{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/v69862dg7p/manifest","type":"Manifest","label":{"en":["Dr. Jim Mold"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer: The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2020-06-21 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["oral history"]}},{"label":{"en":["Agent"]},"value":{"en":["Dr. Becky Purkaple (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["video file"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family physician","American Academy of Family Physicians"]}},{"label":{"en":["Subject"]},"value":{"en":["Jim Mold, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["english (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162459/file/295889","type":"Canvas","label":{"en":["Media File 1 of 1 - MOLD_JIM_(6-21-20).m4a"]},"duration":5063.45941,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/public/images/audio-default.png","type":"Image","format":"image/png"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162459/file/295889/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162459/file/295889/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/295/889/original/MOLD_JIM_%286-21-20%29.m4a?1761150956","type":"Audio","format":"audio/mp3","duration":5063.45941,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162459/file/295889","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162459/file/295889/transcript/85524","type":"AnnotationPage","label":{"en":["Dr. Mold interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162459/file/295889/transcript/85524/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Center for the History of Family Medicine\n\nInterview of Jim Mold, MD by Becky Purkaple, MD\n\n\nBP: My name is Becky Purkaple and I am family physician in Springfield, Oregon. And who am I talking with today?\n\nJM: I am Jim Mold. I am a retired physician and Emeritus professor from the University of Oklahoma. I live in Chapel Hill in North Carolina now since retirement. Now I am a consultant. I consult with the University of Oklahoma and University of North Carolina.\n\nBP: Very wonderful. So first, tell me what made you decide to go to medical school and pursue medicine.\n\nJM: That is an interesting story. Really at that time I think a lot of us really didn’t know—we didn’t think really think about what we were going to do when we grew up. We just assumed we would go to college and maybe, in my case, I figured I would probably go to graduated school but I didn’t really think that much about a career until I had to. What forced me to think about it was that the Vietnam War was happening at that time. There were about to have a lottery and pick numbers for people who previously had been deferred because they were in college but at that point were going to have to be enlisted, I guess, based on our number. I don’t remember the details but it was a frightening time. Plus, I was going to have to make a decision about where I was going to apply to graduate school and I basically had a decision between Field and Stream Biology and medical school. I like being outdoors and I would not have minded spending my entire career counting salamanders and trying to improve the environment, but it was a difficult decision, and I was getting some pressure from my mother to be a doctor. Plus, the friends that I had who were most like me were all going to be doctors. I knew nothing about being a doctor. Nobody in my family was a doctor. I had never been sick. No one in my family had been very sick. I had no experience in the hospital or in any medical environment, but I decided to apply to medical school. It was a safe choice. It was something I thought I could do that would challenge me, and so that is why I did it. When they interviewed me for medical school and asked me why, I said, “I don’t really know. I like biology a lot and I figure there is a lot known about the human body, and I would like to know more about that.” And so, they wait listed me (laughs). \n\nBP: what was medical school like\n\nJM: Well, I did like biology so I took a lot of biology courses in college so I had already had genetics and biochemistry and vertebrate anatomy so I was well prepared for medical school. In fact, they didn’t make me take the genetics course; I just had to do a paper for that and so I cruised through the first year of medical school. I went to Duke Medical school, and Duke has and still has a very innovative curriculum. They had had so many complaints from students and faculty that the basic sciences were too esoteric and too tedious and not interesting to the student and not relevant to the practice of medicine. They told –just like every medical school does –they told their basic scientists that you have to cut it down to core material. And the basic scientists couldn’t do it. And so, they said ok, you have one year instead of two. You have to teach your whole—what you have been teaching in two years now you only have 1 year. We are going to force you to cut it down. So, I had finished my core basic scientists in the first year, and the second year was core clinical rotations. The third year was elective basic sciences, so I could go back and take more anatomy if I was going to be surgeon or do research if I thought I wanted to be a researcher. I had a lot of options. And the fourth year was elective clinical. I think it is a good way to do it. I don’t know if any other schools do it that way. It had a big influence on my life. Incidently, I got into Duke because I was in-state. I was from Durham, NC. And even though Duke is a private medical school, they do get state money and so they have to take a certain number of kids from in-state so that is how I got in. It wasn’t because of my interview that’s for sure (laughs). So, after after my second year, because I went straight through my first and second year I had accumulated time, so I was 6mo ahead because we got 3mo off each summer. So,  I decided, and I can’t remember how I decided to do this. Maybe at the encouragement of my mother (who also lived in Durham) to do something wild and crazy. So, I arranged to go to work with some general practitioners in Idaho and Wyoming,3 months each. And each of these doctors was a solo practitioner, the only doctor in their county and they did everything. You know, they were doing general surgery really and certainly they did a lot of OB, all the hospital work. They were small towns so everybody knew everybody else and a lot of them were related so when someone came into the office, they already knew that they were coming as they heard rumors and knew why they were there and knew all the family members and what the family members had had wrong with them in the past. The one doctor, they were both from that town originally or from nearby so they just knew so much about the people. And I was treated like a king. Everybody greeted me on the street and called me “Doc” and “How are things going today, Doc?” And so forth and so on. And I was given a lot of responsibility much more than I should have been. But anyway, I liked it. And the contrast between how people were cared for in those communities versus what I saw in the medical center was stark. We were still talking about the gallbladder in room 210 and it was very impersonal, highly scientific, but not humane treatment or care. And because I had those experience it was very—the contrast was sharp. I also worked with some, I guess they were general practitioners at that time after my third year. So, I had several experiences with general practitioners. My third year I did half of third year I did—was research in Immunology. I enjoyed that, and then I took some electives. I can’t remember which electives I took in basic science. So, at that point, I knew I wasn’t going to be a surgeon although I liked procedures. When I decided to become a family physician, I wanted to pick a residency that would teach me how to do procedures. I think that is probably true across all the years. I think when people who become family physicians, a lot of—when you come out of medical school you are attracted to procedures for some reason. A lot of the better family medicine programs specifically beefed up their procedures training just so they could attract the best students. So, in medical school then, I wanted to be a family physician. I had heard that the specialty of family medicine had been established and that was the closest thing to what I saw in those unauthorized rotations I did in Idaho and Wyoming. So, I decided to do that. I only knew of one student at Duke that had ever done it, two years ahead of me, but I liked and respected him. I didn’t know him well, so when I announced that what is what I was going to do, the Chief of Medicine, the head of Internal Medicine, brought me in and said, “What are you doing? You are throwing your life away.” Basically, you are wasting your talents. I had done well on the internal medicine rotation apparently and they wanted to give me a position in the Duke Internal Medicine residency. I told him that I really did want to do family medicine. I thought I knew what I was doing and so he basically said that, if that was what I wanted to do, that I should get as far away from the medical school as possible, the medical center, because they had no idea how to train me to do that. Which was good advice I think at that time. In my 4th year they did start a residency in family medicine at Duke which is interesting. And they were interviewing for someone to direct, run that residency. And I was on the panel of people to interview that person because I was one of the only people at Duke who knew anything about family medicine. (Laughs). So, anyway, when it came time to apply to residency, I looked for a residency—there were a few really good residencies at that point. I mean, the discipline wasn’t that old so there were 4-5 highly thought of residency programs: the University of Washington, the University of Minnesota, Rochester in New York, Hunterdon in New Jersey, the Medical University of South Carolina Charleston, and Miami. \n\nSo, I interviewed at most of those places. And the place that I listed first was the University of Minnesota. The reason I did that was because they had a hospital—Bethesda Lutheran Hospital—where they marched out their residents to meet with me and each of which had listed all the surgical procedures that they had done. So, they were doing appendectomies and gallbladders and varicose veins and all kinds of stuff as family medicine residents. So, I said that is what I wanted to do as that is what I saw happening in Idaho and Wyoming. So, I listed them first. Unfortunately, or fortunately actually, they did not like my picking from among 6 programs. They had six programs and they wanted to assign me into one of the 6 programs if I was accepted by the University of Minnesota, and they wanted to put me where they needed me, but I said, “If you don’t put me at Bethesda Lutheran, I do not want to go there.” So, I didn’t get my first choice. I got my second choice which was the best possible thing that could have happened. I actually have lived a charmed life. Everything has worked out the way it should have even when I didn’t choose it. \n\nSo, my second choice was the University of Rochester, NY, at Highland hospital, which is a community hospital. The program was run by Gene Farley, who is one of the fathers of Family Medicine. He had been in practice in Ithaca, NY for many years. And when Family Medicine became a specialty, he started the program. He was an eternal optimist, a truly wonderful person, and he had attracted a whole bunch of wonderful people to work there and be residents there. So, I had just interviewed at University of Washington before that interview and at the University of Washington, they talked about how they always got their top ten applicants, they are all AOA, and we do feel like we are the best program in the country and you should definitely come here. At Rochester they said we want to know something about you as a person because we want residents who are good human beings, who care about their patients and will take good care of them. They didn’t mention AOA and didn’t brag. And that was my second choice. My third choice was Internal Medicine at Duke. So, I got my second choice. And the University of Rochester is responsible for training a bunch of the future leaders of Family Medicine who I know personally because I was there. \n\nAt that time, it was like Camelot, lots and lots of decent, smart people who were trying to change the world. It was 1974, a little bit after the 60s, but still these were people who cared about patients and cared about making medicine more humane. I was in my element. I got good training and then I went out. And of course, again, I had not thought about what I was going to do when I finished. I was there, I was doing my training. I never thought I was going to be a small businessman, which is my least favorite thing in the world to do. But that was what I was training to do. And when that struck me, I had to think about it, what kind of setting would I like to be in. Eventually, I decided to do what I had seen done in Idaho and Wyoming, but in the meantime, I thought—again my mother had a great influence on my life and she always wanted to go to Africa to see the animals. So, I thought well they probably need doctors in Africa. So, I started writing off for catalogues of opportunities. And I started writing to places in Africa saying I was going to finish residency in June of 1977, and so if you have a need for a family doctor, a generalist, let me know. So, I got a lot of responses from East Africa, and they said, “Yeah we would love to have you come, but we are in the middle of a war here, and we have no supplies, and we do not think you would have a good experience.” But then I got a letter from Ghana in West Africa saying “We would love to have you. When can you come?” And so, I signed up and I knew nothing about Africa except that there were animals and that my mother had always wanted to go there. \n\nSo, I am not going to tell you the whole story about Ghana but it is an interesting story. As it turns out, Africa is a huge continent and the animals are in a very small part of it. They are over in the eastern part. So, I never really saw any wild animals other than one monkey, I think, the whole time I was there. And I kept getting sick. It was a very interesting time, but if I had stayed there much longer, I wouldn’t have survived. We stayed there for 6 months working for the government of Ghana in a hospital that had been a catholic mission hospital that had been turned over to the government of Ghana. I learned a lot and came back and took the malaria cure. I had had malaria several times, but the final straw was that I had Dengue fever which was really bad. So, I came back looking for a place to practice. So, we started, I thought that I would like to practice in the pacific northwest like you. We took a trip with what funds we still had left, my wife and I. Africa by the way was my honeymoon. We took off to the pacific northwest. It was spring. There was a tremendous practice opportunity in Bellingham, WA, but it rained the whole time we were there. And my wife said, I am not living in the rain. So, we headed back home, back through Yellowstone that was still covered in snow, only one way in and one way out. Elk all down by the road. It was really beautiful and eventually we made it back home and found that a community group was building a clinic to attract doctors in a small town near where I grew up. There was an older doctor who had been there for 20 some years, and he was trying to attract younger doctors so he could retire. \n\nAt that point, I was 1-year past residency and there was a resident graduating from the Duke program who was very interested in the practice. They were trying to attract two doctors. I met him, and I liked him, and so we joined the older doctor in this practice in the small town of Hillsborough, NC. We did everything—OB, hospital,  nursing home, home care, everything. The old guy decided that actually he didn’t think he would retire. He thought life had gotten so good. He was coming in at 10 in the morning and leaving at about 3pm. He had a PA working from him. He didn’t take any night call or didn’t do any hospital work and he thought maybe he would practice for a little while longer. The problem was that he was incompetent, seriously incompetent. Not entirely his fault. He had trained as a pediatrician but now all his patients had grown old with him, and so he was doing geriatrics with insufficient training. So, he didn’t know how to read an EKG and he didn’t know anything about internal medicine. So at some point, we decided we couldn’t tolerate that anymore, and so we offered to buy him out. It was a community board that owned the building, an enormous building, way bigger than we needed. So, they had this big mortgage and it was very foolish of us to offer to buy them out. I would still be paying that debt off now and we had to borrow money to go into practice in the first place. I probably borrowed $100,000 to go into practice. (It was a different time.) \n\nSo, the board fired us because we told them the old doctor had to go. He had been there forever, and even though they didn’t think he was a good doctor, they still did not want to do him wrong because he had been in the community for so long. So, anyway, fortunately, they were not smart enough to have set up a non-competing clause like they do now. So, we set up across town and renovated a building on the main street and set up our new practice. We just continued to practice there. I was in with the old doctor for 3 years and in the new practice for another 3 years. We were starting to train medical students in our practice from Duke, and we actually helped write the curriculum for the required rotation in Family Medicine at Duke. In exchange for that, Duke agreed to send one of us to the Society of Teachers of Family Medicine meeting each year; we would alternate. So, it was in 1983 or 1984, I can’t remember which, probably the spring of ’84, I was thinking that I really was more of an academician than a small businessman. We were on call every other night and every other weekend. By that time, I had two little children and it was pretty brutal. I was such an introvert anyway that seeing patient every day and nights and weekends and so forth. At that time, there were no emergency room doctors. We would see them and admit them and, if they didn’t need to go to the hospital, we would see them in the office 24/7. We shot our own x-rays and we did blood counts in a pipette that we would suck the blood up into, then spin it in a centrifuge, and then count under the microscope count the white blood cells you know. At any rate, I decided I was probably more suited to be an academician. And that is what they were training at Rochester at that time. A lot of us became academicians. So, anyway, I went to STFM. It was my turn to go to STFM that year and it was at Boston. I ran into Steve Spann, somone who had been in the Duke residency program. We also precepted in the Duke residency program—we would go to Duke for a half day a week and precept. So, I had met him over there. So I ran into him at this STFM, and he was going to be the Vice Chairman at the University of Oklahoma. Or at least that was his ambition to be, I guess that was what he was hired to do actually. Which is kind of crazy as he was just out of residency. It didn’t make sense. But anyway, he was on the faculty at the University of Oklahoma with a goal to be chairman someday. He said, “Well, if you are interested in becoming an academician, then you need to meet the new chair of Family Medicine at the University of Oklahoma because I think you would like him,” he said. I said, “Well, I was kind of thinking about staying in the Southeast.” \n\nI had already set up interviews at a number of programs in the southeast, but he introduced me to Chris Ramsey. And Chris Ramsey was a Bill Clinton type person—I mean, just, very, very charismatic. He had attracted people from all over the country. And like at Rochester, it was Camelot all over again. It was these wonderful people from all over the country that he had attracted there. I didn’t know that at the time, of course, but I met him, and he sat with me for hours, and we talked. It was great. He invited me out, of course. He said, “Send me your CV.” At that time, I had interviewed at some places and they had said, “You might have a place here. You would start as an instructor and you know, we will see how it goes.” So, I sent him my CV and I got a call from him during his vacation in California and he said, “You are exactly the person we need. We would start you as assistant professor. We need you now. When can you start?” I came for an interview, met all of the great young faculty, and I called my wife up and sang Oklahoma, the Oklahoma song, to her on the phone. She said, “Oh God.” \n\nAnd, so that is how we ended up at the University of Oklahoma. Those were interesting years initially. Chris Ramsey, as it turned out,was a great recruiter, buthe was not that great of an administrator. So, a lot of people ended up leaving. I was one of the few people that stayed long term. There was an exodus of people who left for UTMB and then Baylor after that including Steve Spann, who first introduced me to Chris. And there was another fellow who was my best friend who went to the University of Oregon or maybe into private practice, then to the University of Oregon, and then back into private practice. So, people left but I stayed. I had a lot of freedom to do the things I wanted to do. There was no great pressure on me to publish and nobody told me that I couldn’t do things. I was pretty well self-motivated. At that point, I had decided I wanted to be a geriatrician. I had always gotten along well with old women, and they seemed to like me too, so—that was when geriatrics was just emerging. And that seemed to me where the revolution had gone.\n\nBy that time, Family Medicine had become pretty accepted. We were attracting people who actually wanted to be family physicians and they didn’t care that much about the history or that we were trying to make medicine more humane. They just basically wanted to do a job that was called Family Medicine. I was still a revolutionary. And so, I joined the geriatrics revolution. I taught myself geriatrics and became well known in the aging network in Oklahoma City and across the state. I started developing geriatric teaching services and I was having a ball. I got a big grant to establish the Oklahoma Geriatric Education Center. And then my wife said, “Are we going to be in Oklahoma the rest of our lives? Is this going to be it?” And I said, “I don’t know. I had not really thought about it. And she said, “Well, you know I like Oklahoma, but our kids are in middle school now and so if we are ever going to move, this would be the time to do it.” I said, “Well, I am not sure if I could get a job better than the one I have. I really like the freedom I have and the things I am doing.” And she said, “Well, you haven’t really looked, have you?” So, I said, “I will look. I will see. But I do not expect to find anything.” So, I looked around and there was a really good job at the University of Cincinnati and another really good job at the University of Louisville. At the University of Louisville, it was an endowed position, an endowed chair of geriatrics. Geriatrics was owned by Family Medicine, which was unusual—most geriatrics programs are in Internal Medicine -- and someone had given them a bunch of money.—So, they were able to give me a research assistant. It was a sweet position and even though the people in Cincinnati warned me not to go to Louisville, I took the Louisville job. I had a lot of freedom and like I said I had a research assistant. I was working with the rehab people, but my wife hated Louisville. Most of the people in Kentucky had grown up in Kentucky and they had friends and neighbors and family to take care of them. They didn’t need outsiders and in fact they were very suspicious of outsiders and it was very hard to break into that culture. Anyway, she was so upset that I had to find a way to get us out of there. So, I looked at a job at Emory University in Atlanta and almost took it, but then I decided that it would be the safest thing to go back to Oklahoma. Fortunately, I had not burned any bridges, so I negotiated with them to pay for me to get a Master’s in Public Health Degree and become a researcher. And so, I came back. I finished my MPH in—I had been in Louisville from 1992, I am sorry, 1993-1994. I took over the Research Division [of the Department of Family Medicine at the University of Oklahoma] sometime later that year and I finished my MPH in 1999 . \n\nWhen I arrived, they were writing the Department Enhancement grants—I can’t remember what they called those grants from HRSA—but it was a grant to improve Family Medicine Departments. They wanted me to write a section of that grant to established a practiced-based research network. I had been to one meeting -- probably at NAPCRG -- where I heard John Hickner talk about a practice-based research network he had developed in the upper peninsula of Michigan, and that’s about all I knew about practice-based research networks. But I wrote that section of the grant and I think it was maybe the only section that got funded, and so I set about trying to develop a practice-based research network, called OKPRN, which was established in 1994 with a small group of people who had graduated from OU and were in practice and we sort of knew them, or knew of them. I sat down with each of them individually and then as a group. I had in my mind answering all the important questions of family medicine. Is continuity important and how important is it? What do we mean when we say comprehensiveness? And so forth and so on. They said, “No, Jim. Actually, for us to participate, we need to study things that we think are important and it cannot be just about research. It also needs to be about sharing resources, developing and sharing resources.” So, we called it the Oklahoma Physician’s Resource/Research Network. \n\nThe first study we did was “How should you treat brown recluse spider bites?” So, (laughs) you know, okay, it was interesting. And it turned out to be the very best thing we possible could have done. We became the experts in the world on brown recluse spider bites and I learned a lot about practice-based research. The first thing I learned was -- I was trying to design the study and I said, “How are we going to know if it a spider bite or not?” And then I realized after sleeping on it, that was not the right question. The question was—because we did not have a diagnostic test for it—what should a physician do if they think it is a brown recluse spider bite? Which is a very different question from what do you do to treat a brown recluse spider bite? I am sure that is why it had stumped so many people. The only person that had really done any studies on brown recluse spider bites was an emergency room physician who had actually developed an assay where he could prove it was actually a spider bite. But that was not really what we were faced with as that was not  available to practicing physicians, that kind of test. So anyway, we did a 5-year longitudinal study of brown recluse spider bites and we accumulated the largest number of spider bites ever studied. And the network continued to be successful, very low budget; we did some really interesting studies of that type. (We also became the world experts on night sweats,  for example.) \n\nAnd then the University of Oklahoma almost got the death penalty from the NIH. I mean, it did not affect me in terms of funding as I was not getting NIH funding anyway. But the University all of a sudden had to become really rigid about the consent process and training for people who participated in research and so forth and so on. It became impossible for practices to recruit and enroll patients because you had to do a a 2-day course, read a CITI book and take the test, and all these things. It was just impossible for us to then to study patients unless we sent research assistants out to enroll them. Eventually we figured out how to do that, but at that time we had to make a decision. It was a resource/research network, so we started studying practices instead.  Our funding sources became AHRQ, the Agency for Healthcare Research and Quality. AHRQ gave us some money but said we had to do several things. We had to collect data electronically, and we had to do it as a routine somehow even though practices didn’t have electronic health records at the time. We had to expand diversity within our network, and we had to also come up with a plan for how we would translate research in practice. It wasn’t enough to just do research; we had to make sure it made a difference in the practices. And fourth we had to come up with a plan for network financial survivability or sustainability. Dave Lanier who also graduated from the Rochester Program a year behind me was then at AHRQ and he established those criteria. \n\nSo, to meet those criteria we first developed what is now Zsolt Nagykaldi’s preventive services algorithm. It was called the Preventative Services Reminder System at that time.  The nurses at the practices said one of the biggest problems they had was catching kids up on immunizations, figuring out how to do the catch ups. So, we paid aa computer engineer to design a program that would calculate the catch-up schedule for any kid. We called it the Preventative Services Reminder System. We expanded it to other preventative services like cancer screening and that sort of thing. It is now so much more than that. The second thing was diversity. I had met with people who had connection to the Indian tribes and asked them if they wouldn’t like to either join or have a parallel network to work with us. They seemed very interested, but that didn’t pan out. I promised to do it, and we did not succeed. The third thing was to translate research into practice. Well, I had just been to NAPCRG and had heard a talk by a guy named Bill Hogg in Ottawa who had done a big preventative services study where they used something called practice facilitators. So, I got back and was writing the AHRQ grant proposal, and I was reading the history of practice facilitation. It sounded like a really good way to try to translate research into practice so I wrote it into the grant. And the last one was to become financially stable or so that led eventually to us becoming a non-profit entity because we thought we could get charitable contributions or charge for membership or something to try to maintain financial stability. We did become a non-profit, andwe do get donations. I donate every year. But, it never—I am not a business man (laughs) as we know now. It never became financially sustainable except through grants, but the one thing I did figure out, you don’t have to depend only on grants but you can also get contracts. This was a revelation. By the time I left, about half our funding was from grants and half was from contracts. We were always well funded during the time I was there. It was always stressful, but we always ended up getting a contract or a grant and kept things going. It has been one of the most successful practice-based research networks around. It was my claim to fame anyway. The reason I got into the National Academy of Medicine was the network stuff that we did. \n\nBut coming back to the NIH death penalty, because they tightened up on everything, we started studying practices instead of patients. It made it a lot easier. We could consent people in the practices and they did not have to get involved with the consenting process or anything. It also fit with our mission to develop and share resources. By that time, we had figured out how to do practice facilitation and I had added to that a peer coaching component where I would go out and meet with the clinicians, explain to them what the guidelines said to do and why, and give them a practice facilitator for 6months to help them try to implement the things they were supposed to be doing and that they had agreed to do. We did that for 10 years, one project after another, some grant funded, others contract funded, and got really good at it. And after about 10 years, it occurred to me that what we were doing was similar to what they did in agricultural extension. Why didn’t we have a primary care extension system? Primary care practices need support, quality improvement support, because they don’t have the bandwidth and don’t know how to do it and they don’t have reserve capacity to be able to do quality improvement. They need a lot of support just like the farmers did. At that point in Oklahoma, most of the primary care practices resembled small farms. They were privately-owned and at least the practices in our network were small privately-owned practices. \n\nAround that time, I was invited to give a talk, a plenary speech, at the Society of Teachers of Family Medicine. I can’t remember the year. It was supposed to be on practice-based research, and I introduced the idea of primary care extension system, and people liked it, particularly one person whose name is Kevin Brumbach, chair—I don’t know if he was chair at the time but now he is chair—of  Family Medicine at University of California San Francisco. He had given a plenary speech just before mine on how primary care practices were like small farms. We had not talked about this ahead of time (laughs). So, we sat down afterwards and it turns out Kevin was doing a sabbatical at Washington DC. I don’t remember who he was working with exactly, but he had an in with the Senate HELP committee, Health, Education, Labor, and Pensions Committee which was in the process of writing the Affordable Care Act. So, he invited me and a couple of other people to meet with that committee staff and to insert within the Affordable Care Act a section, I think it is 5405, that would establish a primary care extension system. So then of course, the Affordable Care Act passed. It went to the appropriation committee and no money was appropriated. When they asked us how much money we wanted for that part of the Act, we hadn’t really thought about it, but  we told them 12 million dollars (laughs) for 10 states. There was some rational for that but I don’t remember what it was. Anyway, no money was appropriated but it was assigned to the Agency for Healthcare Research and Quality. We made that suggestion that that’s where it should go. And it did, and it turns out AHRQ took that assignment seriously and they started funding efforts to establish an extension system in a few states. We benefited form that and we still benefit from that and we are still trying to do that. We had a couple of grants while I was there. I helped to write a huge grant, a 14 million dollar grant or something like that, that was funded after I retired. I was able to convince Dan Duffy in Tulsa to become the principal investigator on that project and when I left they established Oklahoma Primacy Healthcare Improvement Cooperative, OPHIC, named after me. And, it’s still operating. Dan became the head of that. Now Steve Crawford is taking over, because Dan is retiring.  I am still now a consultant.\n\nSo, all along, when I left medical school, my mission, my quest was to try to make healthcare more humane. I had to learn how to do it first. I first had to learn how to just provide care, and get through the day, and make a living. But it was always in the back of my mind to try to figure out a different way to think about health and healthcare. When I became a geriatrician, I was introduced to all of the rehabilitation therapists. I got to know what occupational therapists do, and I was working in a rehabilitation hospital. One of the new rotations I set up for the residents was there. It was the first time I had really—I mean, I had written prescriptions for physical therapy and they asked me to write goals, but I didn’t know what that was about. I said “Can’t you just write that in for me and I will sign it?” So, I was really confronted with the idea that maybe goals are a good idea. I started doing some literature searching, and in fact, it did look like goals were a good idea. Anybody who studied goal setting with patients, people did better if they set goals. I didn’t really see it working that well in rehab actually. Everybody seemed to have their own goals—their physical therapy goals, their occupational therapy goals, their nursing goals, their medical goals. And they did not seem to becoming form the patient and they were still related to the disease processes. The only group that was actually thinking about what people wanted or needed were the occupational therapists. I was very impressed with what they did. But it was limited basically to current quality of life. They weren’t thinking about prevention or death, or anything beyond just current quality of life, but still they were focused on actual patient priorities. They had a whole assessment process for how to that. \n\nBut as I was developing geriatric teaching services I was also working with PhD educator who was a faculty member in our department. And we were trying to develop a mentorship program for the residents. She told us about the IEP program, the Individualized Education Plan program that they have in school for kids who are having difficulty. She thought that maybe since the residency allows a lot of flexibility in terms of electives and future course, maybe that would be a way to individualize their educational experience. It had the right acronym and nobody knew what it was, so nobody knew that it was based on disturbed children. It was all goal directed. It was all about goals. I believe the Department still calls their mentorship program the IEP process. \n\nSo those experiences sort of floated around in my brain and again it occurred to me that, why didn’t we consider what the goals were before we decided what to do for people. I also had read a paper by a guy in Denver who was a quality improvement expert and he said that he could not tell, could not rate the quality of care because he did not know what the purpose of it was. He was doing hospital quality improvement, but he said the notes don’t tell me what they were trying to accomplish so I really can’t tell if what they did was the right thing to do or not. So, if they would just tell me what their goal was. All those things and many things that I have forgotten now came together and I thought, “What if we started with goals and backed into strategies? Instead of always trying to fix things whether they need to be fixed or not?” So, I wrote a paper and took it to a couple of other faculty members in the department and they said, “Gee, that is an interesting idea. What you are talking about is a paradigm shift.” And I said, “No, this is just a simple little adjustment. (Laughs) Just add a couple of questions.” They said, “No, you need to read about Thomas Kuhn.” So, I got the book and I still can’t read him. He is so obtuse. His writing is very difficult. Anyway, I read enough to get the gist of it. Together, the three of us published this paper. I have no idea if the other two people ever tried to practice Goal-Oriented Care or not. The article was called “Goal-Oriented Medical Care.” It was a fairly simple paper. It got almost no accolades or queries or attention of any kind; at least I didn’t think so. And then, I did hear from someone from Canada -- Queens University – who wanted me to talk about it in Canada. So, I went up and talked about it. There was a guy there of a little-known journal called Educational Gerontology. He said, “Why don’t you write an article for my journal?” At that time, I had published very little and I didn’t really know the game. I wrote a really nice article for his journal. Unfortunately, his journal is not very searchable.  So, nobody found that paper if they wanted to. It was a much better paper than the first one. I kept thinking about it and kept thinking about how to do it myself and why I couldn’t convince anybody else to do it. I published a number of papers along the way, various angles on the same theme. And then I retired. The fellow I had hired to work with me in the Geriatric Education Center, John Belzer, liked the idea a lot. He said, “When you retire you need to write a book for patients because you are not going to convince doctors to do this, but patients might be able to convince their doctors to it.” So, when I retired I wrote a book called Achieving Your Personal Health Goals: A Patient’s Guide.\n\nI thought that was the end of it. I had done what I could do. But I got a call—or an email maybe—from a guy in Belgium named Jan De Maeseneer who had been the—I don’t know—a bigwig, the Chairmen of Family Medicine at Ghent University. He had read that initial article in 1991 and he thought it was exactly what we should all be doing and he had rewritten his residency curriculum around that Idea and he had now spread the idea all throughout Belgium and would I please let him recommend that paper, that original paper, to go into a new book called Seminal Papers in Family Medicine or something. And I said sure. That lifted my spirits, but again I thought that would be the end of it. Then. I was thinking of going to NAPCRG and I started reading through the abstracts, the titles of the talks, I didn’t have the abstracts. And I came across one on Goal-Oriented Medical Care. And I thought “Whoa, who is that?” It was somebody from Canada. And I contacted her and it turns out that she and another Canadian another from Toronto, and a pysician from Belgium (from Jan De Maeseneer’s program) were collaborating on some research to try to learn more about goal-oriented medical care. So, I said, “if I can do anything to help, I would be happy to. I would even be happy to tell a brief history of the idea.” They said, “That would be great.” And they added me to their workshop and I have been working with them since then. Now, I guess because of all that encouragement I received, I am almost finished with a book for physicians. I haven’t decided on a title for it yet. And we are doing more workshops and more talks at NAPCRG, and we all went to Belgium where there was a big conference, where 100s of people showed up to hear about goal-oriented medical care, and they were all really into it. So, maybe it’s time Is coming. I don’t know if it has come yet, but at least there is a ground swell of interest. But we will see. But I do now understand that it is a paradigm shift and paradigm shifts take time and are difficult. \n\nBefore I retired, I had a couple of patients where I ran out of room on the problem list. I had to remove some problems to add new ones. When we all have our DNA mapped at birth, problem lists are going to be a real challenge. What do you do if you are born with a thousand risk factors and another thousand strengths or resources or whatever? How do you make sense of all of that? Plus, I had just been reading a book from a guy form the Geriatrics Department at OU about longevity, And he gave an example of a guy named Michael Rose. Michael Rose raised fruit flies and he bred fruit flies that would live longer. The longest-lived fruit flies, he mated them and he eventually had a strain of long living fruit flies. Then, I guess at some point he turned them loose on a garbage pile and they all died. Their reproductive age was delayed, so they couldn’t compete with wild flies in terms of reproduction.. So, the paradigm of fixing everything, of correcting all abnormalities, is flawed from the get-go as they say in Oklahoma. The only reason we didn’t recognize it is because we were not really good at it, but now that we are getting really good at it, it is clearly doomed to fail. It is not even something we should try to do. The paradigm has to change. I think goal-oriented care is the logical next step; it is the step that many other fields have taken already, education for example, financial planning, many mental health sectors, business. Most people are operating from a goal-oriented perceptive already. It is just medicine that doesn’t.\n\nBP: Why do you think it has been so slow to change in medicine?\n\nJM: Two or three reasons I can think of. One Is just historical. Problem-oriented care did make sense initially. You know the birth of modern medicine occurred at a time when they were developing the classification of plants and animals.  Abd it seemed the thing to do what to figure out and classify what was causing diseases so that you can cure them. The health challenges of greatest concern at the time were infections and injuries. So, the idea at the time was to cure diseases and repair injuries. It just continued. There was not an alternative paradigm to consider really. But problem-oriented care eventually became attractive to two different groups. One group were the economists and administrators and policy makers. It is attractive to them because it really is a mechanical model. You can separate diseases from the people who have them. You can look at them separately. You can have a lecture on Parkinson’s without ever mentioning a person who is experiencing it. Because you can do that, it makes it look if you want it to like a widget factory. Basically, that you can design the system to make a correct diagnosis, identify abnormalities, and prescribe the right treatment. And it iss like being a car mechanic or like a factory. And that is very appealing to those people who know a lot about how to run factories. It also is very appealing to doctors, which is very disturbing,  because it allows you to separate yourself form the fray so to speak. It is like running a war from an office using computers. You do not actually have to touch anyone or feel their pain. You can manipulate lab tests and medications and so forth without ever knowing a person’s story or connecting with them in a meaningful way. And that’s a double-edged sword. It is attractive because it requires less energy, and yet a lot of primary care doctors want that connection with patients so they are torn between cookbook medicine which is simple and what they really thought they wanted to do in the beginning. There’s that tension there. Those are the reason why I think it has survived and there are probably others. \n\nI always would ask the medical students when I had a chance to interact with them, “How’s being a doctor different than being an auto mechanic?”  They rarely gave an answer that I considered to be correct. They would say, “Well, you are more likely to get sued if you are a doctor” or “Human beings are more complicated than cars.” They never said anything like “Human beings are qualitatively different than cars. Human beings actually have goals and aspirations and can change and adapt and grow and develop and that makes it a qualitatively different activity than dealing with an inanimate object. There is in an interaction that happens that is different from the way you interact with an inanimate object.” Nobody ever came up with those kinds of answers, which is disappointing. \n\nThere has not been a lot [of goal-oriented research done and it is hard to know how to design a project. I thought a lot about that. The first step is to come up with some outcome measures. Doing research in goal-oriented care requires a slightly different method, I think. You [Becky Purkaple] were able to do a couple of projects that used the usual methods. You did randomized control trials, relatively simple studies to see if doctors knew what to do with patient priorities, and they didn’t, but that’s not a surprise. And they didn’t like it. They didn’t like doing it, they didn’t like asking those questions—disappointing but not surprising. But really it is a process. But goal-oriented care is, by definition, individualizedd so the usual research methods are not—the things we do to study a drug or a device or something don’t really apply, so the research would have to be about a process. So, what if you used this kind of a process? What if you were thinking this sort of way with a patient and how do you measure the outcomes? Well, the outcomes are going to be individual as well because every person has different priorities so you can’t say as a result of this process did we see the same improvement in all patients on some common parameter because there is no common parameter. Some people will want to be able to walk out to their mailbox to get their mail without tripping over the sidewalk and another person would just want to spend more time with their grandkids or to play tennis—so the outcome is different for each person. So, I think that is part of the reason more research has not been done. Because we have to think about how to do that. When we did try to do research using that Preventative Services Reminder System that I mentioned before, the funding agency said that there were too many moving parts. Which I guess is true: there are a lot of moving parts and it is not simple. But I think we will get there. It just requires a few smart people and some enlightened funders. And, I think we will get there. In fact, we are getting there. I am consulting with the University of North Carolina. I finished a helping on a project to help humanize the care of patients who get dialysis. It was really successful. The patients liked it and the doctors liked it. It was extremely rewarding. And now we are working on a project that has been interrupted by the pandemic. It has to do with trying to implement a component of goal-oriented care called Patient Priorities Care, which was developed by a geriatrician researcher at Yale, in some primary care practices in North Carolina and see what happens. I am not crazy about the approach, but it is a version of goal-oriented care and we will see.\n\n  Purkaple: That is exciting. It is exciting to hear about the dialysis study. That is wonderful\n\nMold: Yeah, it was really good. I mean, just to give you an example, basically we redesigned the care plans. (They are required to do care plans.) Care plans were totally oriented to lab tests, test results, weight, and all that stuff. They decided to focus care plans on what is important to patients and they began asking patients the kinds of questions we learned how to ask when you were in Oklahoma. One patient said, “You know, the biggest problem I have is transportation. I have to depend on someone else for a ride to get to dialysis cause I live 45min away from here.” \n\nSomeone was smart enough to ask, “Why can’t you drive?” \n\nHe said, “Well, a few years ago, they said I couldn’t drive because I had passed out.” \n\n“Did they tell you why you had a passed out?” \n\nHe said, “Well I had a heart rhythm problem that they had to fix.” \n\n“So they fixed it.” \n\n“Yeah they fixed it.” \n\n“Have you passed out since then?” \n\n“No.” \n\n“You should be able to drive now.”  \n\n“I should!” [laughs]\n\nSo, they basically checked on it and yes, in fact, he should be able to drive now and they were able to get his license restored which was probably more important than adjusting his calcium intake. \n\nPurkaple: Probably so. You saw Family Medicine really from its beginning and infancy as a specialty to where it is now. What are some of the things that you noticed about how the specialty has changed over time?   \n\nMold: Well, as I said, it started out as a revolution but the problem with the revolution was that the feeling was, and maybe was correct, that Family Medicine had to have a seat at the table in the medical school and that was the trouble. What we were trying to do, and what the founders said they were trying to do was to improve what general practitioners were already doing but improve it by giving them better training. A lot of general practitioners had just done a rotating internship and gone out into practice. So, the idea was to do a three-year residency because since the science of medicine had advanced so much that they were trying to give general practitioners a really good training before they went out. But they didn’t want to lose the flavor of general practice, what I had seen in Idaho and Wyoming. In fact, most of the early residency directors had been in practice for, you know, 15-20 years different from many other specialties. They came from the field. So, the trouble was to get a seat at the table required that you join a fraternity that was made up of mostly subspecialists. It was really hard to—we were struggling because a lot of the subspecialists and even the specialists of internal medicine and pediatrics didn’t want Family Medicine, didn’t think it was needed, and thought it was a bad idea just like the Chief of Medicine told me in medical school. To be accepted, we compromised so much to gain acceptance within the academic medical center that we lost the energy we had—the revolutionary energy we had—we used all our energy to be accepted and we just stopped fighting for a new approach and it was surprising to me though that a lot of these really smart people who were revolutionaries to begin with couldn’t come up with a better plan. But, they became consumed with getting hours in the curriculum and required rotations and lost a bit of their original zeal and forgot the original mission.\n\nWhat they didn’t realize was that you could not in the current paradigm—it’s impossible to preserve what general practitioners did and insert the science of medicine. There was no human framework within which to apply the science. The science is not human. The science is mechanical. The science is science. What we needed is a framework within which to apply that science to the care of human beings and nobody ever came up with one. I think Goal-Oriented Care is a really good framework. I don’t know how long it would survive until a better one came along but it is the best one I have heard of. There are a few other frameworks that people have come up. There is narrative medicine. Narrative medicine is a very interesting framework but it doesn’t really tell you how to apply the science of medicine. It just tells you how to be humane and to care for people in a humane way through their stories and an analysis of their stories which is great. But it doesn’t tell you how to apply the science of medicine to that. And relationship-based care is another idea that someone had where you focus on the relationship. Again, a really good idea and very important, but it doesn’t tell you how to apply the science of medicine. But I think goal-oriented care does provide a framework where once you understand what you want to accomplish, then you can call up the science of medicine and apply it to try and help achieve those priorities, those goals. \n\nPurkaple: Any other thoughts that you can think of or stories you want to share?\n\nMold: I think we’ve pretty much covered it. I think so. I think we’ve pretty much covered it.\n\nPurkaple:  That was wonderful. I did not know that Ghana almost killed you early in your career.\n\nMold: I told you it was our honeymoon. It had been a Catholic mission hospital just recently turned over to the government of Ghana. But there was a priest and a bunch of nuns there. My wife and I had been living “in sin” at that point so we decided that we had better get married before going over there. We were married by a justice of the peace in Eden, North Carolina with two people in attendance and then headed off for Africa. So, when we arrived, my wife hurt her back lifting the suitcase and got stung in the eye by some sort of a fly and her eye swelled up. She was in bed with a swollen eye and I was foraging for food. The story was worse than that. I will just tell you the shorter version. There was no food on the shelves in the stores because it had been bought up by the black market Makola women who were selling it at jacked up prices at some market. So we were living off of bananas basically for a couple of days until we could figure out a way to get to where we were supposed to go because the person who was supposed to meet us in Accra had messed up. He had forgotten we were coming and so there was nobody to meet us. We got ripped off by the cab driver and had to depend on the priest to find us a place to stay so anyway we flew Ghana Airways with the chicken and goats up to Tamale and met a nun there who drove us to Jirapa in a pickup truck on a dirt road going 70 mph with kerosene and oxygen tanks back in the back of this truck. When we got to Jirapa, my wife said, “Get me out of here!” [laughs]. I said, “I have no idea how to do that.” [laughs] And so, because we could not leave, she decided she had to make the best of it and she ended up doing really well. She ended up getting a job teaching in the middle school and thrived. She even gained weight on the African diet. We came back in 6months and I had lost 17lbs and she was up a couple of pounds and so that was our honeymoon.  \n\nI was in charge of the TB ward in Jirapa. It was full of people with horrible with TB. I saw every type of tuberculosis. The biggest problem I had was that the male nurse running the ward was trading medicine for sex. It was a very corrupt situation, but I did convert my PPD while there because I was sitting on peoples’ beds and talking to them and we didn’t have—I don’t think I wore a mask. And I saw all the preventable diseases—there was a whole polio, group of polio kids, that the physical therapists were taking care of. My wife helped with that. I saw a lady—a lady came who was having what looked like seizures, muscles spasms and so forth. I couldn’t figure out what it was. The African nurse came up and said, “Do you think it could be tetanus?” There is a thought! That was in fact what she had. She had a big sore on her toe and that is what it was. Lots of kids dying of measles pneumonia and measles encephalitis. So, I got a good appreciation for the value of immunizations and the United States government offered to give them $3million of vaccines if they could figure out a way to distribute them in a refrigerated fashion without them being sold on the black market. But they couldn’t come up with a plan so they didn’t get the vaccines. We had an outbreak of yellow fever while I was there. We were two days on a dirt road up away from the capital—nobody cared about us; we were rural—so we called down to the medical center, the public health center in Accra. And they sent people up there to vaccinate people for Yellow Fever and they used the same needle and syringe on everybody. [laughs] It was quite an experience. Life changing experience. \n\nI had to do a tubal pregnancy operation. A lady came in with a ruptured tubal pregnancy. Usually we had Ghanaian physicians. Ghanaian physicians had their medical school paid for, but they had to pay it back by working in a rural community. But they didn’t want to do that so they spent most of their timing trying to get out of it.  But when we did have them, they were pretty good surgeons and we also had an ENT surgeon who could do some things. He did general surgery basically. But they were not around for some reason and this woman came in with a belly full of nonclotting blood. I was the only one there who could do anything about it. I had scrubbed in on one ruptured ectopic in Ghana. I was just getting over malaria. So anyway, I went up there to do what I could do and what they would did is that they would take an emesis basin and scoop the blood out and pour it back in through a filter into their blood stream because they didn’t have a blood bank. So we were doing that. I was scooping the blood out and scooping the blood out and I finally got a look at the tube and I clamped it. And the blood kept coming and I looked at the other tube and that is where the ectopic was. The tube I had clamped was just sort of swollen and abnormal-looking but it was not where the ectopic was. So, I saved her life but I sterilized her, which was not a very good thing to do in Ghana. I don’t know. She would have died otherwise. They had to carry me out of the operating room because I still had a fever. It was quite an experience.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162459/file/295889#t=0.0,5063.45941"}]},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162459/file/295889/transcript/85525","type":"AnnotationPage","label":{"en":["Dr. Mold interview summary [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162459/file/295889/transcript/85525/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interviewee: Mold, Jim, MD\n\nInterviewer: Purkaple, Becky, MD\n\nOral History Summary\n\nAt the time of this interview, Dr Mold was a retired physician, a professor Emeritus at the University of Oklahoma, and a consultant at the University of Oklahoma and the University of North Carolina. He graduated from Duke Medical School and did his family medicine residency at the University of Rochester. He had been attracted to the specialty through two short-term rotations with solo general practitioners in Idaho and Wyoming. After residency he went to Ghana, where problems with malaria and dengue fever shortened his experience there to six months. The interview provided some colorful anecdotes about his experience with medical care in Africa. Upon his return to the US, he joined a small practice in rural North Carolina, where he spent six years. He was recruited to a family medicine faculty position at the University of Oklahoma. There he was attracted to geriatrics and obtained a grant to establish the Oklahoma Geriatrics Education Center. He left Oklahoma for an endowed geriatrics chair position in the family medicine department at the University of Louisville. That lasted only two years, and he returned to the University of Oklahoma. There he received an MPH and turned his focus to practice-based research networks. He established the Oklahoma Physicians' Resource/Research Network. Ultimately he moved to studying practices instead of patients. He helped, through family medicine colleagues working in Washington, DC, develop a primary care extension within the Affordable Care Act. He subsequently studied and became involved in the concept of goal-oriented medical care. The interview captures the breadth of his experience and tells the story of an inquisitive physician who evolved his thoughts and contributions over a fascinating career. \n\nLocation: North Carolina","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/162459/file/295889#t=0.0,5063.45941"}]}]}]}