{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/v97zk57m29/manifest","type":"Manifest","label":{"en":["Dr. Jeffrey Susman"]},"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":["2007-07-26 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral history"]}},{"label":{"en":["Agent"]},"value":{"en":["Lindsay Young (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["audio file"]}},{"label":{"en":["Keyword"]},"value":{"en":["American Academy of Family Physicians","family physician","family medicined"]}},{"label":{"en":["Subject"]},"value":{"en":["Jeffrey Susman, 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: \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/2195/collection_resources/154163/file/283387","type":"Canvas","label":{"en":["Media File 1 of 1 - Susman_Jeffrey_07_a.wav"]},"duration":3773.30948,"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/154163/file/283387/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154163/file/283387/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/283/387/original/Susman_Jeffrey_07_a.wav?1753300983","type":"Audio","format":"audio/wav","duration":3773.30948,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154163/file/283387","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154163/file/283387/transcript/81844","type":"AnnotationPage","label":{"en":["Dr. Jeffrey Susman Interview transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154163/file/283387/transcript/81844/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Side One of the oral history with Dr. Jeffrey Susman recorded on July 26, 2007 by Lindsay Young. Just to reconfirm, it’s all right if I record this, correct? \n\nPlease do.\n\nLet’s start with a brief background. Can you state your name in full for us? \n\nSure. Jeffrey Louis Susman but just call me Jeff.\n\nWhere did you grow up? \n\nI grew up in St. Louis, Missouri area, University City. When I was about 12 years old we moved to northern New Jersey, town called Westfield, New Jersey. From there I went on to school at Dartmouth College in Hanover, New Hampshire, to Dartmouth Medical School and then did my internship residency in family medicine at Lancaster General Hospital, Lancaster, Pennsylvania with Nik Zervanos and then from there, had a National Health Service Corps commitment and did three years of rural practice in a town called Wahoo, Nebraska. That’s Dave Letterman’s home office or at least [    ], one claim to fame. And then I entered academia at the University of Nebraska Medical Center, I did one of the part-time fellowships up at Michigan State with Bill Anderson and about eight years ago moved here to University of Cincinnati where I’m Chair.  \n\nThat’s a good overview. When you were younger did you have any role models? \n\nI can’t say that I really did. There was nobody in my family who was in medicine. I was interested in the sciences. In college in particular did biochemistry major and was interested in environmental health and at one point toyed with the idea of sort of environmental medicine. Worked at the Environmental Protection Agency and did some things like that but eventually decided that working with lab sort of things was not as interesting as working with people and went down the primary care path.\n\nDid you have any special dreams or goals or were they all related to kind of what you were just talking about? \n\nI think from relatively early I was still interested in research and trying to look at just why things are the way they are and that probably drove some of my choices during my college career, I was involved in research and had done a thesis on some of the effects of sulfur chemicals that were supposedly bad for people and worked through the folks in pharmacology over at medical school so I think it was a natural segue once I got into medical school and then residency to continue that interest. \n\nDo you have any other stories from your childhood you’d like to share? \n\nChildhood. I think we can move on and probably spend our time beyond childhood. I can’t say that I have anything like some folks that I’ve talked to where they’re, oh, I’ve always wanted to be a doctor like X.\n\nWhat was your major in college at Dartmouth? \n\nI was a biochemistry major and did a fair amount also of education courses.  \n\nAt that point did you know what you wanted to do for a career or not yet? \n\nI’d say after the third year or so, I was toying with some environmental-related career or public health. I thought at one point if I didn’t get into medical school that I might pursue a public health career. We have some very, very smart folks up there, I didn’t realize how smart but Jack Wenberg and Jean Nelson and so on at Dartmouth and Dartmouth Medical School who really shaped the whole idea of looking at variations in disease occurrence, sort of the forerunners of the now Dartmouth Atlas Project looking at how disease patterns are shaped and the whole idea of our practice patterns based on any evidence, the difference in underlying populations or is it really local custom and sort of micro influences that are affecting where people practice. With that in mind, it’s very interesting folks that I was exposed to and at least gave some possibility of gee, be kind of interesting to be kind of these epidemiologic sleuths that look for the asbestos from the shipyards cause disease type of thing but I decided that probably wasn't really the focus of what I wanted to do. I think equally I was interested in behavioral sciences and psychiatry and so the big choice as I was completing medical school for me was whether to go into maybe psychiatry or internal medicine or family medicine. Ultimately decided family medicine was the best opportunity to meld all those things together and I did.\n\nDo you have any more stories or information you’d like to share about your college undergraduate or medical school? \n\nI think if I look at…I’ll jump to medical school. Having people take interest early on really was important. Jeanne Arnold and [    ] were medical school advisors and while that name doesn’t mean much to you, she was very involved with the national Academy with our Board of Directors at one point, the national Academy and took me to the New Hampshire meetings of the Academy, got involved in the committee and commission system about the time your dad was so involved so that was our first connection together. I think like many people who had that experience, it really motivated one to become increasingly involved and sustain an interest in family medicine. The other things that were going on at that time like the Doctors Ought to Care and the whole emphasis on smoking as hazardous and trying to change behaviors of youth and smoking, this was way before it was such an emphasis as today so there was a lot of excitement. I think there was still a sense of sort of the ‘60s generation although we were at that point, beyond the ‘60s and well into the ‘70s but I think a sense of mission in that there was still many of the first sort of founders of family medicine, folks often through practice were still very active in the discipline and they were good mentors and role models I think and a sense of social justice, social obligation motivated lots of folks. Those were the combination of factors that I think were most important at the time.\n\nDo you have anything between your period in residency you’d like to talk about? \n\nI think residency was a great experience. I had looked at a number of different residencies all over the country and the one thing that was just memorable was working with Nik Zervanos and it started the first time you went in for an interview. I don’t know if you’ve had the opportunity to ever meet Nik?  \n\nI don’t quite remember.\n\nYou would remember him probably.  \n\nI probably would.\n\nQuite a character. He would interview – the applicants but also your spouse or whoever happened to be involved in your life. It was a very intense period. Some people didn’t like it at all, in fact that was reasons why they chose to go elsewhere. I also met a fellow by the name of Tom Weida who is now the Speaker for the Academy. Tom was two or three years ahead of me and he was involved in some of the committees and commissions of the Academy and I learned about this residency and ended up going to Lancaster General, which was a great decision. Had wonderful classmates, people like Stan Kozakowski, very big in the residency directors and just folks who were excellent role models. We had an unusual residency in that we had sort of a city experience in the town of Lancaster, which was largely underserved population and a more rural population that was initially run by a fellow by the name of Herb Tindall and then another fellow came in, Dr. Bachman, a little later on so it was sort of the best of both worlds. You see Amish coming in occasionally, that Mennonite population and you see hispanics and occasionally we’d see patients that Nik took care of, of Greek heritage. We got to do a lot in residency and I think it was one of those time periods, again, where the gross (?) in residency, the experience of having a real desire to remain involved at the Academy level, which I did and thinking about sort of the population as a whole was a lot of fun. Probably the experience that I had that I didn’t tell you about in medical school of going overseas to Africa, I spent about four or five months there working at a rural hospital in South Africa and then a very urban hospital [    ], huge hospital. Again, it set me up thinking – primary care and really the foundation for COPC was – many things that emerged from the sort of community outreach, a focus that they had in this particular part of the country and then seeing in Lancaster, populations like the Amish and Mennonite, sort of the epidemiology of the communities. For example, fuzzy (?) injuries – with your ingestion of the kerosene that people would eat with.  Sort of tied together the pieces of population in a way that you might not have had otherwise, with intersection of experience.  \n\nThat’s really interesting. You were talking a little of what kind of big issues were in medicine at that time. Were there any other big issues for family medicine when you were first getting involved? And how did you perceive those issues being addressed? \n\nI think there was certainly the idea that family medicine was something that everyone should have. One of my, I guess you’d count them as mentors, actually a physician from the local area, he’s recently retired but he had a [    ] that basically was, everybody deserves a family physician. Right now, I’ve still got it hanging up on my bulletin board here and I think the sense was that there really needed to be a reform in healthcare, that we really needed to change from a very specialty-dominated healthcare system and many of the same issues that are still playing after so many years later. I think few of us wouldn’t have thought that we would be still addressing them. I think particularly during the first Clinton administration and the health plan that was ongoing then, there was a sense that we would really revamp and solve some of these issues of access and distribution of health and here for everybody, not just those who are wealthy or insured. And of course that’s proven to be a lot more difficult. I think family medicine also was transforming or changing in a way that mirrored medicine, sort of a cottage industry where small practices predominantly to more of a business and larger practices. While that happened suddenly at first…I can remember in residency where one of the local physicians put in a one-sentence description of their practice in the Yellow Pages and that was awful. Here physicians advertise. Of course today when you drive home from the center you’ll see probably a dozen different ads for one hospital or physician group or another touting their liposuction and bariatric surgery and why their cardiac center is better than another. As you’re going through that process of course the change seems somewhat subtle and slow but looking back, there’s been a dramatic shift in the way business is organized and conducted. I’m not sure it’s always been a great shift from a patient/physician relationship. I guess that, to move on, motivated my interest in enrolling in the National Health Service Corps in addition to being able to sort of pay for medical school, it fit in with my desire to practice in a more rural and family medicine friendly environment. I looked at a bunch of different places in New England. We happen to have a camp for what most people call a summer home in Maine, worked at some places up around there. As things happened, I got a letter one day from the National Health Service Corps, said something to the effect, after extensive analysis into your background and interest we’ve matched you to a place in Nebraska. Oh my God, I don’t even know where Nebraska is so went out after a number of forays into the Nebraska wilderness, if you will, to a small town, basically the distance from Lincoln where the big football team, the college is, in Omaha, there’s a medical school there and practiced rural family medicine. Did OB and deliveries and dealt with car wrecks and really got fairly quickly sort of the additional training that you never get in actually being in medical school or residency, sort of the practical issues of practicing. Sitting on the health board and working at the local hospital and dealing with different constituency needs and do we do immunizations at immunization clinics or do we do them in our office? Pretty micro, on the ground issues but really where healthcare, I think, met the real world and that’s probably informed my belief about medicine and some of the things, we need to keep the personal touch in medicine.  \n\nProbably the most memorable experiences, I just wrote this up for Family Medicine, they were looking for very brief vignettes and one day I was out in the yard and it wasn’t uncommon that I wouldn’t be on call that someone would come by the house and want something attended to. There was a particular patient that maybe I didn’t see that wanted to be seen. So one day I was digging in the mud, someone comes by, “Doctor, doctor, we’ve got a delivery, come quick.” I’m just caked with mud, I brushed myself off as quickly as I can, running out to this beat-up old pickup truck and he said, “Yeah, yeah, the goat’s about to deliver.” I’m like, oh my God, I’ve never delivered a goat, I don’t know nothing about it. Fortunately down the gravel road where we lived there was a woman who cared for a bunch of farm animals, a farmer and she supervised the goat delivery, which was nothing more really than letting nature take it’s course. Fortunately I didn’t have to play veterinarian then. In rural practice, there’s a close connection with patients and there’s a necessity to be pretty reliant on one’s own [    ]. If someone has a cardiac arrest or someone has collapsed lung, whatever it is, basically we’ve got to take care of it. That’s a tough responsibility, x-rays have to be read by docs and it isn’t like here in a large university setting where there’s literally every specialist and test known to man at this point available. So when people start looking at how medicine should be practiced, the development of guidelines and all that sort of stuff, it’s tempting to apply its answers to other areas where these sorts of resources and access may not be available.\n\nWhy did you leave Wahoo, Nebraska? \n\nWell, two issues. One, my wife who was looking for work was commuting and that was very challenging for her and really now, I understand to be sort of the first wave of consolidation, if you will, businessification if that’s a word, making healthcare into business was a trend and our office, right before I had gotten there was bought by a hospital in Omaha so I think they probably had the reasonable motivation in mind. They weren’t very good managers of outpatient facilities, at least not at that time. It just got to be very frustrating to deal with the “suits” and try to practice good medicine. Looking back on it, it was very quaint management and fairly unaggressive management compared to what happens today but back at that time, which was about 1987 or so, it was a real constraint to physicians and we’d get into long discussions about what the signage should be or things like the profits or so on were going to be distributed. I started looking and I’d been precepting, which is supervising residents at the closest medical school, which is down at University of Nebraska. [    ] couple of friends down there and they needed someone to help them out, to make a long story short, ended up moving to about a half hour, 45 minutes from where I had been living to a fairly rural suburb, at least at that time, of Omaha and worked at the University of Nebraska Medical Center. Spent time teaching residents and doing the typical office care but never had lost interest in doing more research. After time had gone on for a little bit, applied for the residency director position there and didn’t get that position but the Chair said, we need somebody who can research, why don’t you direct the research program so I did. That serendipity happened. Really was positive, I was able to give really time and the experience doing research and had a chance to do everything for grand [    ] control trials, smoking cessation to some interesting work with some of our rural practice colleagues, use of emergency medical systems to how we were caring for some common conditions, was able to eventually recruit a much stronger research director and became engaged over time on both the clinical and educational administration at the college. To make a very long story short, reformed medical school curriculum. There was a big move to change what medical students learn, in particular, to introduce basic clinical concepts and teaching earlier in the curriculum. Traditionally people had two years of basic science and two years of then clinical science. Motivating those of us at the time was the sense that we’re trying to train doctors, we’re not trying to train PhD researchers and maybe we should be training them more about taking care of patients and if we’re going to talk about things like ethics or if we’re going to talk about interviewing or any of the other things that are in the first couple of years, that they should be integrated with the clinical settings. That, indeed is what we developed. We called it the Integrated Clinical Experience and it was meant to be a four-year longitudinal curriculum and subsequently that’s what it has become but there was a long period of grant funding through the Robert Wood Johnson and HRSA and a bunch of these other organizations that fund development of medical education and this change really happened across the country but the school I was at was one of the earlier schools involved in sort of relooking at how we do medical training.  \n\nThe other thing I did while I was there that was interesting was get more involved in the office development – which was full scale into the business vocation, the making of medicine into a business where particularly the healthcare reform was very strong, people were working at securing the referral lines into large academic centers. It goes on even today and development of primary care networks offices was meant to be a way to do that. [   ] the office [    ] calls it referral and we probably learned a lot along the way about what not to do and maybe even a few things which should be done. I’m trying to marry the goals to provide high-quality patient care and to bring primary care disciplines together, which I think really does make a lot of sense. Pediatrics and general internal medicine and family medicine but allowing people to maintain the uniqueness of their discipline. The Chair where I worked had developed a partnership with internal medicine that combined general internal medicine and family medicine or primary care residency program and it was sort of in that spirit that we looked at developing  collaborative offices and maintaining a standard of quality that really cut across all the different backgrounds of offices so…  \n\nOne of the other threads I guess that began during that period was also interest in guidelines development, the way to distill down the vast amount of medical literature about a topic and decide what we know about it and how to best practice. You would think something like how you take care of people with back pain or ear infections would be pretty slam dunk, everybody would know but it turned out, particularly at that time but even today, that a lot of what we were doing is based on old wives’ tales or less than powerful scientific evidence so there was a federal agency at one point that did a lot of these guidelines and got involved in that and became very interested in how we translate what we know to be effective out in practice. We might know that, for example, taking care of lower back pain you don’t need to do a bunch of x-rays or tests unless some very relatively rare symptoms or signs are present. If you had a motor vehicle accident yesterday or if you’re running a high fever or if you’re a drug addict, for example, that might suggest that you need to look at the person’s back pain a little differently but for most run-of-the-mill patients you don’t need to do x-rays and most of the time the x-rays that we did showed abnormalities that really didn’t change the way they needed to be treated and there was a focus more on what are patient-oriented outcomes. In other words, things that really would matter to a patient. So a patient probably doesn’t matter what their x-ray shows, it matters whether they have pain or if they can do the activity they like to do. So this whole idea of patient-oriented outcomes became popularized, evidence became much more important, evidence-based medicine and trying to rationalize healthcare, if you will, became a lot stronger of a theme in medicine and there was a hope, I think, that many of us had that we’re just starting really, to see pay-off that by saving money by not doing things that aren’t indicated would help solve some of the healthcare financial issues. While I don’t think that’s been fully supported, certainly there’s emerging evidence in a lot of different areas that hey, if we just stop doing things that weren’t needed and started doing the things that were, we could save a lot of money and probably take better care of patients. I think the other thing that emerged for me during that time was paying particular attention to patients’ wishes, preferences and trying to modify therapy based on that. For example, if someone’s got advanced cancer, we may give them a choice to have therapy just to keep them comfortable or therapy to try to aggressively go after getting rid of the cancer even though it might only have one in twenty chance of working. While that’s a fairly extreme example, this sense that patients that should be driving healthcare, involved in healthcare I think was really starting to fully permeate both the educational and the clinical and research…that became very important to me.  \n\nI also started to become more interested in some mental aspects of care. I had done some research initially on things like alcoholic recognition, substance abuse recognition. Was looking a lot at depression. We had gotten funding from the National Institute of Mental Health to teach medical students about depression fear and we were doing projects to look at the recognition of depression and the utilization associated with people who had depression and basically some of the early work that we were trying to figure out. Well, what do people in practice actually do around caring for patients with depression? That’s work that really we’re continuing today. So I think, looking at my time in Nebraska, there was certainly a focus on education, the research and particularly research that was evolving into a mental health theme, the sense that there were challenges of translating even what we knew we needed to do out into the real world and that there was really beginning to come up with a sense that you just can’t simply tell docs, go do this or wasn’t simply a matter of docs being under-educated or ignorant and many times physicians were quite knowledgeable about a particular problem but doing what we’d like you to do didn’t square with either the health system or the preference of the patients or was very difficult to do out in the real world. So that, I think really set the stage here for the last eight or nine years where after there was a merger between the university hospital and another local hospital in Nebraska and a new CEO there after some real exciting experiences being involved with the merger itself and the details of that, the large part of the job that I was doing was then running the clinics and doing faculty development and still some research and so on, a large part of the job was being consumed in a different organization, said well, I’ve been doing this other stuff in the dean’s office and so on and probably trying to see if I could [    ] running a department. That was when I transitioned here to Cincinnati. I’ll take a breath and a swallow here of some Diet Pepsi. About eight years ago or so. I’ve had, I think many of the hopes of, particularly here there was a real strong emphasis on international health, a focus on mental health, we have a combined family medicine/psychiatry residency and very early on met a collaborator in the College of Nursing who was interested in primary care decision-making around depression, which continues to be a focus of our research but I think in Cincinnati, was struck by the challenge of organizing, delivering care to the underserved on a more global basis, the global health disparity. If you’re familiar with the work of Barbara Starfield and others that show basically we spend far more than every other country but our health outcomes really aren’t all that great. I think it’s starting now to really be accepted but was just coming out and people were just talking about it probably about the time I was in medical school. Work that I initially alluded to back at Dartmouth is now developing things like Dartmouth Atlas where people are looking at the distribution of care and things like the distribution of specialists and is specialist care leading to better care or not? As it turns out there’s a large body of evidence that suggests that having all these specialists take care of you without a family physician or family care physician is a bad thing and people don’t get as good outcomes and it costs more. So out of the suppositions are things that we think all believed back when I was in medical school, have started now to be accepted as truths and we’re looking back at the same old issues that motivated my interest back in probably the late ‘70s, early ‘80s in medicine, the system, the society, our culture, is screwed up with healthcare. We have the most bizarre healthcare delivery system and financial support system in the whole world. Have you seen Sicko yet?  \n\nNo, I haven’t yet, have you seen it?\n\nYeah, we watched it awhile ago and while there’s a lot of quibble by debate with the movie, it’s a fun portrayal of many of the challenges of today. It trades off to Guantanamo and looks at the   [  ] healthcare there and the implication that really they’re much better off in Cuba and the detainees in Guantanamo than the average person here in the US. They interview people from Canada – and talks to his mom and dad about the Canadian system versus the US system, the Cuban system versus the US system and it’s sort of the personification, if you will, of Barbara Starfield’s [    ] about health and health outcome. We’re still struggling with the very same issues and I guess as I’ve become a bit older it’s understandable that we haven’t made as great progress in really retooling healthcare but I think continues to be the motivating force for me. We care for the homeless, we’ve got a racetrack clinic that one of our doctors have set up, we’ve got an association with some of the health centers and so on. It’s amazing to me in a country that has so many resources that so many people go without adequate healthcare. Many of the same sort of issues that we face in rural Honduras are issues that we face with people that are right outside my office, probably within a block or two away. The big challenges remain. How do we provide everybody’s healthcare? How do we provide people with a family physician, a person who coordinates their care and provides their medical home? How do we do evidence-based care? How do we do cost-effective care? What do we do around trying to reconcile our fascination as a culture with technology and choice with the reality that we have probably a limited budget for healthcare? And many of the same issues, while better researched and perhaps better articulated now, are still the same issues that your dad and I were all roused up about 25, 30 years ago. I think while I see our society beginning to grapple with some of them in a way that we haven’t before, I still don’t quite see the momentum required to change our health system substantially. Where does that leave family medicine? I think the basic values and construct of family medicine remain very, very important and I think they’re as relevant now as they ever were, the founding of family medicine in 1969 or so. There’s been a lot of work in the Future of Family Medicine project which you might have talked with some of your other interviewees with. What I see that we are looking for easy solutions in some way to what are very culturally-driven, societally-driven norms and expectations. I don’t think the model particularly of family medicine is wrong. It’s a great model. I think having a personal physician who knows you, who cares for you in multiple settings, who can coordinate care, get you the type of care you need when you need it, uses good evidence to practice, I don't think any of those things are different than what the original model that people like Nik Zervanos were advocating for back in the late ‘60s and on. Now the technologies have changed. I think I hold as much information in my little Palm Pilot as we had in rows of books back 25 years ago. I can send a prescription over the wireless connection to the pharmacy by tapping a few keys. I can get a guideline on how to treat your back pain in minutes by looking it up electronically, I can communicate with patients using email, I can maybe more efficiently move patients through my office but frankly, I think the model was right, it’s still right, we need continuity, we need coordination of care, we need comprehensive care, we need to be able to create a place where a patient feels like they have a home and a relationship with their personal physician. It’s to me what family medicine is still all about and I think in some ways we’ve spent an awful lot of time navel gazing, worrying about is the model of family medicine correct without really spending time thinking the way we do family medicine, the reasons why we do family medicine. I’m not one of those people that believes family medicine is broken. If anything is broken it’s the healthcare system in which family medicine exists or societal values that allow us to commit so much time and energy to bombing countries and creating war and so little time looking at the person who is pregnant and doesn’t have ready access to healthcare. On a global basis, we spend so many resources in the US compared to our colleagues across the world and our outcomes aren’t all that much better and sometimes much worse. Comparison is often made to our healthcare sort of like Bulgaria or some Eastern Bloc country or a health indicator. I think the big issues for family medicine as we move forward are going to be what role does family medicine play in patients’ lives? Do we want to play a role in every person’s life or are we content to play a role in just those that seek us out? How do we remain an advocate, in fact, a driver of change in today’s healthcare system? I think we’ve sort of grown into our adolescence, early adulthood and some of that sort of revolutionary zeal is gone. There’s a number of new leaders in family medicine and for the most part the initial founders of family medicine are either gone or starting to fade into history. I think the question is, what do medical schools look like in the future? Is there any way we can change their focus on research and reduction of big research and start looking at the healthy populations and communities. How can we really transform places like rural healthcare and inner city urban healthcare where there’s still so many health disparities. How do we really apply technology in ways that enhances healthcare [    ] just repackaging it, something that’s sexy to look at but really doesn’t have a huge effect on outcomes of patients. But it’s this next generation of consumers, people like yourself [    ] healthcare and like many people, people want convenience, healthcare at this very moment, they need it, they don’t want to go through a lot of hoops to get to it. There’s increasing interest in prevention and being able to just deal with the downstream effect but nonetheless, we seem relatively enamored with quick fixes and the hard work that occurs or needs to occur with lifestyle changes. I think a lot of the answers to things like obesity are well beyond what we do in doctor’s offices. Trying to change obese patients, when they come into my office in suburban Cincinnati, we’re way downstream. A person is 220 pounds or yesterday I saw somebody that’s 337 pounds, not likely I have a solution for the surgery that’s going to be very beneficial. I think for example, we’re now working in the schools, we’ve got to change what’s going on in families. We need to work with churches, we need to get out in the community, schools to deal with these health issues and recognize where as physicians, that at least within our offices, we have certain advantages or roles and where we need to be really focusing on a community basis or at a legislative level or advocacy level and we need to reform healthcare financing. We look at how we assure that there’s financial support for everybody to have a family physician, everybody to have access, that they have healthcare, get the prevention they need.  \n\nIt’s been a great career. Someone asked me the other day on a plane whether I would want to do medicine again. They’re surprised when I say oh yeah, it’s been a great privilege, it’s really fun and while my day-to-day job is challenging like most people’s in some ways, it’s a tremendous, tremendous privilege to be a family physician, doctor. He said, oh well gosh, you’ve got all the paperwork, you’ve got all this, you’ve got all that and it’s true, you do have all that but I think if you look at the daily satisfaction of sort of the long-term fight, if you will, of trying to move medicine lower (?) and to change a little bit of the societal norms, it’s been tremendously rewarding, exciting, a great career. If my sons or daughters would ask whether they want to go into medicine, I’d say sure, go for it.\n\nWhat would you say throughout your career is the achievement that you’re most proud of or the thing that you worked with that you’re most satisfied that you were involved in? \n\nThat’s a hard question. I guess I would point to things like reforming or changing the medical school curriculum because I think there are so many different downstream effects from that, starting to really integrate clinical medicine and all the important aspects of clinical medicine together. I know that talking to my former colleagues, it continues to influence and shape what people are doing. I think the support we’ve been able to provide as a department to efforts like our support of the homeless – and development of the racetrack clinic and things that I personally haven’t done but when you become a department chair or administrator you start looking to get your sort of rewards at different levels. The ongoing development of innovative training programs for our residents. I think the research that we’re doing really matters. I’m very excited about looking at how mental healthcare is provided -- for changing that because while we know a lot around how mental healthcare can be provided on an everyday basis, what actually happens in practice is much different. I think we’re contributing some very unique perspectives on that. I think you look at some of the just individual interactions. Another story I like to tell is of the woman who I first treated in the emergency room during residency and had this large mass in her breast that turned out to be breast cancer and made house calls in this sort of run-down place and you could see that it was probably very beautiful at one time, very distinctive iron work and you went into this house and it was just beautiful woodwork and these old books and things but there were 50 cats running around. By and by I learned that this lady was a madam and this was a house of prostitution at one point and I think the very day that I was to leave for Lancaster, loading up the U-Haul, learned that she died and went and pronounced her dead. I guess to me that’s a sort of fitting place to close, it’s a reflection of what we do as family doctors, seeing people in the emergency room, making house calls, finding out unique aspects of someone’s life and eventually the life comes to an end and providing care all along that continuum and all those different places is something that I’m very privileged to do and ultimately I think most of us, while we’re proud of all kinds of other accomplishments and things that end up on people’s TVs, it’s probably that person-to-person care, ultimately those relationships that one can be most proud of.\n\nWould you like to close there or are there any last thoughts you’d like to add? This is your opportunity to share your thoughts with future generations who might listen to this tape or set the record straight on anything you think is important to address? \n\nI hope that somebody listening to this, say 25 years from now would be able to say, my goodness, it’s bizarre that they didn’t have universal coverage, that people were going without healthcare, bizarre that people didn’t have family physicians and that before my life comes to an end, we’re in a place where everyone has the wonderful ability to work with a personal family physician and doesn’t have to worry that they won’t have the funds to cover their healthcare, that we really have made a difference. So since 1969 when our discipline got to be really started, although the general physicians came before then, 1948 or so, but if you go from 1969, say 50 years from then, if I do my math, that’s 2019 so 12 years from now, it’s probably pushing it but maybe a 50-year anniversary of family medicine, we’ve actually gotten to that point. I really appreciate this opportunity. I did most of the talking but I guess that’s the point of it.  \n\nThat’s it, it’s your oral history, we want to know what’s important to you.\n\nAnything else you’d like to know?  \n\nOnly if there’s anything else that you’d like to address. Anything that we didn’t cover or go more in depth in.\n\nI think that’s a good place to end. Appreciate very much the opportunity to chat one-sided with you.  \n\nThat’s kind of how these work.\n\nI hope this has been valuable to you.  \n\nOh yes.   \n\n(Taped conversation ends.)","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/154163/file/283387#t=0.0,3773.30948"}]}]}]}