{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/r49g44kp76/manifest","type":"Manifest","label":{"en":["Dr. Duncan Etches"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1990-05-14 (created)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","Dr. Duncan Etches","family medicine","family physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Dr. Duncan Etches (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["english (primary)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813","type":"Canvas","label":{"en":["Media File 1 of 2 - Etches_Duncan_1990.05.14_-_Side_1.mp3"]},"duration":3917.936,"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/3180/collection_resources/150635/file/277813/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/277/813/original/Etches_Duncan_1990.05.14_-_Side_1.mp3?1750274706","type":"Audio","format":"audio/mpeg","duration":3917.936,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251","type":"AnnotationPage","label":{"en":["Dr. Duncan Etches interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"John Frey: Facing [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=0.0,4.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. This way. You got correlation into transcription. The orientation.\n\nDuncan Etches: [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=4.0,14.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: Tried to do it, but it didn't work out very well. Working a new ... figure out this ... It's a new machine. My other machine got stolen at the airport about a month ago. And my whole briefcase got taken. But fortunately, I'd just taken out all of the interviews I'd just gotten back from, so I was very unhappy, but I could have been a lot unhappier, a lot less ... More unhappy, I guess.\n\nDuncan Etches: I had a terrible experience when I was driving back from my fellowship year in Ontario back to British Columbia with my family. We stopped in Calgary to go to the Calgary Zoo. And our car was broken into. And I had my data in a computer box. And they must have assumed that I had a computer in there, grabbed it.\n\nJohn Frey: Oh my god.\n\nDuncan Etches: With the camera and the Walkman. [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=14.0,67.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/4","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: There was no backups or ...\n\nDuncan Etches: I had some of the data on computer, but not the raw ... The sheets, the questionnaires and things. [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=67.0,81.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/5","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. Newspapers actually ran into the human interest story. I was on the second page. I walked about half a mile away from the zoo in each direction, side of the road.\n\nJohn Frey: Well, I don't know why anybody would want my notes and a couple of notes and some photographs. And lot of notes from the interviews that I've done, but nothing ... The interviews themselves. I quickly ran back and tried to reconstruct as much as I could. Anyway. Well, could you ... Realizing that a little bit about what I'm trying to talk with folks about, it would help me if you could tell me a bit about the story of how you ended up going to Hazleton.\n\nDuncan Etches: In medical school, the United Church offered elective opportunities for six weeks to go to one of their hospitals, among all the many hospitals in DC. And they had one on the Queen Charlotte Islands, and I went there, which is the same place [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=81.0,148.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/6","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. And my wife went to Hazleton. And this ... We had all this arranged before we were engaged.\n\nJohn Frey: She was a doctor too?\n\nDuncan Etches: Yeah. By the time we got there, we were actually married. After six weeks, [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=148.0,164.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/7","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nAnd she had a great time. And I was over to visit her once in the middle of her time there, and was very impressed with the staff and the place. And so we went away to New Zealand to intern. And we were casting around as we left there for something interesting to do. And we contacted the church again about whether they have an opening, and went to Hazleton for a year. And then I think as I mentioned earlier ... Maybe that wasn't to you.\n\nJohn Frey: No.\n\nDuncan Etches: But I became aware that to practice good quality medicine, think you need to have time, and that you can't do it by being in a place for year. And that they removed [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=164.0,228.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/8","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] that turnover in which had been rented at the rate of average every two years was making a full relationship between the physicians and the community.\n\nJohn Frey: That was after ... You were there for a year. Did you ... Where did you do your fellowship? Is that ... That was sometime during-\n\nDuncan Etches: That was just last year.\n\nJohn Frey: Last year.\n\nDuncan Etches: That was '77, I went.\n\nJohn Frey: You and your wife sat down and said, \"This is the place we're going to stay\"?\n\nDuncan Etches: Mm-hmm.\n\nJohn Frey: Did you have a family at that point? Did you have children?\n\nDuncan Etches: Two children at that point. Actually, there was ... Hazleton is a mixed racial community. [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=228.0,278.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/9","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. And that creates also division in the community. And it's not very wealthy, being rural and with the native population having high unemployment rate. Also, my family was in Vancouver and Nora's family was in [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=278.0,302.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/10","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"], which is not as far away. And so it was tempting many ways to go do something else. But someone was talking about this story of Adam and Eve and how they were in this place that was perfection, except for one thing. They couldn't take the fruit off the tree, but everything else was fine. And their reaction to that situation was, \"You've got to take that.\" Unless we can do that, we're not really going to be happy. And how they ...\n\nHappiness is intrinsic. It's a state of mind. It's not related to the externals. And it's so easy to live thinking that if this one thing happens, if I can arrange this, then everything will be okay. And so we decided to just live with the things that [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=302.0,361.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/11","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. We were happy. That came, this discussion, in that first year. Maybe that something ...\n\nJohn Frey: That would be a good discussion to have, again, between the two of you. I think one of the things that I found about a lot of things, both the conversations I've been having, but also burned back over my own life songs, I'm not really clear why I did things. Now, that may be ... I can't capture what my thoughts and feelings were at that point in time. And I have had 15 or 20 years of going back and rethinking and coming up with new versions. But that's a very ... That's what went on between the two of you around the decision to stay in Hazleton [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=361.0,410.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/12","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nDuncan Etches: And also, we saw a lot ... Being in a small place, I think it's very easy for children. We never lock our doors. We know ... My daughter's now a teenager. I know all the kids. [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=410.0,432.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/13","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] a parent would be a physician in a small place. I know which of her friends are on birth control, maybe even more than she does.\n\nJohn Frey: Probably.\n\nDuncan Etches: And who they're sleeping with, who's out late. Probably have a much better handle on a few clients [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=432.0,447.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/14","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: Your wife, she's one of the members of the six person group?\n\nDuncan Etches: Mm-hmm.\n\nJohn Frey: I see.\n\nDuncan Etches: She actually hasn't been practicing that much until this year because now our youngest is in school.\n\nJohn Frey: Oh, okay. So that's ... what ... as you think about reconstructing the 15 years that you've been there, what do you remember as ... If you could think about the stages of your career in the community, are there periods of time that went by? And then at some point ... I talk about nodal point. I'm not sure that's the right word. But is there something that you remember was a time of really reevaluation and reassessment at all?\n\nDuncan Etches: No. The first year, in '84 ... I'd been there, at that point, seven years. I became the administrator of a small hospital. And so that, in a way, was a nodal point. I was away for a year, and could have spent a lot longer if I'd wanted.\n\nI could have become more of an administrative practitioner at that point. Decided that wasn't for me. Came back and the administrator at the hospital I'm in now went on sabbatical, and so was a neat opportunity to become administrator.\n\nBut the next one, I guess, would be more gradual. And that was noticing that one of the attractions of Hazleton was the breadth of practice you could do. And there was more encroachment on that. There was some new younger surgeons in the neighboring community who started to put the pressure on you for having them do the surgery that you'd been doing all along. And also, that I was becoming more isolated among the younger physicians that I was working with. They weren't used to taking on the kind of responsibilities I was used to. And it became an environment where many more transfers were happening, things that didn't used to be transferred in the past. And that set up an atmosphere for me also that something came in that was serious, that in the past, I felt I could have dealt with the patients. Having experience in the community, that that kind of thing is transferred, putting the pressure on me.\n\nI wondered about some other kind of medicine. Doing call. I still don't mind getting up in the night, but you have a few nights when people are getting you up for these things and you wonder, \"I'm 45 now. What's it going to be like when I'm 55? Do I want to be doing this?\" I was reevaluating the practice then. And that's when we decided to take the sabbatical.\n\nJohn Frey: How did the sabbatical help you make decisions?\n\nDuncan Etches: I realized, again, that the continuity of care gives you opportunity that you can't have in places where there's a high turnover.\n\nIf I went into an academic practice in the city, I probably wouldn't be able to ever replace the kind of practice that I have now. And so I couldn't teach in the same kind of way that I'm able to teach right now. While I'm back, I've decided to go back to the same practice.\n\nJohn Frey: When ... I'm sorry. Your children become very important to you. And so what's ... We've always raised our kids in a small town. We wonder a little bit about how will they cope and the world that's becoming increasingly urban. And so we had this year when our children were in a town which prides itself on being a medical center, a university center. Only 300,000 people, but there's a major transplant hospital for the country and the university of 25,000 students. It's quite an academic wealthy kind of town. And my kids went to academic schools there. And I think I seem to see that they did fine.\n\nAnd so that took that pressure off perhaps of needing to be in a better academic environment. That's just ... Because that is a big issue that people talk about all the time, is children and the concerns about their ability to get the education that you want them to have. And in some ways, it's validating that your children are learning and are bright and are capable to put them in an environment that's supposedly probably more pressured and more competitive and them doing well. It's very interesting. That helps.\n\nDuncan Etches: Things have gone very badly. And we realize we've really jeopardized our kids' future by having them here than we might have moved. But I think having recognized that that's not true.\n\nJohn Frey: That's very interesting. What gets ... The mission you made of your daughter and knowing about her friends.\n\nOne of the things that I told ... has been an interest for me, it's kind of started this whole project, was the complexity of the relationships that doctors had in small towns and knowing a lot about ... Knowing a lot more, in many cases, about everything than any other individual will know. Maybe sometimes more than you want to know. And I wondered if you'd reflect a little bit on how that question of confidentiality, is the term that's used, but just this whole sense of knowing a lot about everything has affected your ability to live and work in the community.\n\nDuncan Etches: There's so many ways to talk about that.\n\nSuppose one of the effects is that you're friends with everybody, but maybe not too close to anybody. Might be one of them.\n\nJohn Frey: Where would that have been?\n\nDuncan Etches: That's maybe the nature.\n\nI know people's strengths and weaknesses in a kind of way.\n\nI think as well on a good friend at the farm. And we looked after their farm when they went on holiday, but their daughter got an anorexia disorder. As part of that, you're looking at the family dynamic. You know what I mean? As soon as you start doing that, you're distancing yourself, putting up barriers.\n\nThe farmer ...\n\nJust that kind of thing happens with all of the ...\n\nSome people from the patient side go to the next town, care for different things, which doesn't bother me at all. But then that makes a little distance too because they know that they're doing that to distance themselves from your office.\n\nJohn Frey: Did your-\n\nDuncan Etches: [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=447.0,1006.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/15","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: I suppose they might think that it was protecting your relationship with them in some ways from the burden of knowing all those things. Does it ever feel like a burden to you?\n\nDuncan Etches: Not particularly.\n\nTrying to think of relationships that ... It would only be that it's hard to cut them off. I came here and I had two friends here. And I expected a baby. And in fact, I told my wife. One of them [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1006.0,1045.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/16","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. That's the hard part, is to saying no to a baby.\n\nJohn Frey: But you had mentioned when we were talking earlier about one of the advantages about your ... That being somebody who stays is that when you say no, they know that that doesn't mean that you are abandoning them, I think was the term you used. That was an interesting ...\n\nDuncan Etches: I don't think that the distancing is a big problem. And it's not that severe a distance. What you want, in some ways, maybe is ... For the one side is you want friends who when you're in trouble, and are willing to help you. My wife had a car accident. Lots of people came to help. [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1045.0,1098.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/17","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"], but your wife's in hospital having a baby. There's lots of people to support you, you know that.\n\nJohn Frey: Do you feel that there's some places that are sanctuaries where ... Or is it even a necessity for you?\n\nDuncan Etches: [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1098.0,1141.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/18","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1141.0,1144.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/19","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nDuncan Etches: I forget exactly how you asked the question because I was thinking as you asked it. You could answer it in many different ways. You could try another way of asking it.\n\nJohn Frey: Well, I just was saying that the idea of, in a sense ... The sense of distancing that you feel sometimes by knowing all of the things that you know about people. In some cases, more than you like, on the other hand. And in a sense, that means that your role as a doctor is, not selecting my words all that carefully, but intruding. Or somehow, it's there all the time. It's kind of visible, in a sense. I'm picturing it as a sense of yourself being in relationship to other people. Pretty much always their ... Not always their doctor, but their doctor and then other things. But whether there are places or things you do that are doctor-free.\n\nDuncan Etches: No, I think it's one of the things in a small town. And maybe that's not always true, but it becomes part of you. The image part of you and the reality are mixed up tightly. And who you are is defined partly as the way people see you. They see you as a doctor in the community. That's what you are. It's like being ... Age, sex, racial origin, employment, it becomes the way you are seen, the way you are.\n\nJohn Frey: The times when you would-\n\nDuncan Etches: But I play hockey, ranked hockey. And I do that kind of thing. Right now, I'm a school board trustee. For a while, I was the mayor.\n\nJohn Frey: You were the mayor?\n\nDuncan Etches: Well, I live in an unorganized area, so we formed a community association to get a few things going. Fire protection. And so for a while, lots of people called me the mayor.\n\nJohn Frey: Well, that also gets at this whole-\n\nDuncan Etches: Each of the images became a reality in people's minds. And so I wasn't necessarily the doctor the people of interest [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1144.0,1313.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/20","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: If you were the school trustee, they talked to you as the school trustee.\n\nDuncan Etches: Sure.\n\nJohn Frey: Did you feel some, either you yourself, feel some expectation of yourself? Or do you think others have expectations of you to participate in the larger activities of the community?\n\nDuncan Etches: I don't think they expect it, but they appreciate it. The crew of educated people is fairly small, so they like it when people who they don't want to [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1313.0,1345.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/21","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: Was there an expectation you had when you came into a small town that you would become a more multifaceted part of that community's life?\n\nDuncan Etches: I guess we talked about family medicine as having three layers. The individual, the family, and the community. I've always thought of the community as being a really important part of the people of town. That to have a job ... The level of meaningful jobs in the community determines a lot about the health of the community. I've always been interested in ... An interest in health that the community has. Those kind of things, I think. That the community feels good about itself. Those are such hard things too. But in some ways, you worked on them.\n\nJohn Frey: Well, that's also-\n\nDuncan Etches: Encourage them.\n\nJohn Frey: ... a long term ... I remember one doctor in the mountains in North Carolina was ... he worked and worked and worked to get jobs because he felt like ... He would go with the community group that would go out and try and recruit industry or small industries just because he knew that it had nothing to do with financial reward. It had to do with the health of his community, being proud.\n\nDuncan Etches: One of the things that's happening right now is we're getting a new high school. It's always ... Always looking to cut costs. And they can't proceed with the project that they're getting going. Good luck to find a reason to do so. Just keeping the pressure on, keeping making solutions.\n\nJohn Frey: And probably because you are the doctor, that has a certain amount of prestige associated with it, that if you were another person in the community might not. Which is, again, part of the sense, the burden that we don't talk about explicitly. But there is this role of being the doctor in the community that carries with it more acknowledgement of being special, I think. What ... Privacy is something that you haven't felt to be problematic for you and your family?\n\nDuncan Etches: No.\n\n[inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1345.0,1515.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/22","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] about he had it all, wife, home, kid, the whole catastrophe.\n\nYou get all the things. You're not missing anything [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1515.0,1532.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/23","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] matters. It was kind of funny when we bought our house. We hadn't told anyone we were buying. We went out to the show that night. All kinds of people came up to us at the show. \"Hear that you're buying a house.\" Surrounded.\n\nBut not doing anything that I care very much about, if people know or not.\n\nJohn Frey: But you do have your [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1532.0,1568.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/24","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]?\n\nDuncan Etches: Sure. To that point.\n\nJohn Frey: They're fairly respectful of call and so on. When you're not on call, people don't bother you and-\n\nDuncan Etches: No, I've got my number listed in the phone book.\n\nBut it's seldom used.\n\nAnd if things are worth it, and even if I'm not on call, then I would be willing to, but that [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1568.0,1603.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/25","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. No. And I think that fear keeps people from being approachable. Then there's a suspicion about [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1603.0,1629.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/26","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. If you don't set them up, then it's a different relationship with people, and so then you don't need them.\n\nJohn Frey: How about your family? Do they ... Do you ever have any sense that your kids, I don't know, resent, but too strong a word, but meaning the doctors, children and so on?\n\nDuncan Etches: I've asked them a couple of times in different ways. One of the things that came up at the school board was whether we were going to have condom machines in the school.\n\nI'm not afraid to open my mouth, and then I [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1629.0,1682.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/27","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. I said that I was in favor of it. All right. Afterwards, \"Jesus, I wonder what my kids are going to say.\" I spoke to them and said, \"There's going to be a piece about me in the paper, but being in favor of condoms. And do you mind me saying anything about that?\" And, \"Nope.\" And about me knowing too much about their plans and things, that I don't think they've ever seen it as a problem. They've never said anything. I know at other times, they've indirectly said things like, \"My friends are glad to have you as a doctor,\" or something like that. In that way, they're saying that it's all right that I do.\n\nJohn Frey: But they haven't felt that somehow they're under extra scrutiny or have to behave extra normally or anything like that because they're the doctor's children?\n\nDuncan Etches: I don't think so. One thing is that we're not very well paid as students who goes through the church. And so we maybe don't have a lifestyle that's different from the community that some physicians might have. My kids don't have the latest fashions from Vancouver. And we don't drive a BMW.\n\nJohn Frey: Do other physicians in town?\n\nDuncan Etches: No.\n\nJohn Frey: They're the same?\n\nDuncan Etches: Yeah.\n\nJohn Frey: That's another small town. It's a-\n\nDuncan Etches: I think that kind of elitism isn't as much of a problem with us. They don't get labeled as being snobs or that kind that you might have. [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1682.0,1814.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/28","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: What ... This issue of confidentiality and so on. I've asked folks ... You're in a different situation because your wife is a physician. In a sense, you have a ... You're working. She's a colleague, as well as your wife, and all of that. Keeping confident. Well, that's a very interesting question, and I had a variety of answers. You can imagine the range that people have given me. But I'm curious what you and your wife ... or what ... In a sense, what do you do with the kinds of things that are difficult? Or are there discussions you've had about what she will and won't know?\n\nDuncan Etches: We have a policy with each other that we don't give names more than we would ...\n\nWell, than the patient would expect or that we would not be doing with the public health nurse or ... But we certainly discuss the principles of a lot of patients.\n\nJohn Frey: And that sometimes even comes up with people ...\n\nDuncan Etches: Often an accident or concerns about people drinking or something we might not [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1814.0,1889.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/29","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: What about that example of your friends with the farm and the daughter that was anorexic? Is that something that you found out in the course of being a doctor? Or is that something-\n\nDuncan Etches: Yes. Although we might notice something, someone's smelling it.\n\nJohn Frey: But would you say something, for example, about that girl to your wife or talk about that at all particularly?\n\nDuncan Etches: Yeah, probably would.\n\nJohn Frey: It is different. I haven't talked to anyone who's ... Where the couple are both physicians, per say.\n\nDuncan Etches: We ... For example, I think the news about who's pregnant is always an interest and it's the kind of thing that's usually confidential. And so we don't tell each other who we've seen as prenatals, until it's obvious to everybody. And so that's sometimes funny because people, community expects that no one will know all who I know is pregnant and vice versa. And they're always surprised when you don't know.\n\nJohn Frey: Well, it goes along with your house story, in some ways. They know all about everybody. Confidentiality is not something that's very big in a small town. On the other hand, I think it's probably very important for them to be surprised by you not knowing because that reinforces their ability to talk to you in confidence, I suspect.\n\nDuncan Etches: And the other side of that is maybe I'm not ... I'm a community rights person too. Maybe I'm not strong on personal rights. Confidentiality is not high necessarily here if there's other overriding things.\n\nJohn Frey: Can you think of an example about that?\n\nDuncan Etches: One was a man who murdered his wife and told me some significant things about it. And I was really uncomfortable with knowing that. Not really. He was a school teacher.\n\nHe showed no remorse for what he'd done.\n\nI felt that wasn't something that should be kept confidential, so I talked to the police about that. That's one example I can ... And those kind of things don't come up very often. But maybe that-\n\nJohn Frey: Yeah, that's pretty dramatic.\n\nDuncan Etches: Maybe that's the only example that I can think of where I've breached confidentiality without patient permission.\n\nJohn Frey: What about among family members? About this whole ... With residency training, we're always talking about each member of the family being very clear that what they say is confidential. But in discussions with folks I've talked to, there's the sense of not breaching that confidence, but somehow stretching things here and there little more than you might.\n\nDuncan Etches: That's pretty interesting. I see the patients that are in pharmacy, over the counters. For example, teenage girls wanting birth control. That's their problem or their family matter. I wouldn't tell. At least I never have. Maybe there would be some circumstances come up where I might. Husbands having affairs. I haven't had any of these cases. I don't know how that might go if ever happened. I guess on that, those kind of areas, I see the privacy of the individual, the family. Although, often, I'm encouraging people to open up secrets to families, or husbands to talk to their wives, things like that. We always ... They'd rather talk to us.\n\nThose situations [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=1889.0,2155.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/30","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. Although, knowing things, you can engineer care for the people who don't know what's going on.\n\nJohn Frey: Right. It's very interesting how people are very clever about constructing situations where people can bump into things that they wouldn't normally bump to and to find information out that they wouldn't normally. And again, I think that's really quite ... Things are much different in small towns. This six months I spent in this practice in Wales 10 years ago probably brought this whole thing along in my mind because it was just ... I would talk to people in the middle of the street about birth control because they wanted to know about it right there rather than go down to the office. And I kept saying, \"Why don't we go to the office?\" And they'd say, \"Why? Can we talk about it here?\" \"Okay.\"\n\nDuncan Etches: It's like the Alcoholics Anonymous doesn't work in our town as an anonymous group. Everybody knows they're getting ... Everybody's getting together to have an interest group.\n\nJohn Frey: Well ...\n\nDuncan Etches: I'm quite ... The power scares me still. As a medical student, I was surprised at the power of doctor. And it worries me still in this manifestation now in practice of knowing ... The idea of knowledge being power and knowing so much.\n\nAnd I'm not sure you can always control the power. It gets to be part of you. But it's something I've got in my mind to be really careful not to use the power.\n\nJohn Frey: I think as long as you feel that way, your power will be all right. When that isn't in your mind, that it's probably the dangerous time. What about mistakes? Mistakes you've made or feel you've made. And how you feel and how the community feels around that? Do you think that's different in small towns, in your town?\n\nDuncan Etches: Yeah, I'm sure it is. One is I think probably people are ... The malpractice environment, even maybe more the ... Even the earliest bigger problem in Hazleton, I've been threatened a few times with suits, and had one proceed-\n\nJohn Frey: Really?\n\nDuncan Etches: ... to discovery. It happens. When people are not isolating [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=2155.0,2349.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/31","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"], they ... Particularly some of the teachers and some of those kind of people are nearly always from Vancouver or somewhere. And the mill workers, the executive mill workers and so on, generally are from Ontario, sophisticated and well beyond able to. They keep the demand for a level of service and style that's similar there. People watch TV and LA Law.\n\nJohn Frey: Lawyer shows.\n\nDuncan Etches: Yeah. I think you're still in touch with some of that. [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=2349.0,2393.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/32","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: You think people are more forgiving?\n\nDuncan Etches: I think so. Although, not necessarily. For example, I don't think Hazleton is bad. But this community where I was the administrator of the hospital was a native community also. And so the hospital staff and physicians were non-native and the nurses were heavily non-native. There's sometimes ... The hospital is a manifestation of the imperialism of the non-native culture. And so mistake frowned upon as opportunities to show the imperialism and callousness of uncaring ... There's been communities where that's been ... That medical care has been the focus of the political activity.\n\nJohn Frey: Really?\n\nDuncan Etches: Hazleton hasn't quite a good relationship with that. But I think that there's always that vulnerability.\n\nJohn Frey: What are some of the ... you do practice in a very different community than many of the people I've talked to as far as the native ... the cultural difference being quite obvious in the sense of people being from a ... They have different languages too. And which is different than staying in the south where there may be Black and white. There are racial differences and there are certain cultural ... as we were talking about, the cultures are different, but not that different as ... What are some of the things that are unique to your practice in your community around that issue?\n\nDuncan Etches: One of the things, I think, is medicine is a great bridge between cultures. But the kinds of things that you deal with in medicine are universal.\n\nJohn Frey: Right.\n\nDuncan Etches: Everyone's delighted to have a baby, and everyone's sad about the death. And so I think we have a great opportunity to be bridges between cultures.\n\nAnd that came up very strikingly recently. The bands have taken the provincial government to court because there's never been a treaty signed. The Europeans just occupied the land. And so they've taken the provincial government to court for the land, that they say it's theirs, never been compensated for it. And the provincial government has been arguing in court that the natives acquiesced to what was happening, that they didn't put up a struggle against it. What they've been doing is they've been blockading the logging companies from logging the trees to show, \"You see, we do establish that this is ours, not yours. We determine what's done here, not you,\" as part of the court case that's happening.\n\nAnd the income of the community depends very heavily on logging, and most of the non-native community's involved in it. It started to create a very strong racial confrontation. And as a way out of it, we decided to set up the committee to look at how the logging is done and our proportion can be earned. And they asked me to be the arbitrator, chairman of this committee. And I think that's a reflection of you're giving medical care to both communities. And so both sides see you in the same kind of light. You're a trusted person in both communities. It's hard for other ... Teachers might have that. Although, the teach ... Schools tend to be by community by community. And so some of the communities are white and some are not. The teachers tend to be ... There are ones who teach natives, and ones who teach whites and don't have that kind of bridge.\n\nJohn Frey: Medicine has a remarkable ability to cross, as you say, be a bridge. I've heard almost the same story from a doctor who was asked to be president of the school board in a small town in North Carolina at the time when the school system was being integrated. And the reason that he took that on, the reason he was asked, was because he took care of both the Black patients and the white patients. And he, in a sense, was a ... You could look at it in one way as a neutral figure, but I think it's a much different than that, which is not just we're neutral, but that we are somebody who has that power that you talk about.\n\nIt is frightening sometimes to ... There's nothing inherent in me as a person that should have that. But on the other hand, communities turn to physicians in very difficult times to be spokesperson. There's a sense of being an unbiased person, not value-free, but there's someone who's non-judgemental. And I think it's a great risk that's violated by physicians. And if we appear to be someone who has distinctly judgmental feelings about anything that we learned, anything that people present us with, there's the danger of that destroying our ability to bridge things. Was that recently, the logging?\n\nDuncan Etches: Mm-hmm. Just last week.\n\nThat came up part of the ...\n\nThe special thing about being in the community.\n\nJohn Frey: Are there difficulty-\n\nDuncan Etches: I think having to deal with another culture, the way you do that is, I think ... I know now that's what it is. But to the level that you're able to do that is the level to which you're able to enhance your sensitivity to all people. I think that to be able to get along with the native people improves your ability to get along with the very old or [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=2393.0,2827.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/33","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] or with the Italians, whatever community it is that ... I was interested myself in going to London. And I worked in urban hospitals to see whether I had become more comfortable with native people than non-native or something. I had to find that skills, being able to relate to the native people, applied just as well relating to the professors and other people that ended up in your practice.\n\nJohn Frey: An understanding of the other, I guess, is the way people would talk about that. What's been the most difficult part about practicing in Hazleton all these years?\n\nDuncan Etches: My parents are in Vancouver, and I don't see them as often as I would like. Not so much for me, but I wish that they were seeing my kids more, because they had a close relationship with Vancouver. And I really love ... I grew up in Vancouver and went to university there. And I felt Vancouver was kind of a hometown. I could go to the theater in the evening, and I would meet someone I knew. I loved the parade of cultural events that went through Vancouver, and the airport being there so that you could hop on a plane and go easily all over North America. And that's a lot harder to do out of Hazleton because you don't have that. We get a lot of interesting people coming to Hazleton, and you meet them, which you might not do on the same kind of intimate basis in the city. But I miss that wider circle of friends of similar interests that you have in the city.\n\nI used to do rock climbing, for example. And there was no one else in Hazleton who did high-angle rock climbing. And I like to ... I like the big library. I just loved that when I went back to London last year, having this enormous library. Some of those things I miss a lot. Modern technology helps a lot to overcome some of that, but I still ... To get on MEDLINE, I have to phone long distance, 100 miles, to get on. Then ... It makes the calls on MEDLINE much more expensive because of the long distance journey. It's one of those things I don't like. It would be pretty exciting to have that. One small thing is I grew up on the coast and I love the ocean. And Hazleton's 100 miles inland. [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=2827.0,3050.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/34","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: Are there mountains there?\n\nDuncan Etches: Yes. Beautiful mountain there. I have a beautiful [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3050.0,3055.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/35","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: Well, I guess what it brings up is what is it that keeps you there?\n\nDuncan Etches: I think we spend a lot of our day working. And especially, medicine tends to have long days. And if you don't like the job, then it's not very satisfying. If you do like it, it's worth a lot.\n\nWe've had a very nice group of people that I was working with, an excellent group of other physicians. And we've all been there for a good period of time. And actually, it's been a lot harder this last year. It's been a fair change. Maybe again, that'll be another node you talk about. I just see how it's going to shake down.\n\nJohn Frey: Well, your collegial relationships are an important part of feeling good about your work.\n\nDuncan Etches: And they maintain the standard of the hospital too as being a high-standing place with the data. Everyone there was interested in a high standard of medicine, good quality teaching. And whether they ... Other people who have that commitment do not. I can't do it for the whole group. It was nice when it was shared with 10 people, but ...\n\nUltimately, I think that's why I'm there. In theory, it's nice, but there's lots of nice places.\n\nJohn Frey: What is it about the work that's particularly satisfying for you?\n\nDuncan Etches: That just stable relationship with the patients and that it's a high quality practice. It's really a practice with a good standard, and good people to work with, good facility.\n\nJohn Frey: You mentioned the term when we were having ... Referenced about service. This idea of ... What's that all about?\n\nDuncan Etches: I think small towns tend to have ... Easily get a high turnover of poor quality. And so they need someone who is committed to them. The population feels that. And native communities especially because of the difficulty of working in the ...\n\nExpresses a need for stability and so on.\n\nThat's kind of Canada's third world, I guess. A difficult place to serve, I find interesting. But I ... That's a really dangerous thing to be, to be central. I think native people don't want to be their recipients of need or something like that. They want good quality medical care because people are interested in being good doctors, not because they're wanting to be noble in some sense.\n\nThat you have ...\n\nJohn Frey: Well, no, I think there's a variety of different ... and I think the one thing that I've started to recognize in myself, and I'm 45, and I've been doing this for 20 years now, is how much my own ... I'm slow now to get to the point where ... But I'm getting there. But I have certain things I need about my life to feel satisfied about what I'm doing. And that my practice is ... I take pride in being a good practitioner and being a good teacher and doing all the things that I know I should do or as many of those as I can and so on. But I think I recognize also that I have ... I wouldn't be doing what I'm doing where I'm doing it unless I had some kind of fulfillment from it, whatever. I'm not sure I come up with the right word. But the fulfillment comes ... I have needs that have to be met, not always by my patients. And I think you don't ... I don't need to be ...\n\nWhat I ... What's nice to have people do is to say thank you in a variety of different ways. And I think you must ... My sense is in a small community, that probably comes out in a variety of ways that are different than saying a larger thank you. Maybe the bill gets paid if you're in a large group practice in an urban environment. Thank you might be something different in Hazleton, or I may be completely wrong right now.\n\nDuncan Etches: No.\n\nI remember having a long talk with my wife before we got married about how to go into medicine because you want people to thank you, you'll end up not being very happy perhaps. That you got to do it for your own reasons, not for thank you. And native people don't ... I shouldn't generalize, but I think traditionally, thanks is not given in the form that we're used to, people saying thank you. It takes a long time to find out whether you're being thanked or not. That's an [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3055.0,3446.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/36","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] thing. You'd never hear the thanks if you don't wait for it, good luck. But then it shows up in this request to be the arbitrator [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3446.0,3454.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/37","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] that I was surprised and ... But recognizing that was a time that thanks. The native people ... I don't know if you've heard of Potlatches. It's the native people on particularly the northwest coast, and I'm sure it extends down into Washington. They have these feasts at which the status of the chief is shown by the amount that he gives away.\n\nThese tend to be held on some special occasion, but a death is probably the most prominent one. When someone dies, the family puts on a feast to the person who gets the previous chief's name. In recognition of him getting the previous chief's name, he has to host this feast and they give out enormous amounts of stuff. Food. It could be ... There was one recently of a very high chief, $30,000 that was given out at this feast. And so then you're thanked often in a traditional kind of way that you received some of the [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3454.0,3535.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/38","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] from the chief. That's a Potlatch.\n\nIf you take part in the traditional culture, you'll get thanked in a traditional way.\n\nJohn Frey: And that's happened to you?\n\nDuncan Etches: Yeah. It's very time-consuming to take part in all of their culture. There's a lot of unemployment and that kinds of things take up a lot of time, and so I just don't take voting part in it. Also, I don't want to be native. I think I want to be treated myself and my own culture.\n\nI take part with particularly close patients that I've had. Then I will take more part. With other patients, I won't.\n\nYou put a ... you come to know that whenever you do that, you ... I get thanked for some and not for others because I didn't take part. And I don't think that they're not thanking me because they didn't like what I did. It's just they recognize I'm [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3535.0,3615.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/39","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"].\n\nJohn Frey: How have you changed over the 15 years?\n\nDuncan Etches: I get a sunburn now.\n\nJohn Frey: I noticed a lot of that in this place. I kept looking. I noticed that when I went skiing. I now have a sore head and I thought, \"Where did that come from?\" Then I realized it.\n\nDuncan Etches: I got these this year.\n\nJohn Frey: Right.\n\nDuncan Etches: Well, I guess native people, I think, have taught me about silence. It's a concept that comes up in all the doctor-patient interaction literature. But I think they've been very good at bringing that to my attention really early on because they use silence a lot.\n\nI tend to be kind of a bore and pretty antsy about things, and I've gotten to slow down a bit.\n\nBut I guess just getting to know people very well. I've got insights into people and communities and people's life development, life cycles that I wouldn't have not knowing people for so long.\n\nOur charts go back to 1950, and so I can see the development. I find it particularly interesting, the chronic pain syndromes or dealt with migraines. I can see the record of people starting to have them, having them through their adult life, and then having them change as people get older and they'll have migraines anymore. Think that kind of lifetime view of people has been very special and given me a lot. I think you understand.\n\nJohn Frey: That's something you have to see to be able to understand. You can intellectually read that and know that, but to see it in someone's life is really dramatic.\n\nDuncan Etches: I end up with quite a bit of criminal activity. Someone beat up, and I'm the witness for having seen all that. The stitches were this long and there was this many of them, or child abuse, and all those legal kind of things. And so it's been interesting to see. For example, murderers are quite different than I expected reading the newspapers. Criminals, they're much more ordinary than I thought they were. And jail wasn't an appropriate place to put most people in trouble with the law. I maybe got a more greater tolerance for people had not knowing.\n\nJohn Frey: There are things that come to mind as we're talking that we haven't talked about that would be worth some discussion.\n\nOther than you're probably aware of all the literature on why people stay in small towns. There isn't much. Or why people stay. There's a lot about why people leave and why people choose, but not much about why people stay. People who come from small communities have more greater likelihood than ... those are all ... we've looked at those data around ... A lot of studies we're doing on rural practice choices in North Carolina. And we've found that ... This year, we tried to look at staying, and there's no data around that. The initial choice is well examined, and the leavers, but no one's looked at the stayers, which is why ... it's not why I'm doing what I'm doing, but it's ...\n\nDuncan Etches: And I think I would love to see a lot more opportunities provided in mental school- Speaker 1: ... every four months. We have residents who do one month rotations, [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3615.0,3608.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/40","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. I'm always getting these phone calls, about a month before they arrive, \"Do you mind if I take a week of my holiday time, during my rotation there,\" to try and minimize this time they have with us. Because the thought of going out to this remote place, it doesn't appeal very much. And then we have them for the month, and they all say, \"Well, this was the best experience that I had in my whole career.\" You know, they'd like to have more of that kind of ...\n\nSpeaker 2: It's the question of getting rid of some of the mythology around small town practice, that I think is ... based upon stories from people who don't know anything about that experience, who've never done it themselves, only hear that rumor and innuendo about ...\n\nSpeaker 1: Well, how they hear about it, is they're working in Emerg, and they get the transfer that's flown in, somebody else who hadn't diagnosed that a brain tumor was a masto cytoma, and not a glioma. And they're kind of put down on the receiving people, our biases and-\n\nSpeaker 2: But it's also going on in their own field. There are people who, in family medicine, who are not countering residents concerns about ... kind of quality of practice, and the quality of life, satisfaction, all those kinds of things, that don't have any real ... stories of their own, or they aren't able to talk about people who live very satisfying, fulfilled, successful lives, whatever term you want to use, in small communities, in rural places.\n\nWhat you hear are, you hear ... the way I'd say it is it's like the admission that comes in from Hazelton that the only people [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3608.0,3743.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/41","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] is the quality of the person, based on the one that gets to the tertiary care center, then you make an assumption about that person's practice on that, then ... wow. That's a completely distorted view. And we're doing the same thing in Family Medicine. There's a lot of people who have retired into teaching, or burned out and gone into teaching.\n\nThere's a dynamic, at least in the States, going on where students are saying, \"I want personal life, I want all this kind of ...\" and no one's there to counter it and say, \"You can have all those things, and you don't have to be ... you know, 120 hour a week worker, and all this kind ...\" that there are satisfactions beyond a good income, and the ability to have some privacy, that are much more satisfying and much richer, and are, in some ways, at the heart of why I hope you want to do medicine in the first place, [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3743.0,3805.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/42","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] students. No one is there to counter that, at least in our case.\n\nSo, what we hear are the stories of how tough it is, how financially difficult it is, this that and the other thing. But, in fact, most people that go into rural practices are quite happy and satisfied. But it's those people that tell you stories is the ones that left it, and unless we get people out as residents to see and experience, as you said, the life and how much fun it can be, they're not ever going to know.\n\nSpeaker 1: So, tell me a little bit about, like, you probably read [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3805.0,3846.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/43","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]'s book?\n\nSpeaker 2: Oh, yeah.\n\nSpeaker 1: And he couldn't take the ambiguities, the-\n\nSpeaker 2: Right.\n\nSpeaker 1: ... the bubble pressures, and ...\n\nSpeaker 2: I'm afraid that's unfortunately become ... kind of a \"I told you so,\" book for a lot of medical students.\n\nSpeaker 1: Mm-hmm.\n\nSpeaker 2: And it gets them enormously, as a contribution to the literature. Primarily because he was a young ... think of you, or I'd say, probably me three years, four years out into practice. A certain amount of angst, and then looking at experiences and it's confirmed everybody's idea that what goes on out there is a brutal, emotionally trying, discouraging experience, that you have go do penance in a big city and work in a clinic for the homeless, in order to be able to ... it's a very Catholic work.\n\nI know a lot about him, and about what he's doing, and ... it's very interesting. It's a kind of expiation of guilt and sin that's very ... I've been very angry at that whole process for a long time, I should probably go talk to him, but I have no interest to. Really, not ... matter of fact, what I'm trying to say is, it's a story about a young person who had not prepared himself, either emotionally, psychologically, or intellectually, to work in a community where ... and if you can't understand that I make mistakes every day, or the whole idea of putting your life 100% in [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3846.0,3952.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/44","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] and saying, what I found, from my patients, what's happened is, I mean, this is not in a community where they know me all that well, at first.\n\nThere's a sense of, you know, you tried the best you could, and it's that kind of ... we're spending a lot of our time, I think, forgiving patients, I've found. My role isn't ... people coming in saying, \"I got too tired, I got a cold.\" Or, \"I didn't wear a warm sweater and I got wet, and I got a cold,\" or, you know, \"I got cancer because of things I did.\" And so on, and \"I'm fat because I don't have any self control,\" and all this stuff. My job, more and more, is feeling comfortable saying, \"It's okay. Try again.\" And it's the same dynamic as I used to have when I was growing up with the [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=3952.0,4008.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/45","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] Saturday, saying, \"You screwed up this week, get out there and try it again.\"\n\nJust kind of, not blaming, but forgiving, and I think there's a certain ... a reciprocity to that that goes on, that I haven't started to recognize until recently, where that's needed. Definitely, patients do that.\n\nSpeaker 1: I appreciated his honesty, about his angst.\n\nSpeaker 2: Mm-hmm.\n\nSpeaker 1: But he ended up leaving [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=4008.0,4037.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/46","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"], but I would suspect probably thought he was a good doctor.\n\nSpeaker 2: Right.\n\nSpeaker 1: And leaving them without a physician.\n\nSpeaker 2: Right.\n\nSpeaker 1: That they liked.\n\nSpeaker 2: Right. Because of his issues, not theirs.\n\nSpeaker 1: Mm-hmm.\n\nSpeaker 2: Which is okay, I mean, but I think it's ... I don't like people laying it off on the public, and it's really saying he couldn't handle it. So ...\n\nSpeaker 1: So you're in Chapel Hill?\n\nSpeaker 2: Mm-hmm.\n\nSpeaker 1: Which is a moderate, sort of 20,000 people?\n\nSpeaker 2: 35,000.\n\nSpeaker 1: And there's a medical school there?\n\nSpeaker 2: The University of North Carolina.\n\nSpeaker 1: And how long have you been there, now?\n\nSpeaker 2: 10 years. 11 years, now. It's been a long time. I don't practice full-time, I only practice part-time. And so I have a different experience than you, certainly. But I probably ...\n\nSpeaker 1: I guess, I can easily have honest responses, you know. I didn't know him really well, but I certainly knew him, but ... only 45 years old. [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=4037.0,4117.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/47","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] I heard through the grapevine that he's going to be coming in. Our ambulance is [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=4117.0,4125.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/48","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"], you couldn't just dispatched to the hospital, there's a central dispatch, several hundred miles away, so the service is not very good, sometimes.\n\nBut I heard this guy is coming, and that he had chest pain. So, I actually went down to Emergency, to meet him. And here's this guy, rolling with agony, with this pain. I couldn't figure out what was going on, because he was so restless, [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=4125.0,4156.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/49","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. Moved him straight to ICU, and he proceeded to arrest just as we got him in the door. Intubated him, [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=4156.0,4165.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/50","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"], but we couldn't resuscitate him, and it looks like he had a massive MI, and [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=4165.0,4173.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/51","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] pulmonary edema. Kind of hard to blow up. So ...\n\nAnd then, my age, everybody liked him, and I knew his wife was sitting out there.\n\nSpeaker 2: Oh, yeah.\n\nSpeaker 1: Going out was hard, because you're upset, too. And so, you know ... your voice isn't great, and you're ...\n\nSpeaker 2: Mm-hmm.\n\nSpeaker 1: It's natural. Not blaming anything, but ... be upset, and ... and you go home and ... tell your wife, \"I had a terrible experience.\" But, I think I knew that patient quite as well. I don't think it was a big difference. So I don't think that's ... people can get bad news, and then they want to kill the messenger. That's maybe harder when you have some bad thing to tell them, like that they've got some cancer or other, it's bad news for them. Then they turn on you and get angry for you having told them that. And suddenly, you're bad care, or something. That maybe gets to me a little more.\n\nBut again, I've found the best thing to do with that is ... and this happens a lot easier in a small town, you realize that when people are angry with you, that's it's partly their problem, and this is your patient, and you don't respond in kind with more anger, if you don't distance yourself from the person, don't avoid the person, and just keep going, you'll run into them in the store. But those things pass, and people who've been very angry with you do get over it, and you can actually end up with a stronger relationship if you can keep slogging through the hard things.\n\nSpeaker 2: That probably characterizes any relationship.\n\nSpeaker 1: Mm-hmm.\n\nSpeaker 2: So, [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=4173.0,4327.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813/transcript/81251/annotation/52","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] and harder, in a small town.\n\nSpeaker 1: And they need to thank you, so you need to avoid any mistakes.\n\nSpeaker 2: You could live 10 miles away.\n\nSpeaker 1: Mm-hmm. So you're part-time-","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277813#t=4327.0,3917.936"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277812","type":"Canvas","label":{"en":["Media File 2 of 2 - Etches_Duncan_1990.05.14_-_Side_2.mp3"]},"duration":897.944,"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/3180/collection_resources/150635/file/277812/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277812/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/277/812/original/Etches_Duncan_1990.05.14_-_Side_2.mp3?1750274704","type":"Audio","format":"audio/mpeg","duration":897.944,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3180/collection_resources/150635/file/277812","metadata":[]}]}],"annotations":[]}]}