{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/zk55d8qp0n/manifest","type":"Manifest","label":{"en":["Dr. Herman Drill"]},"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":["1985 (created)"]}},{"label":{"en":["Format"]},"value":{"en":["video"]}},{"label":{"en":["Keyword"]},"value":{"en":["family medicine","family practice","American Academy of Family Physicians"]}},{"label":{"en":["Subject"]},"value":{"en":["Herman \"Tiny\" Drill, 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/collection_resource_files/thumbnails/000/290/342/small/DRILLHERMAN%281985%29y.mp4_1756928539.jpg?1756928540","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342","type":"Canvas","label":{"en":["Media File 1 of 1 - DRILL_HERMAN_(1985)y.mp4"]},"duration":892.19137,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/290/342/small/DRILLHERMAN%281985%29y.mp4_1756928539.jpg?1756928540","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/290/342/original/DRILL_HERMAN_%281985%29y.mp4?1756928538","type":"Video","format":"video/mp4","duration":892.19137,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342/transcript/83673","type":"AnnotationPage","label":{"en":["Dr. Herman Drill video transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342/transcript/83673/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Speaker 1: I am delighted to introduce Dr. Tiny Drill today. And his topic is the history of the family medicine movement in the United States and Minnesota. And I know of no one that could talk about this more authoritatively than Tiny, who's lived through all this. And I can remember just as a medical student and as an early practitioner hearing your name but not really knowing you, but appreciating the tremendous work and effort that he was putting into helping to develop the groundwork for what turned out to be family practice residencies. And in fact, I think it's honest to say that if it hadn't been for Tiny, I doubt if we would be here right at this time. And certainly not only on the national level, but all the negotiations that were necessary on the local level at the University of Minnesota to get the program off the ground. So because of all that, we're really pleased that you're here today and look forward to your presentation.\n\nDr. Herman \"Tiny\" Drill: That's awfully nice of you, to say all those nice things about me in introduction, but I think it must be obvious that many other people had a hand in shaping the Academy of Family Practice. To begin with, I want to straighten something out. I may be referring to the American Academy of General Practice and at other times the American Academy of Family Practice. The change came about along about the same time in the 1960s when the applications for a board had been submitted and there was some criticism on the part of many that to say it was ... continue with the Academy of General Practice wasn't quite what we meant. To get a board, we had to make some definitions of what family practice really was. And many definitions were submitted before the Congress of Delegates accepted one. Along with that, there was a proposal to change the name from the Academy of General Practice to what we are today, the American Academy of Family Practice, because this is really what the training program was to be all about.\n\nDr. Herman \"Tiny\" Drill: I want to take you back [inaudible","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342#t=0.0,188.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342/transcript/83673/annotation/2","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"]. As I told a few of the boys, I've been around now in practice for 54 years. I came to Hopkins in 1930. Back in the '30s, I can tell you that the first surge towards specialty training began not in general practice to be sure, but training in surgery, pediatrics, internal medicine and the like. Those specialty trainings as they developed then also changed through the years, through the '30s up to the Second World War. And this is the transitional area for what I'm going to talk about today. Back in the '30s, the trained general surgeon did everything. He did the general abdominal surgery, he did the hip fractures, other fractures, he did the nephrectomies, he did what pulmonary surgery there was, and there was very little because many of these things evolved after that period in medical history.\n\nDr. Herman \"Tiny\" Drill: So the internist did everything. He took care of the pulmonary problems, he took care of all the sick people. He was a general internist. It's hard to find one today because they fragmented themselves into so many different parts, pulmonary, diabetes, nephrology, you name it. There's a specialty for everything, so everything's going down the tube and there's nothing going laterally the way we planned to go. So that in the '30s then, it became apparent that more and more students as we approached the '40s were going into specialty training. Along about that time, 50% to 60% of graduates in Minnesota at least were going into general practice, the other 40 or 45% went into some sort of specialty training. Well, then the Second World War came along and many of the boys who had been out maybe from the early '30s up to 1941 when Pearl Harbor and all this happened got into the service. They were in then for the next three, four years.\n\nDr. Herman \"Tiny\" Drill: That did something to general practice because these men that were in general practice saw that maybe they ought to go into some specialty when they got out instead of going back to the old stand, \"I broke it up now, I might as well go on and specialize in something.\" Up to that time, the field of psychiatry was wide open. Actually, in school we were all taught neuropsychiatry, neurology and psychiatry were together. Obviously, neurosurgeons were few and far between, and those that there were carried a horrible mortality rate on the people that they worked on. We didn't have all the sophisticated equipment to work with. The neurologist had to try to locate where the brain tumor was from clinical symptoms and findings. He didn't have any scans that he could throw up on the screen and say, \"There it is,\" and then go after it.\n\nDr. Herman \"Tiny\" Drill: So, many of the boys got out of the service and went into psychiatry. A lot of general practitioners took up a residency in psychiatry. Others went into internal medicine. That was another popular one. And then about that time, the surgeons were beginning to break away from orthopedics, they weren't doing that anymore. So that the university began to set up a department of orthopedics, which had prior to that time been a part of surgery. So many of them went into orthopedics. By the 1946, after the war was over, we found that the number of students graduating from Minnesota going into general practice had dropped down to about 33%. The doctors that had been in these smaller towns, that had been there for as long as I've been in Hopkins, maybe longer, died off, but there were no new young people going in to fill these small communities.\n\nDr. Herman \"Tiny\" Drill: Furthermore, at this time there was a little move toward doctors joining together into small groups, clinic groups, three, four, five doctors. In Minnesota, the Northern part, maybe there'd be five solo doctors that would get together in a place like Little Falls and open up a clinic there. Well, that left five communities without a doctor. So there was a lot of hue and cry among the people up there that said, \"Gee, we need a doctor in this community.\" And, \"Now we have to drive all the way to Little Falls.\" Using that as an example. So as that kept on being beat around, the legislators began to get into some of this and they said, \"Well, the reason that doctors that are coming out aren't going into general practice and filling these spots is because ... is inadequate hospital space, there's no place to take their patients. If they have some real sick patients, they have to take them way over to Little Falls or what have you, 20 miles, 15 miles away. We want to correct this.\"\n\nDr. Herman \"Tiny\" Drill: And out of this came the Hill-Burton Act that said okay to a community, we'll have some federal funds here for you and help you build a little hospital and that'll help you get a doctor. Well, the truth of the matter is it didn't. These hospitals were built around way up in the Northern part of the state, some of them close to the border, they were never used. So still couldn't get a doctor. By this time, medicine was becoming a little more sophisticated and the doctor said, \"No, we don't want to go up here unless we can have well-trained nurses and well-trained anesthetists to put our people to sleep and do all of these things that we do in our hospital.\" So from my point of view, Hill-Burton flopped out on helping the situation of providing doctors out into the community.\n\nDr. Herman \"Tiny\" Drill: Along with this, the big problem east of Chicago, in the big cities was that the GPs were being frozen out of the hospitals, they were being denied privileges that they had previously enjoyed. You have to remember that many of these general practitioners when they got out, sometimes would affiliate themselves or scrub in with an established surgeon for a period of a year or a year and a half, and by getting that exposure and the expertise that he had and so on, they would finally start going on their own. They'd take out some [appies","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342#t=188.0,689.0"},{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342/transcript/83673/annotation/3","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"] and do some gallbladders and do some C-sections and what have you. The surgeons in those days, even when I started out, were much more oriented to teaching the general practitioner to do things right rather than letting him go on to do them wrong. And I can recall that when I first started out, I always had a well-known surgeon in Minneapolis who scrubbed in with me on cases.\n\nDr. Herman \"Tiny\" Drill: Even the cases that I later did myself, aspired to doing such like the vein stripping, the ones that were being done, hemorrhoidectomies, et cetera. And after a certain period of time, the surgeon said, \"Oh, look, you can do this just about as good as I can, so why don't you do them yourself?\" Well, that day is all gone by, they don't do that anymore. Doctors in general practice who had been accustomed to doing some of these things in the hospitals very well and now the surgeons who had been trained and who were now belonging to the American College of Surgeons, et cetera, begun to look at these fellas with a jaundiced eye and say, \"Hey, you shouldn't be doing this thing.\" Now, that wasn't entirely wrong because the thing that created all this upheaval was that there were some fellas in general practice that were doing things they shouldn't be doing and they were getting bad results. Today, you could never do this anymore because our society has changed too, because now we've become so suit conscious that everything you do is done defensively because you might get sued.\n\nDr. Herman \"Tiny\" Drill: When I came out in practice at Hopkins, my malpractice insurance premium was $35 a year. Now I don't do any surgery now, no OBs or anything and it's well over $2,000 a year. This is sometimes hard for me to ... it bothers me a little bit. And part of it is that the public is suing, suing, suing, whether they're justified or not. And many of the suits that are leveled off against doctors are finally just settled on what they call a nuisance basis, but it costs money to do it and the premium keeps on going up. In the Middle West and the West, the men in general practice didn't have quite such a hard time. We didn't have too much trouble in the Metro area here, although some of the prima-donnas in surgery, surgery was the big deal, said, \"These fellows shouldn't be doing this thing.\" So out of this then, with the lack of graduating students going into general practice, along with the hospital privilege problem ...","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2195/collection_resources/159372/file/290342#t=689.0,892.19137"}]}]}]}