‘71. So, I was in Chicago when the Democratic National Convention came to Chicago with the tear gas and Mayor Daley and I was totally unconnected from my own culture. I was going to school all the time. I didn’t have the time to go get much of rock and roll and whatever was going on. I remember walking by demonstration where there would be—imagine the side walk by the armory with armed troopers coming out 6 abreast with their guns blocking protestors who were walking on the sidewalk and the protestors are putting flowers in their gun barrels. Meanwhile, out on the curb of the street were the film crews for the TV stations. So, it was all made for TV. It made me scratch myself; what the hell. And the hippie protestors wore outrageous clothing and long hair. Anyway, it was a tremendous culture clash. So, the night things really got bad and the police got out of control beating people, tear gas and all that. Mayor Daley was on the TV being interviewed by Walter Cronkite—you remember that Walter Cronkite used to be the most trusted person in America—and Walter asked Daley a question about if the police were out of control. Daley said, “Let’s get one thing straight, Walter. Police are not there to create disorder. They are there to preserve disorder.” They he kept going with the interview. But that was a typical Daley-ism. \n\nSo, I go through that and I hear about Kent State and I just had no place to put it. At the end of medical school, the war was still going on. And, most of us did not want to go and get shot so you could opt out. So, you could get your Berry Plan deferment agreeing to sign on with one of the major—Army, Navy, or the National Health Service Corps—and go to rural areas to go to rural areas. So, I did that. I signed up with the National Health Service Corps and did my family practice residency and then went to Superior, Montana, which was the home of the Gideon Bible Society. Isn’t that an interesting story? The first Gideon Bibles were put in a hotel in Superior.     I think there were 5 bars and 5 churches, a town of 2000. This was mineral county, tiny little towns with farming and ranching and timbering. And, they built a little hospital while I was there. It had 4-6 hospital beds and 4-6 intensive nursing home beds and a larger nursing home, maybe 10-16. That was built at the time I was there.\n\nI had a partner who was a DO, David Stingle and he lived really remote up river on a little stream and had a Pelton wheel to give him electricity. So, this was at a time when it was back to the earth, kind of thing, so it fit the time very well. \n\nI am trying to think of—I was really learning as I went along. I had to learn how to call up the docs in Missoula to get advice, how do people deal with staff. And, uh, I tell you another funny story. The guy we were replacing was an old guy who had been a doctor there for about 20 years. He had a stroke and he did not quite fully recover but he went back to work so he would write prescriptions to the pharmacist—we had one pharmacy in town—and it would say “Give this guy something for the flu.” Can you imagine?\n\n But the pharmacist was given free range to write whatever antibiotic would make him the most money or whatever. It was bizarre. The town was very interesting. I remember seeing one of my first cases of Alzheimer’s disease. I went over to the house. She is reading the newspaper. IT was the newspaper from 1 year ago and she would read same newspaper every day because it was new information for her. But that was a good example. I had no training in Alzheimer’s. There was a guy there with a son with MS (Multiple Sclerosis). And there was no treatment and he was going everywhere to Mexico and here and there looking for help. There was a lady who was sister of the main grocer in town and she would stay around at the grocery store sometimes sweeping or whatever. She was mentally retarded and she, she would go out walking and walk down the road and she would be 5 miles from town and then someone would see her and recognize her and say, “Hey Sue, get in the car. I’ll drive you back.” So, everybody knew everybody. It was a small town. For better or for worse. They took care of her. Now similarly when I would go out jogging, many people would stop and ask me if I wanted a ride back because they were unfamiliar with the jogging boom. That was the start of that era around ‘75, I think. That’s when people started jogging. But anyway, it was fun. So, then I moved to Springfield. One last thing in Superior, Montana. The hospital we started was in an old house. The best room was a delivery room that had sealed wooden floors from a while back and so we would in retrospect it is pretty risky—we were doing OB out in the boonies 60miles from Superior, I mean Missoula. But anyway, moved to Springfield just kept at it. For better or worse you get experience. Good judgement comes from experience which comes from bad judgement. That is a motto that I lived with. What else would I say? From early years…so this is mid-70s to the 90s, it was all book support. Book and magazines. Didn’t have electronics. So, it was a pain in the ass—you can quote me on that—it was a pain in the ass to look something up in the PDR. Side effects, drug interactions, who knew? You were just on your own. I got involved in some medical groups. One time, a couple times, 2-3 times, I was chairman of family practice at the hospital. I did a long-term on the board of Agate, which was the Trillium of that item. So that was interesting to grow a little bit in group dynamics. I recognized finally that I had trouble speaking in public so I’d have to get angry before I talked but it would come out more emotional than it needed to. And that was frustrating to me so I joined a Toastmaster’s club as a way of desensitizing and it really helped me quite a bit. As chairman—I was also chairman of LIP, which is the Lane Individual Practice Association, that would be the independent mishmash of primacy care docs, pediatricians, family docs and internists who were not aligned with OMG or Peace Health. One thing that I did there that I was proud of, we could see the tide coming in term of electronics. So somewhere around 1990, I started using a PDA which was a little machine where you could load programs like Epocrates, that was one of the first electronic programs. This was obviously such an advance and people were starting to make noise about computerizing. We had a project through LIP that essentially said “Hey, if you can buy a PDA and install one of these medical programs to make you do better quality medicine, we will buy your PDA. Just notify us through your office manager and we will send you $400 bucks.” That was big money back then. 400 bucks. And I went and I pitched it at our yearly meeting and I pitched it at the office manager meetings. Hey, I need your help. I want to do this. And we got about 100% who did that and I think it really prepared them toward the push toward electronic records. It was not such a foreign deal. The other thing I was involved which that I was also proud of was through the LIP board. They were coming gup with the ideal of a capitated contract for Medicaid patients, OHP [Oregon Health Plan] patients, and this was approximately 1994. There had been no capitated contracts in the county. People were pissed off at OHP. Reimbursement was terrible. The care received was terrible. Cause people could wander around. If they had a headache, they would go to the ER. If they still had a headache, the next day they knocked on the neurosurgeon’s door. It was total bad care and so we were asked by the state, might have been through BlueCross also, to try to come up with a plan on our own to deal with these people. We came up with a plan and said, “Well, let’s make sure that everyone has a family practice, or internist or pediatrician, for their primary care for their home so it is there go-to place whatever their question. Second, let’s capitate the primary care. It was something like $12 bucks a month. Well, for someone who has never done a capitated contract, that was gutsy to even think that they could get away with it and make money on it or break even, even. The problem is similar today. With the capitated contract, you have 300 patients. You don’t see 40% of them ever. You see some of them 5 times a month. It is hard not to get anxious and irritated cause you are not thinking globally from a population perspective but we got it going and in part we got it going because I made a speech in front of the LIPA membership describing how bad things were now. And it just was a sarcastic speech about people wandering around and doctors saying, “Ah Christ, I don’t know. I will at least order some labs to try to make money off that.” How terrible the care was! And then they said let’s give it a try. Capitation for primary care, a slight increase on what Medicaid is paying you for specialist, bonus pools if we save money on hospitalizations, and everything was a guess. And then good feedback. As quick as we had information, you are making this that or the other. Our pools are okay. We would be right out there educating people. There is also a fair amount of arm twisting and comparison. Doctors like to see how they are in comparison to other doctors. So, we would say “hey Your body Dr. Jones is taking 100 patients. You only have 20 patients signed up. What do you think?” As time went on, it became clear we were making better money then we were on old-fashioned Medicaid and the care were better and the specialist became happier and so on and so on. It became a very successful program. I was chairman of the committee that ran that for 6-7 years. It was really an eye opener. I didn’t know anything about finances. To get the LIPA people doing reports and seeing where the money was going. You have to buy re-insurance, in case you had a million-dollar case. \n\nThere were things I never heard of before. There was also—I didn’t know I was going to get talking so much—there was also dealing with other doctors. My favorite story is the story of OB ultrasound. Mid-90s, all the OB groups were buying their own ultrasounds. They were in the habit of saying, “Hey this is a Medicaid patient and I am not getting paid very well, so I’ll do an ultrasound.” They could bill for the ultrasound and get paid for that. Doctors are not saints. They are motivated by money, in part, like everybody else. So, we had this one doctor, an OB, in Springfield, who would order an ultrasound every month. He was doing 7-8 US per pregnancy. And our little committee had an OB, surgeon, a pediatrician, and a few family docs. We brought it up and said, “What the hell.” (laughs). We laid out some numbers and cost. And the OB guy said, “I will handle it.” What he did is that he went back to his county OB-GYN group. It is a different culture now; they don’t have that any more. Medical society meetings, nobody shows up. Groups of surgeons and OB-GYNs, they don’t get together any more. They just meet with their own groups and so on. There has been a loss of collegiality through the years. But anyways, he took it back to his group, they talked about it, they came back to us with a proposal that we accepted. If we sign up an OB-GYN Medicaid patient, a pregnant patient, pay us the fee of delivery and 1.5 ultrasounds. If we don’t need to do any, fine. If we need to do 3, fine.  Isn’t that a sweet conclusion? And that is local control. If you think about that nationally. Everybody wants a national fix to health insurance. It is much more to be successful if you have local people talking to each other solving problems like this. It was really a great, great example of how that worked. But luckily with the OHP contract, everybody got paid better which eased some of the irritation also. LIPA became better at having Exceptional Needs committees that is, when someone is driving everybody nuts, we turn loose on them a nurse or social worker. That sort of thinking has expanded through the years. It is, like, we should probably have a couple social workers at our clinic for example. So that is interesting. \n\nThe next big thing that came in was computerized records. I am thinking 2000 for our clinic is when Doug Jeffrey researched this very well and came up with eClinicalWorks, which has been, I think, successful for us. Some groups in town made bad decisions, OMG for example. It is going bankrupt. They made a bad MER decision and then a couple years later they made another bad one. Their doctors are pissed off and they’re not productive and they are in financial trouble. As rumor has it, they are looking for someone to buy them out. So young doctors thinking “I will join big group and I am safe and secure.” Bullshit. \n\nSo, the medical records, some people at the office predicted that I was going to hang it up at 55yo because of the frustration of learning a computer program. And initially they did a terrible job in educating us giving us some sort of feel for what it was like. But, the advantages became clear the longer we came into that. By the way, I did something else. I think I forced our group to have a problem list and a medicine list on the paper chart cover so at least, allergies, medications, problems, and a little bit of social were up on top. So that was obviously good medicine in a clear way. If you had a chart like this [hold hands up to show thick chart], what the fuck! Totally useless. But I think I will take credit for that too. \n\nBut then, shifting that into the format of ECW pretty easy. And it is the main, one of the main advantages of computers, that is really clear. Every medicine that we have prescribed is in the record. So that is neat. So, the computerized deal, and the rise of the other internet backups, the programs and so on, made it easier to practice good medicine. And I thought I became a better doctor as time was going on because of the electronics. \n\nThe other thing that I’ve told you in medical meetings, I went to an AAFP meeting maybe 25-30 years and learned about the BATHE technic of interviewing. To me, that solved a lot of problems. Some of the problems of empathy, how to be empathetic when I am tired, but you can’t do it but at least you can be curious and ask questions. It solved the problem of “I can’t listen to this patient for 30min, I can’t do it!” Spend 2-3 minutes and get a very good emotional history that is, that lets the patient know that they are heard. To me emotionally, that solved a lot of difficulties and frustrations that I had in the practice of medicine. As your starting and learning, and you feel “Oh my God, this patient” and there is tension, relax and use that Bathe technique. And it reminds you at all times, it is adult-to-adult. It is their life and their handling it. You might have a suggestion or two, it doesn’t matter. It is their life. And that is a useful thing to keep in mind. \n\nBP: I liked the poem you included. \n\nJB: About Betty? I am collecting those poems and am adding commentary. She later fired me, which is okay. She wanted a style of somebody who would join her in her anxiety, and Christ, I wasn’t. Betty, come on! (laughs) So she got someone who was more dramatic and they were both happy and I didn’t take it personally. It takes a while to not take some of those hurts personally. \n\n Where was I? Oh! So, I learned to really enjoy it about 30 years ago. Finally, the balance between anxiety and I know what I am doing here happened. I started to enjoy patients a lot more after using the BATHE technique because I was an introvert in part and people could be exhausting especially if I didn’t know how to control things. I started enjoying it. And it has become better and better and better the longer I have been in practice. It has shifted into a joyful state especially in the last five years or so. I had an aortic valve replacement and didn’t know if I was going to stroke out or what. I survived that in good shape. That helped to reset my brain a little bit. But, just that confluence of age and time and patients who have been with me for 40 years who have become friends, you know, in part, so it has just been wonderful. So, my conversations with people now are different. I will ask them what is going on in their life. And I want to bring up a word, “What does gratitude mean to you?” Old guys and gals know, they have a relationship with this word. The young folks, not so much. I don’t know if you have. It is a word to grow into. It’s a fun word. But, part of that is what happens is when you get older, realize you have been fortunate to have a good ride and see a bunch of things and to make mistakes and have successes and on and on and on. And it is just a different view of the whole thing. I have had a lot of patients say, “Well, I am ready to go.” It is the same thing. They are not depressed. They are just satisfied and ready to go. \n\nWhat else would I say? Last 30 years, the growth of our group and how we’ve learned on the job in how do you manage a clinic, how do you deal with people. We have gone through things like my nurse puts pressure on me to intervene on management because there is always a mistake. It took years for us to figure that out. A funny version, I don’t know, we had a woman doctor who was a jerk who at meetings we would say here is our protocol on scheduling patients and well, she had different ideas and, in fact, if she thought something was off, she would get angry and she would go up and yell at the person at the counter. And we said, “Don’t do that” and she said, “you guys were a bunch of…” And so, we went into counseling with her. We did group counseling with her to no avail. And finally, when she in a fit of anger, resigned, we said okay. And when she tried to un-resign, we said, “Nope. See you.” That sort of thing. We started out old-school, a doctor is a doctor, a king or queen of their area, who went through a bad medical school and so on and so on. We have shifted to a more group mentality, smartening up about, hey, we can’t intervene; we have to let management be management. It is still an on-going kind of thing. Shifting in the way of management is sometimes going to come up and be pissed at you. So here is somebody who has never been to medical school saying “Dr. Beckwith, you should quit doing this. It makes everybody upset.” We have to give them permission to do that so lots of cultural changes that are not immediate even though logically they are like “Oh yeah, that’s right.” Sometimes it takes years for that to solidify. So, now we are finally getting to a place where we kind of know what questions to ask new candidates who want to join us to get a better feel to see if they would be a long-term fit. So that has been fascinating. The group has done well especially in the last 5-6 years in contracting and joining larger groups and metric stuff which I fought initially. I didn’t think it was—I thought we were losing track of who is important but there had to be good medical evidence that what you are collecting data on actually benefits the patient. It is still a little bit of an irritation, it can still be an irritation. For example, if we are doing cognitive screens on people older than 65 and US Preventative Services comes out and says there is no benefit that we can figure, how do you balance it? So, lots of growth in management, in trying to learn how to thing as a group as opposed to our selfish individual ways of thinking.  \n\nThis reminds me fun story and an issue of call. There came a time—I can’t remember dates, Mark Meyers would know—where we were doing full service medicine, babies, ICU admits, medical admits, un-doctored patient admits, we would take our turn. But other doctors were dropping out so it turned out that we were on call we were admitting 2 un-doctored patients per night in addition to our own and so on in addition to OB. We were hard-ass. We tried to negotiate with Mackenzie Willamette. They stiffed us and belittled us. They said, “it can’t be that bad.” WE gave them statistics and they stiffed us again. We said, “We resign as of July 1st. We resign all of our hospital privileges.” So, then they hired hospitalists. But we had to go to the wall with them before they would do it. That’s an interesting story. \n\nAnother big change was having behavioral health in. That is a big quality jump. And even though our first group did not mesh in culture—they’d see the patient in their closed office and that was it—we didn’t know the hell what was going on. It wasn’t my impression what behavioral health should be, but their schooling was that it was their sacred space and I am not going to tell anybody anything. But that is bullshit for a family practice clinic. But then the pharmacists—what has that been a year and a half—it is obviously been such a major increase in quality. It is just hard not to stay excited from that point of view. It is from the fact that we are doing a good job. We have a reason to be proud of our clinic. \n\nWhat am I leaving out? These stories…I will give you another this deal on narcotics and benzos. We have discussed this in depth every year or two. It is ongoing. It has been a slow shift and finally a recognition that most people are harmed rather than benefited. Always the issue is harm vs. benefits—all that we do, ordering a lab, ordering an MRI. But finally, after a few years, after having a few successes, I had one patient who worked at the hospital—an ICU nurse. She has back pain and is on oxy somewhere in the 40mg per day. 3-4 years of negotiation and cautious tapering and articles to her and slowly cut herself off and is very grateful for that. And many other people have done well and virtually all of them say that “Ah, my pain is just the same or better but my brain is better.” So, I felt very, very good about that change in thing. I think we need to still work on not starting people on it. Nip this thing in the bud. I had a friend who was in Ireland and his wife broke her arm and they gave her Tylenol IV, paracetamol for pain. Tylenol? She is hurting! It worked well. And the doctor said, “Yeah, we don’t use narcotics like you do in the States.” There’re wonderful things you can learn from other countries and increasingly I am interested in reading about them.  For example, I was trying to go my first colonoscopy. I don’t think I want to do drugs. What, everybody uses drugs? I went through it and I didn’t use much. And the GI doc said, “Yeah, in Europe, nobody gets anesthesia.” Similarly, when I did my liver biopsy, I didn’t do anesthesia. With my port placement, I didn’t have anesthesia just local. And again, the docs said, “Yeah, in Europe they don’t use it.” Our culture is really screwed up in the way we do pain. And it still has s0me unwinding to do and the drug companies played a big role. I am happy to see them gone to the docks. \n\nAnother wonderful thing, Dan Paulson and I, 6-7 years ago, started reading about deprescribing which is a Canadian thing, started in Canada. And if you look into Canada deprescribing, there is a website with very good information. The US is starting a program this year. 7 years late. But that whole idea of what is successful aging and getting the drugs out of the mix and being very suspicious about drugs and deprescribing. It is a wonderful intellectual idea that I use every day. \n\nThis reminds me, I have left out. I did hospice for 7 years at Cascade hospice. I was co-medical director with John Leboe. That was a real education, because what hospice does is deprescribe right and left. Why are you on this? What? How much insulin? How many times a day are you checking your sugar? I don’t think so. What’s our goal sugar? 250. Okay we are good! So, I carried some of that back to medical practice with my aging patients. So, my philosophy is when I see my patients, I am thinking about how to keep them safe from drugs, from our medical system which is bound and determined to overtreat them for the sake of somebody’s wallet unfortunately. But that’s for a geriatric practice which is what I have mostly now is a very appropriate attitude. \n\nAnd so, the last thing: cancer screening. I have been very cautious about cancer screening. I think it has been oversold in lots of ways. And it is continuing to be mismanaged in several ways. For example, very few people who are giving CT scans of the chest for lung cancer screening are given any sort of informed consent of pros and cons and possible harms and statistics, how many people benefit and how many people don’t and how many people get anxious because they have a lung that we are not going to do anything with for 6mo. All this stuff is harm-based and should at least if we are going to be honest with people at least we should talk to them about what we know, what are the harms and benefits. Mammograms are a close call, but there is precious little benefit at overall mortality—I do not know if there are any benefit if you look at overall mortality rates. People do die less of breast cancer, but their overall mortality the best I know is the same. So are some of them dying and they get anxious and have a car accident or commit suicide. Other countries have looked at that and are backing away and are stopping mammogram programs. \n\nProstate cancer is a terrible one. I wrote an article. The urologists—you know, life is good but it is better to know—all this bullshit. They make $50,000 buck for every patient they can talk into radiation therapy which they do poorly compared to the other radiologists and they do in their own in-house clinic. It is a money-maker for them. They were not giving proper informed consent about harms and benefits. One of my patients reported to me that he was at work and they were having one of the urologists coming to tell him about advancements in urology. And they’re 40 guys sitting around and they got the pitch and my patient got up and said, “Doctor, what would you say if your doctor was not enthusiastic about the PSA test?” And he said, “Get another doctor.” I wrote them a blistering letter which including things like “Yes, when I talk to my patient, I refer them to, send them to websites and have them review statistics” and ended up signing sarcastically: “My patient is happy he has his current physician. Thank you very much.” Fuck you. That was not the end of it. They kept advertising it and there was all this fucking advertisement. And finally, I had enough and so I wrote an editorial and published in the Register Guard. I got a lot of positive feedback from the primary care docs. The urologists were pissed off. In fact, one of them called the president of the medical society, or whoever the lady was who ran the medical society, and said, “What the hell is Beckwith doing being part of our medical society when he is so out of bounds?” And she said, “You know what, Dr. Beckwith called last week inquiring the same about your group.” So, I am proud of that. I am proud that I at least am trying to think about harms vs benefits and giving patients information about testing and expenses and so on that they are being pushed into by our society; back surgeries are another big example of that. \n\nSo, as I look back, I have many, many reasons to be grateful and happy and proud and joyful about a lifetime in medicine. And I can’t imagine why anyone would retire form the practice of medicine, what would they do with their time.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162460/file/295890#t=0.0,3477.37397"}]}]}]}