{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/v40js9kf0v/manifest","type":"Manifest","label":{"en":["Dr. Ian McWhinney (1992)"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Date"]},"value":{"en":["1992-02-12 (created)"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. John Frey (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Society of Teachers of Family Medicine","family medicine","family physician","Dr. Ian McWhinney"]}},{"label":{"en":["Subject"]},"value":{"en":["Dr. Ian McWhinney (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}},{"label":{"en":["Description"]},"value":{"en":["\u003cp\u003eThis interview is a continuation of the interview conducted by John Frey on May 23, 1991. \u003c/p\u003e (general)"]}},{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}}],"summary":{"en":["\u003cp\u003eThis interview is a continuation of the interview conducted by John Frey on May 23, 1991.\u0026nbsp;\u003c/p\u003e"]},"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278298","type":"Canvas","label":{"en":["Media File 1 of 2 - McWhinney_Ian_1992.02.12_-_Side_1.mp3"]},"duration":2791.56238,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278298/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278298/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/278/298/original/McWhinney_Ian_1992.02.12_-_Side_1.mp3?1750858530","type":"Audio","format":"audio/mpeg","duration":2791.56238,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278298","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278298/transcript/81396","type":"AnnotationPage","label":{"en":["Dr. Ian McWhinney interview transcript 2 [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278298/transcript/81396/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview by John Frey of Ian McWhinney\n\nFebruary 12, 1992\n\nQ. - John Frey\n\nA. - Ian McWhinney\n\n_________________________________\n\nQ.  So if we could go back and, you had told me about your (?) making that decision and its effect on your family and your father in leaving that practice. Could you reflect some on what your initial reactions were in joining academic family practice in North America, and some of the areas that you feel were important to think about during that period?\n\nA.  First of all, it was exciting, because there were new ideas being formulated and (?) of change, and in London, Ontario, itself at the University and the medical community, and there was a group of people who were thinking very hard about these things, and there was also a strong core of general practitioners, committed general practitioners in London at that time who were very much committed to education and becoming involved in (?) presentation and it's interesting that they, that group remained together right up to the present day, oh, some 25 years ago, and they're still, many of them are still there, members of the Department both full-time and part-time but most of them in their own practices which are part-time, (?) members of the department and I think that group is very important. And then within the medical school there were also people who were very I think progressive in their ideas in this regard, for example (?), who would be head of the Department of Epidemiology, who was one of the leading figures in getting the chair of Family Medicine established, and that was quite a struggle. I don't know whether I mentioned it before, that (?) they never anticipated that it be a full chair, of course there was opposition to that, you know, (?) this was the first one in Canada, and they complained to the leadership of the (?), and that, you know, (?) so they were (?) their point, and I don't think that was important for the (?) be used, Division of Family Medicine as it was then, that was another supporting figure was the Dean at that time, (?), who during his deanship was very innovative in this regard and very supportive of family medicine. \n\nQ.  So all that work had been done prior to your actually coming to--\n\nA.  Yes, right, and so I landed, you know, in a very supportive climate. Having said that, the – it soon became pretty clear that a lot of the faculty of the medical school, not surprisingly, didn't really understand what we were driving at, you know, the--it was, (?) misunderstanding about what family medicine was, and what our objectives in (?) medical school were. You know, there was the common misconception which (?) to be a general practitioner you need to have a taste of all the special areas of medicine, and somehow that adds up to a general practitioner, and getting the point across (?) was (?) difficult, although I think was much greater than now than it was then.\n\nQ.  But that was quite a difference from your experience in general practice in Britain.\n\nA.  Oh, no, I think the same problem existed there. A lack of under-standing by the medical school (?).\n\nQ.  I don't know if that's reassuring, or--\n\nA.  The main difference was, though, that postgraduate training, residency training, in Canada is entirely under medical schools’ control and supervision, and in Britain it was entirely, largely outside the (?) colleges. And so that, that it was the concern of the medical school. So Canada is a somewhat unique in, is really unique in that regard, but it's also different from the States, I think, in that there are many freestanding residencies that they've gone to a hospital--\n\nQ.  Yes, 80 percent, actually.\n\nA.  That's virtually nonexistent in Canada. All the residency training is really under the (?) medical school. So anyway, that's a little bit of a digression. The (?) was (?) in those early years, I think the principles on which we operated were laid down very early and they really haven't changed very much. And I suppose the two basic ones were that the, that family medicine can really only be learned in family practice, that one learns many other useful things by working in other settings and other departments, but the core experience had to be learned in family practice setting. And it was based on the general educational principles that if you want to learn swim-ming, you go to a swimming pool, and if you went skiing you went to a (?). It was a very simple one, but it, but again, that was a very difficult thing for people to grasp. So the first teaching unit was actually in one of the teach-ing hospitals, and again we were very fortunate in having a lot of cooperation from the two teaching hospitals which were then in existence in London (?). And one of them was particularly advanced (?) thinking and encouraged us a lot and made the combination available in the hospital, but we very soon came to a unanimous conclusion, those of us who formed the small group in the depart-ment, and (?) five people (?) at that time, but a hospital was not the place to run a family practice from. They (?) confused with outpatients. And it was very difficult for both the hospital people and/or patients to – the concept-tual is the same between the role of an outpatient department and the role of a family practice, and that again was one of the most difficult conceptual barriers to get across, to make it clear to people that the role of a family practice is different from the role of an outpatient department, the role of an emergency department. And fairly early on, for example, when emergency medicine was coming on as an academic subject in its own right, there were proposals that we link up with them, you know, that emergency medicine come under family medicine and--\n\nQ.  I didn't know that.\n\nA.  Yeah, in our medical school.\n\nQ.  And that's the case I think in one or two schools in the States, but not most.\n\nA.  Yes. But we again, (?) the point, here this is presented to us by the administration as a, in the medical, it's a very natural alliance, one very advantageous for us, but we had to try and explain, you know, that the two (?) were different.\n\nQ.  In some cases they're antithetical, almost.\n\nA.  Yes, yeah, and so – but anyway based on that experience we very early decided to call (?) with the outside hospitals, and then we could then discuss two, the first hospital we were associated with to go with this and they, they accepted this and they built us a new medical center, or rather it was already built but they converted it for us, and within a few blocks of the hospital. And that became our first teaching medical center. And the other fortunate thing is that in those days, the 1960s, money was not very tight, so it wasn't difficult to get the Interior Ministry of Health approval for it, and again the Ontario Ministry of Health at that time was very supportive. So that was followed very (?) by another center in association with the other teaching hospital. And then a third one, which was a rural center, about 50(15?) miles out of town, which was financed by the Ministry of Health with a community board, and finally a fourth one associated with the second teaching hospital, which was in a suburban area about five miles from the hospital. So these four centers became the main teaching centers, they're all grouped right (?) team. And each center has several full-time members of the department of each, full-time membership from over(?) a practice, and (?).\n\nQ.  Was it a model that you and your colleagues developed? Or was it something that was pretty prevalent in Canada as--\n\nA.  No, no, it was I think it was quite exceptional for Canada and (?) developed right in those very early days in which (?) to, and most of the Canadian (?) at that time were being based at hospitals.\n\nQ.  So that was unusual.\n\nA.  It was the exception, really.\n\nQ.  Which then became rule over the next 15 years, I suppose.\n\nA.  Well, it's moving that way, but of course once you're established inside a hospital and that's the way the funds are flowing, and once money gets tight, I mean (?) for change (?), so I think there is, I think there's much more acceptance of that idea that it can be (?), should be considered a (?).  \n\nQ.  So you said that of the two principles that really guided you, the first one was this idea of family practice having to be learned in a family practice setting.\n\nA.  Right. And the links with the hospitals are maintained, I mean the--\n\nQ.  Sure.\n\nA.  And (?) hospital staff, but then (?). The second one was that family practice should be taught by family physicians. You know, that the, they had, the resident training had a lot to learn from others, but very useful thing (?), but that the actual practice of family medicine had (?) people who had experienced it themselves. And again, that was another, it was a major (?) I think interestingly enough they'd reached a point made by Dave Mackenzie in his book (?) Medical Education, remember it?\n\nQ.  No, I don't, but--\n\nA.  He made exactly that point, that the general practitioners were being taught and trained by people who had never experienced general practice (back in the early days). So it was just a continuation of that principle. But again, that was difficult very often for people to understand what we were driving at.\n\nQ.  But once you had accomplished, at least gotten people to grudgingly accept perhaps, those two ideas, then the training was able to get under way and move ahead in the way you thought.\n\nA.  Yes. And then the other thing I should mention is that we began to build up a network of teaching practices. These were private practices from different (?) right through the province, stretching from London right up to northern Ontario, you know, it's like a thousand miles. So--\n\nQ.  Amazing.\n\nA.  So that our, our students from the undergraduate program would, you know, be able to have (?) culture in family medicine in one of these prac-tices. And also (residencies?) some of them are used for educating as well, and are now still being used for that. And then, and also the program of family development to help the (?) develop their teaching. So (?) their workshop.\n\nQ.  My impression is that, and this is maybe an impression, that most – student education but also residency education in Canada has more flexibility about the nature of the training than it seems to have down here. Is that your perception?\n\nA.  Yeah, well, I don't know a lot about the accreditation system in the States. But the, in Canada the College is the accrediting body.\n\nQ.  I see. But that's different for us, it's a composite board of a third, I think, Academy members, a third, people from academy family medicine and a third from non-family medicine fields, so that in a sense we don't control our own destiny completely.\n\nA.  The College (?) has criteria and guidelines, but I think you're right, (?) flexibility. Yeah, an example of the criteria are the – of the two years (?) core training (?), and eight months of that has to be in a family practice setting. So that's (?) and (?). (?) example of the guidelines that they. And so that certainly is – although there are rules and criteria, I think (?) flexible.\n\nQ.  What – I mean subsequent to getting things up and running, what were some of the, I want to say crisis but not exactly crisis, but the major issues that came up over the course of developing training and then persisting with that over 20 years?\n\nA.  Well, one major change that we made quite early was that the training program which began as three years college – and the college really decides how long the training program should be, because they decide what the eligibility for certification are, and when they decide that then that really could take what the (?) training program is, they reduced that from three years to two years quite early on. (?)\n\nQ.  Really.\n\nA.  And I think that was a mistake, because once you've reduced it it's very difficult to get it (?) again. And so our core training is now half, just short of the minimum residency program of the Royal College (?) of the (?) organization (?). So family medicine would be half, or less than half of the training of any of the other (?).\n\nQ.  Has that had an effect on, in some way, on the field?\n\nA.  Oh, I think it has, and of course I'm inserting my own personal opinion, I don't know how many people would agree with me, but well, first – the first effect is that I think there can be mixed reasons for somebody to enter family medicine training. (???) Because it can (?) the quickest route to a certification and an income. So there are certainly material advantages to going into family medicine quite apart from the (?) vocation. So it's, you know, within two years you can be certified and be in practice early and get a good income. So where it would be, the shortest basic training would be four years (?), that's the first I think practical, and I would say that (?). I have no idea what the sign of that particular (?) is. Then the second is that I think the, the sort of hidden message there is that, what it symbolizes is, and the message that's sent out is that you know (?), (?) become a family physician. You know, you're in the league. You need four years' training to be a dermatologist, but you only need two years to be a family physician. And to me, that's the wrong message. I don't think that's a very good reason to increase the training, and my own kind of suggestion is that we stop thinking in terms of sharp dividing lines between (?) training, and when you're, how long it takes to mature (?) but we would need a two-year full-time residency and the participation of the States (???) go into practice and (?).\n\nQ.  Well, actually, a lot of the boards of this country, which I have only thought about recently is something that's beneficial, require a certain period of time of practice before you could actually become board-certified.\n\nA.  Yes, yes.\n\nQ.  So what it reinforces, I think, is your idea that learning is not something that is wrapped up in two years or three years or four years and then something that takes a certain additional period of time, whatever that might be. And I think if I were doing boards down here, that's what I'd try and arrange, because you know, it says that being a family doctor is something you learned in stages, and one of the stages is application of what you've been taught in residency, for example. But--\n\nA.  Yes. And I think, I think the College (?) is thinking along these lines.\n\nQ.  Oh, really?\n\nA.  --since they change (?). One problem is that is facing the College at the moment is that the licensing body in Canada which (?) provincial college (?) surgeons at (?) have got together and they said that very soon, I think 1994, two years postgraduate training would be required for a license. And you know if you get a license people will have to take those certify-cations and the licensing body's exam sometime during the second year of training. But if the training (?) two exams in the second year of training, that's (?). And so it certainly is going to increase the numbers in training in family medicine has already done so, and those who don't want to take either special (?), there will be (?) in two-year program.  \n\nQ.  But that probably won't be too many people, do you think?\n\nA.  Probably not. But one result (?), which I think is a greater problem, is that (?) I think they experienced in Quebec first, was the first (?) change, they got a very, a lot of very hostile (?) that they (?). There was (?????). And so instead of (?) the early years, people in the residency in family medicine were the people that really wanted to do it, you know, people at the very beginning, you know, quite a courageous thing to do with no obvious future. So they were a very committed people. And what I think we're facing now is (?) lot of people (?).\n\nQ.  Well, something that, we should be, I mean there's a great deal of curiosity about what's happening in Canada from all quarters down here, and one of the things that someone said was how are we going to create, you know, a core of generalists to be able to take care of all the people that need the care in a national health system if we were to have a national health system? And he said that perhaps we have to retool, you know, 100,000 specialists to become generalists. And I dread that, because there's nothing worse than someone who is doing something because they have to rather than because they chose it, so we should probably listen to what's going on with that more carefully.\n\nA. But that may be the effect of (?) 25 years (?) there is a very good supply of family physicians in Canada, right across the country (?). (?) family practice and (?). But (?) they're a young group so that they, the (?) future they will not be difficult to keep the number up. The biggest shortages are likely to be, rather than family medicine, general surgeons, like (?) group at the moment, so that's where the manpower (?).  \n\nQ.  That's an interesting switch. Well, what--\n\nA.  Just to get back to the (?) our problem and family development, and the, I suppose the problem which has become a major one, I just (?), the, everybody (?) continuing (?), so it's been much more difficult to get money for development.\n\nQ.  It's interesting what you said about money in the '60s being more available (?).\n\nA.  Yes.\n\nQ.  That certainly did have an influence on the rapid development all across the, North America. You know, you look at the rate of new programs, it was exponential, and hasn't been a thing happened since the mid-'70s, anyway.\n\nA.  Yes. The other problem which goes back quite a long way was that it was much more difficult to get money to provide career positions for research faculty. And that's more of a struggle. But we did eventually succeed in building up a research team, and it took a number of years to get that kind of career money, and to build up a research team based on this, but that's one of the things which really has come to fruition in the last few years when the money for that has become more available.\n\nQ.  Is that part of the development of the Center for Studies in Family Medicine?\n\nA.  Yes, that's right. (?) the Center for Studies in Family Medicine. But it's been about a ten-year task, really, to create that. (?) good deal of (?). But the developing, (?) center was sort of developed on the basis of the first group, you know, the first group in the department.\n\nQ.  And also the persistence of people in the department over time certainly gained some credibility as well as productivity.\n\nA.  That's (?), yes. We had, right from those very early days, you know, Martin (?) and Morris (?) really joined the department many years ago, you know, they joined a very (?) research member and they showed a (?) commitment in their philanthropy and (?) beyond that (?) difficult for them, really, led to what we have now.\n\nQ.  Well, what things are, still need to be done?\n\nA.  Well, the other thing I should mention which dates (to those early days) was our graduate studies program, getting the master's degree.\n\nQ.  Oh, right, that was the, that was probably, well, it was certainly the first, but it may be the only one that I'm aware of.\n\nA.  I think there are quite a number now.\n\nQ.  Master's in family medicine?\n\nA.  Oh, I don't know about, but graduate training programs, and I'm sure some of them would lead to a degree. But again, that started (?) in 1970s, and that wasn't, there was never a problem (?) financial, going through the (?), (???).\n\nQ.  Why did you think that was important, to have that degree?\n\nA.  I think it – for a number of reasons. First of all, it was a tremendous impetus to the faculty, (?) again, one of the (?) was that the courses should be taught by family medicine (?), that it shouldn't be a program whereby people went to one of the departments for this, another department for that, you know, and do research (?) epidemiology, (?) some other subject (?) psychology, so that all the courses were taught by our own faculty. So this was a tremendous challenge for us, to be able to develop these courses and to explore the knowledge area.  And--\n\nQ.  I think that's what's unique about the program, and my recollection is that I don't think that any other degree program has that characteristic.\n\nA.  Yeah, well, it may be.\n\nQ.  'Cause the rest of them are all MPHs and joint programs with a variety of other departments.\n\nA.  For example, you know, there is a course in (?), and (?) faculty, and of course the important thing about this is that the, it means that the contact is family medicine, that the examples are from family medicine, the--the whole, I think the methods may be, you know, have a lot in common with the other (?) the actual contact is a family medicine contact.  So that was wonderful to (?), a lot of the faculty took the program themselves, and (?) there was great course in faculty development for both full-time and part-time people, and the (?) that it brought people to the department as graduate students from many different backgrounds.  You know, a lot of them were people who had been out in practice for 5, 10 years, a lot of experience and from many different backgrounds in many different countries.  So they were the, you know, (???).  And I think that's one of the, one of our problems now is that you cannot go around having (?), and no additional money coming in, and (???) minimum.\n\nQ.  I used to think that was only our problem in family medicine, but I think that the training programs and fellowships in all of the fields are almost exclusively run on grants and whether it's NIH or foundation grants, and so that's--without any support, and this question comes up of how are you going to support this beyond the time of the grant?  I mean, essentially everyone would have to say we can't.  Not just family medicine, but I know the internists, the pediatricians and others here are really having difficulty because their grants, their training grants also (?) the fellowships.\n\nA.  Well, our program continues because it's (?) department.  (??) we can't, (????)\n\nQ.  Well, are there other things in respect to looking at the department over this period of time that are important to you, to have felt that you accomplished?\n\nA.  I think probably (?) and of course it can, I (?) chairman 5 years ago, you know it's all gone on.  (??) and--\n\nQ.  That's a tribute more than anything I know of a particular vision, that something continues beyond your time, that it means that it was something that people really believe in generally rather than just a particular idea of some, one person.\n\nA.  Yeah, and I think the, that's very important in our department but it has been very much the consensus that (?) values of the department has been a, very much a consensus.  That doesn't mean to say that some people (?) than others, but (?) variation.  There was a (?) I think goes before (?).  The other thing that I didn't, maybe I mentioned this last time, is our interest in the actual clinical medicine, you know, family practice and trying to conceptualize a clinical members.\n\nQ.  No, I don't think we talked about this.\n\nA.  Which I think started with the actual (?) process and it's a fact I think that family practice (?) the idea that the (?) in trying to conceptualize this and to formulate it in a way that (?) teaching.  And that I think is where major progress (????????????????????) Rockford.  You met Joe?\n\nQ.  No, I don't know him at all.\n\nA.  I haven't, he was the (?) at that time.  And he spent several months with us (????).  And we brought together a group (?) to develop some ideas.\n\nQ.  I think you sent me, in the reprints that you sent me, I think there was, I know there was an article about the patient centers.\n\nA.  Well, there was a whole series of articles which came out first in (?).  That goes (???) Rockford.  \n\nQ.  I would like to.  I have some names of people that I want to look up when I go to, to meetings and try and find to talk with.  That's how I guess over the years that I've learned best which is to get suggestions from people I respect and try and (?) in person or in books.  Which actually is a question I wanted to ask you about, which is--where do you get, where do you get your ideas, where do you draw from to pick them up with?  Ideas that interest you.\n\nA.  That's a difficult question to answer.  I suppose there are two, well, three things, one the (??), what is from talking to people, those day-to-day contacts within the department and that really has been a very important source for me.  You know, working with people.  The second is reading, and I've always done a lot of reading, and have done books which I go back to time and time again, and (?) a dialogue between different books (?) one example of (?) that interests me a lot, oh, about 20 years ago, I read one book that (?) general systems theory(?).  And I did pick it up again last week (?) last chapters (?), which related to things that I'm thinking about now, you know, that--and that relate to discussions we had had in the past (?) 20 years ago.  And we're talking about the ideas that they, the Germans (?) called (?), and I've been thinking about them, but then I went (?) pick this book up from those (?) and there it was.  You know, I'd forgotten it was there.  So that kind of interaction between (??).\n\nQ.  It's wonderful, I love that term about, and dialogue between books, because it's, I mean I've found myself doing that and wondering whether I'm kind of in a pinball machine where I bounce back and forth from the things that I am familiar with and occasionally insert a little bit of new things.  And it's a very interesting process, I like the idea of having a dialogue between the--especially over time, because how you remember things and how you read them also changes.  I mean the book, the book is a different book if you read it 20 years later.\n\nA.  And if a book is really, has a lot of depth, then one reading just, you just get so much from it, and of course it relates to one's experience at that time, with what one has experienced among (?) at that time.  Then 5 years later, one has moved on so much and has experienced a lot more, read a lot more, you reread that book and there are things in it that you think, now why didn't I, why didn't I find it before?  And that's a continuing process.\n\nQ.  I don't know if I mentioned this to you, but when (?) late '80s with an English professor, and he--I was frustrated a few years ago because I have this stack of books that I want to read.  I buy them, and I put them there, and I start going through it and it seems like the stack always stays ahead of wherever I am.  And I was expecting frustration about that, and he laughed and said, \"Oh, I don't even worry about that, I haven't worried about that for years.  What I do is I go back over my favorite books and read them again.\"  I thought, I'll never get all these books read, and he said, \"I don't worry about that.\"\n\nA.  And it's a nice thought, really, because however much you read you can always go back and reread (?).\n\nQ.  I'll never run out of books, that's for sure.  Well, what kinds of things are you working on now?  You had mentioned, over the last 5 years you were working in areas of palliative care was one area--\n\nA.  Yes, I just finished that (?) five years as medical director of (?), and that I learned a tremendous lot from getting back into (?) medicine and working (?) and also working with (?), I learned a lot from that experience (??).\n\nQ.  Do you think that you're a different kind of doctor now than you were 25 years ago?\n\nA.  I think I (??????).  I think I have some insights that I didn't then.  I think, I hope I'm a better listener than I was then.  I think, yeah, I would say that, in that sense (?).  I think I'm less, I'm probably, yeah, well, I don't think I'm as up to date as I was then with the latest drugs and (?) technology, and I think (???) I made up my mind that I would (?) was used to, you know, (?) and the work for me and I suppose that's (????).\n\nQ.  Actually, the data show that it probably doesn't make much of a difference, at least that's been.\n\nA.  Yes, interesting that that to me is an example of the difference between the personal aspect of technology, you know, here we have medication which is standardized and (?) technology which is the actual way (?), and one becomes comfortable, you know, by working with a, with the technology one becomes comfortable with the skilled (?), use a new one (??) becoming (?????) want to embark on that and that's a really typical advantage.  For example, I, even though I was out of practice for all those years, I retained my feeling of being quite comfortable using (?), it's something that I've used from my early days of practice, and I guess I never got the same degree of comfort with Haldone.  And--because it was, you know something (?), and you know it was something I hadn't used before.  And it's just a reflection of that (?).  Again, something I've become very interested in.\n\nQ.  Was it (?) you were working with those patients who were at the end of their lives, I mean is that a different kind of experience for you as a clinician than the work you'd done before?\n\nA.  It wasn't different, because as a general practitioner, you know, I'd always done that.  And, but not, nothing (?) concentrate with.  And I, so it wasn't, it wasn't really different except in the numbers.  But I think I developed a lot more understanding and I think I saw in retrospect some of my failings, you know, in the early years in practice, you know, in what (????).\n\nQ.  You had mentioned that, that's why some of the ideas about healing and so on had come from was from this last 5 years of experience, or is that something you--about healing, I guess was--or different ideas of healing.\n\nA.  Yes.\n\nQ.  And again, I think the other thing you mentioned was that the influence of kind of a--spirituality is the word you used, but the sense that that also has a relevance quite important.\n\nA.  That certainly (????) care, particularly I think working with (???) and about the (???????) you know, of having some experiences (?) myself (??).  But you know, (??) along those lines.  Somebody could (??) know where ideas come from.  Why (??)\n\nQ.  There was a man named Reynolds Price who was a wonderful novelist, who's a professor at Duke who's really a remarkable person and he, he said one time people were asking him where his ideas for novels came from and he says he dreams them.  And somebody said, well, really--he said no, I dream them.  I have these dreams.  And then I'd get up and write them and that's where they come from.  So I suppose that's--where things come from is often a mystery.  But why something that has probably laid around for decades suddenly becomes of essential importance in your life is really interesting, too.  Well, do you--what things do you see now about family medicine that would need to be done?\n\nA.  Well, I, the--one of the things that interests me at the moment, I think on the philosophical level, I would think the, I see a need to (???) a new synthesis which we, science, technology and art are better (?????).  And I've, try to break down some of those books by compartment, because I think they're really artificial barriers, there really isn't a hard and fast line between science and art, between the general public and individual knowledge and public knowledge and personal knowledge, and all these sort of (?) by compartments of the, we built up.  And between technology and art, for example, we're letting that (??) our present industrial crisis (?) quantity that technology spends on the (???), on the technology, and so I think we have to decide what (???) of these (??) broken down into both compartments.  And then to decide new ways of thinking and about some of the other (?) compartments of the, we've made for ourselves.  But my department, for example, like (?????) and packs some values.  And that's, I see a major transformation in our whole world view. And I (?) back to the medicine, I think of family medicine as really a (????), many of our colleagues in other disciplines.  Family medicine (???).\n\nQ.  Well, what clearly is happening is that people start to understand the less defensive specialists start to realize is that their major limits are that they have these water-tight compartments, as you say, and that our job is to integrate things.  And if they see us as anything, if they see us as trying to bring a variety of different health problems together and just to begin with, but certainly you can extend that to a lot more--\n\nA.  But it's a very difficult process, it really is (??) world, and not (???) myself at my age, I think (?) generations will be to develop these different world views and not just in medicine (???).  You know, I think there are some aerodynamic examples of what our present world view has (????), and one of them is (???) the whole range of conditions in which the (?) is the main problem, and one would be chronic pain, another would be chronic fatigue or (??) disease, and (??) complete rigidity (??) blocked by our (?istic) way of thinking.  We're often unable to help people, because (???).  What is the cause, the cause that we don't forget (??), something in the organism that's triggered by (??) and that type of very (?), system.  That thinking, means that we can't help thousands and thousands of people with, who have illnesses and in fact we often (??) rejected by the system (??).\n\nQ.  In many cases I think those are the people that flock to (??) because they're seeking someone who will not somehow dismiss or at least regard their illness as mysterious and unknowable.  The other thing that I remembered that I have experience in my life was when I was in the Southwest in many, a Navajo (??) and I said, I asked him what he taught at the community college, and he said he taught culture.  And I said, do you teach herbal medicine or--and he said no, I teach culture.  And went into this explanation of how people are ill because they are somehow out of line or out of sync with their culture.  I just--the language he was using I couldn't even, I couldn't even fathom, but I think that's an example of the kind of thing you're speaking of. \n\nA.  Yes, and again language is a very important aspect.  The terms that we use are often (neolithic?) terms, and what we need to do I think is start using terms which are not (?), which raise different kinds of questions in the (???).  One example it seems to me would be to, a word like (function).  If I talked about function, then it's a term that transcends all that (????) mind and body.  (?) talk about can somebody do their shopping, and then they walk out, (?), get to the doctor, get to the shop (??), and they (???).  Everything can (?) so their function isn't (??) realistic meaning for--and I think we can develop, start using terms like that and asking different kinds of questions.  One of the things I've read recently is a book by Elizabeth Manger(?), the American (??), who said that what we need are not new answers to the old questions, but new questions.  We, you know, we need to (?) ask some of the old questions, because they're not that answerable in our own framework.  So that's one of the things (??).  Another thing is, I've been interested in home care, that's my kind of research (?) role of home care and who's working in home care.\n\nQ.  (?) from the point of a local hospice, and had been doing, unfortunately because it's been a terrible month, I've had three patients of mine, and one of them is, one of my oldest friends from Chapel Hill here, who just died yesterday, and he--but we've, I've been spending a lot of time in homes, and it just feels to me so much better to be doing that in some way or the other, and I can't describe why, but it's all of the relationships which seem to make me uncomfortable in the office or uncomfortable in the hospital are changed to the point where I'm much more comfortable and I see my role much more clearly, for some reason, when I'm in the home.  And it's also, it's a welcoming experience, whereas most of what goes on these days seem to be confrontative more than anything else.  \n\nA.  Yes.  It also, I think there's a great symbolic significance in going to somebody's home.  One is that I think that it's got a change in the power structure, that the (?) power in the doctor's position (?) any way, accentuated in the hospital and in the office.  Somehow the, when you go to a patient's home there's a kind of (?) of some of that power.\n\nQ. Well, it's certainly, the language comes into play again, because I remembered in Wales it was called making a visit.  You know, as opposed to a house call or a--the visit was a more wonderful term to me than some--it's not medicalized, you know, it's like friends visit friends, and the nature of the relationship is to find (??).\n\nQ.  Did you get to Wales (?).\n\nA.  I did, and it was--it was many, Julian is having a kind of slow withdrawal, he's officially officially done in March.  He retired about 18 months ago and has been working for MRC(?) I guess as a research assistant or something, and then officially retires in March.  And he's very good, I mean he's working very hard and I think (??) he is an eternal optimist, which is wonderful, because it's been a long 12 years.  It was 12 years ago this month that I moved to Chapel Hill, that I left Wales and came here, and that was when Thatcher had just gotten in.  So Julian has remained optimistic through all of those terrible years, and now he's working with Labor government to come up with a, I guess a Labor policy about (??) government, so he's very excited about that.  So I think he's, you know, his interest in the system keeps him going, but he's also now computerized all the records from 25 years in the village, so he's got at least some basic data sets and he's going to start playing with that.  But it was nice.\n\nA.  How old is he?\n\nQ.  He's 66.  So he's really good.  My son is over in London this term, so he (?) village to see his friends.\n\nA.  Is he studying over there?\n\nQ.  Yes, he's doing a semester abroad and learning literature and theater and other such things.  Having a wonderful time, of course.  Well, listen, this has been very helpful, and I really think--are there other things that you had thought about since our last conversation that would be worth talking about?\n\nA.  I don't think so, no.  (??)\n\nQ.  Well, I really appreciate it, it's a wonderful experience for me, it certainly is.  Peter gave me a copy of your, I haven't had a chance to read it, but a copy of the (??) the Annals or something?  I forgot where the article's going to be published that you'd just written.\n\nA.  Oh, well, I sent one to the Annals.  Is he one of the reviewers?\n\nQ.  Whoops--well!\n\nA.  Great.\n\nQ.  I thought somehow he had gotten that when he had seen you or something.\n\nA.  No.  Oh, I'm delighted if he was.\n\nQ.  Oh, he really liked it, and I just got it and he said you should read it.  \n\n[interview ends]","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278298#t=0.0,2791.56238"}]}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278297","type":"Canvas","label":{"en":["Media File 2 of 2 - McWhinney_Ian_1992.02.12_-_Side_2.mp3"]},"duration":1435.08744,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278297/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278297/content/2/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/278/297/original/McWhinney_Ian_1992.02.12_-_Side_2.mp3?1750858529","type":"Audio","format":"audio/mpeg","duration":1435.08744,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/3629/collection_resources/150912/file/278297","metadata":[]}]}],"annotations":[]}]}