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«Memories, Reflections, and Stories of Hoosier Family Doctors of the Mid-twentieth Century Written and Edited by Richard. D. Feldman, M.D. (EXCERPTS ...»

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Family Practice Stories

Memories, Reflections, and Stories of

Hoosier Family Doctors of the Mid-twentieth Century

Written and Edited by

Richard. D. Feldman, M.D.

(EXCERPTS GENEROUSLY PROVIDED WITH PERMISSION OF THE AUTHOR)

Copyright 2012

Richard D. Feldman, M.D.

And

The Indiana Academy of Family Physicians Foundation

This book was supported by

The Max Feldman, M.D. Memorial Fund, Indiana Academy of Family

Physicians Foundation

Family Practice Stories Book Fund, Indiana Academy of Family Physicians Foundation Family Medicine Philanthropic Consortium, American Academy of Family Physicians Foundation The Center for the History of Family Medicine, American Academy of Family Physicians Foundation Introduction Our family doctor is retiring the first of November. What a surprise. One never thinks about his doctor leaving, always taking it for granted that he will be there.

And he was, whenever we needed him - in the middle of the night or during his working hours. He always took the time to listen and advise.

From measles to mumps, sprained knees to broken bones, heart attacks to surgery, he was ever present, reassuring and helpful. We never worried....Some would say it was his job, his profession, his duty to be there. We look at it differently.

We weren't a dollar sign - we were people in need.

He was and is a good family doctor we will miss you, sir This letter, that captures the essence of the traditional family doctor, was written to the editor of the South Bend Tribune in 1983. It's about my father, Max Feldman. A family doctor in South Bend, Indiana for nearly 40 years, he passed away in 2003 at the age of

93. I believe he was exemplary of the traditional family doctor that these words capture so wonderfully; the physician who many have experienced in their lives and fondly regard. I am proud to be my father's son, but he was not unique. He was only one example of so many good family doctors of his time.

My father was a person of great character and determination. He was devoted to family and profession, and served as a primary role model in my life and in my career as a family physician. His life in many respects is not only the story of America but the story of family medicine.

His family came to America through Ellis Island in 1920 seeking a new life free from poverty and anti-Semitism. As a child, his entire family lived in a fourth floor singleroom tenement apartment on Delancy Street in Manhattan. He worked his way through school and did well. Dad was one of the most intelligent people I have ever known, but because of the quota system in those days that limited the number of Jewish students admitted to American medical schools, he was unable to gain acceptance.

He returned to Europe to attend medical school at Konigsberg, Germany and Basil, Switzerland. My father was a courageous individual who defied the Nazis in 1933 as a young medical student. He endured the Great Depression and was valiant as a medical officer at Pearl Harbor on that infamous day in 1941. Typical of that "Greatest Generation," his character and values as a person and a doctor were shaped by such experiences. It was from this generation of family doctors, our founding fathers, which the contemporary specialty of family medicine grew.

After graduating medical school in 1937, my father completed two years of rotating internships in New York City hospitals. I remember Dad telling me that during his first internship, he lived at the hospital and made $15 a month! After his training, as did most new physicians at that time, he went into the general practice of medicine. He called himself a general practitioner. In those days, it was not a demeaning term or a term that signified something less than what you were.

My dad was kind, modest, and unassuming in nature. Possessing a wisdom that came with experience and understanding people, he was always pragmatic in his approach to situations and life. He was known as one of the brightest and best family physicians in South Bend. He displayed an incredible fund of medical knowledge and always amazed me with his understanding of the physiologic basis of disease processes. He only consulted when he reached the limits of his abilities. He read his journals every night, he saw his patients in the office and in their homes, and he took care of them in nursing homes and in the hospital, even some who were critically ill. He delivered babies, set many of his patient's fractures, and performed tonsillectomies.

Today, the concepts and core values of the discipline of family medicine are incorporated into standardized formal residency training and board certification. But no family medicine residency programs existed in those earlier days. The principles of comprehensive and continuous personalized patient care came to him and other general practitioners of his generation by experience and sensitivity to the needs of their patients.

They knew their patients well and were committed to their communities. Especially in small towns, they were among the most respected individuals and were considered as trusted friends by their patients. They seemed to intuitively understand, as William Osier once said, "It is more important to know the patient than to know what disease the patient has."





The formal specialty of family medicine was created from these best traditions and attributes of general practice. But as well-known family physician and educator, Nick Zervanos, M.D. once recounted, it was created out of necessity. The over-specialization of medicine in post-war America reached a point that threatened the very survival of the general practitioner.

It was at a time when medical knowledge, research, and technology were exponentially expanding, stimulating the development of the medical specialties. The GI Bill helped pay for medical school and up to four years of residency training, so the number of specialty residencies grew swiftly and the ranks of specialists swelled (there were no general practice residencies).

Graduating medical students flocked to the specialties that offered greater prestige, larger incomes, and with the explosion of medical knowledge, the security of mastering only a limited area or organ system. Many felt general practice was simply on its way out.

General practitioners returned from the war finding it difficult to obtain hospital and surgical privileges in the new age of specialized medicine. Although held in esteem by their patients, general practice physicians, especially in metropolitan areas, felt disrespected by the larger medical community. The family doctor was fading.

In reaction to these threats, generalists rallied in support of their profession. The American Academy of General Practice was founded in 1947 for the purpose of garnering political voice, protecting hospital privileges, preserving the practice of general medicine and encouraging new physicians to enter the field, promoting continuing medical education and research, and maintaining high standards of medical practice for its members. General practice continued to struggle but the new organization was successful in enhancing the public's recognition of the general practitioner's role in medicine.

Yet, across the entire country, the lack of family physicians extended to every segment of our nation. The loss of the trusted advisor and compassionate counselor, who cared for every problem, for everyone in the family from birth to death, was lamented by the American people. The time-honored general practitioner, who took the opportunity to talk and develop on-going relationships with his patients, advocated for them, and coordinated their health care, was still highly desired.

Society was changing. Health insurance was made more available to American workers, but there was increased concern for the availability of medical services for the poor and elderly. The vision was for a health care system based on all patients having a medical home with a personal physician. It was evident to government, academic and organized medicine, health-related foundations and associations, the press, and the public that something had to be done to satisfy this societal need; thus, the new specialty of family medicine was born.

The creation of the American Board of Family Practice in 1969 established family th practice as the 20 medical specialty and reversed the trend away from primary care by bolstering the stature of the family physician within American medicine. Thefirstthreeyear residency training programs in family practice were established that year. The American Academy of General Practice was renamed the American Academy of Family Physicians in 1971. Today, patient visits to family doctors account for the largest proportion of doctor's office visits.

Family physicians do not have a monopoly on what's good in the medical profession.

Family physicians are not better than other doctors, but they are different. They continue to be the heart and soul of medicine. More than any other specialty, family doctors humanize the health care experience. Focusing their attention on the person, not just the disease, they are driven to develop relationships over generations with the patients and families they care for and by the need to make people whole. Ask any family doc what makes his or her profession rewarding and fulfilling and that's what they will tell you.

That's what family physicians do.

Sure, I present the family doctor as a romantic and idyllic figure in American culture.

But I believe it is real and validated by anyone who has had a long-term, comforting and reassuring relationship with their family doc.

A few years ago the discipline of family practice underwent an organized in-depth selfevaluation called the Future of Family Medicine Project. The initiative's goal was to identify its core attributes and develop a strategy to transform and renew the specialty to meet the needs and expectations of the contemporary American public. Even the name of the specialty was changed from "family practice" to "family medicine". The final report from the project concluded that family practice must reformulate itself and reconstruct its place in medicine to assure future public confidence. But the core values of family medicine remained unchanged. It's not surprising, because they define our very identity and our uniqueness. It is simply who we are.

The medical world has changed radically in the last twenty-five years, and the family physician has not been immune to these developments. Medicine is again overspecializing, fueled by corporate interests and a market-driven health care system. It is a paradigm that promotes the expansion of procedural medicine and specialty practices squeezing the last and most profitable dollars from the health care system. Primary care physicians are increasingly employed by health care corporations that judge and pay them mainly on the basis of productivity. Our reimbursement system is not designed to reward spending time with patients to counsel and educate, or to promote health and prevent disease, or to develop the necessary therapeutic relationship by knowing the patient as a person. Medicine is becoming increasingly depersonalized as a system largely dominated by a business ethic. Patients can easily become widgets.

I was recently reminded of the thought that we see the future by standing on the shoulders of the past. No matter how medicine changes, the future will belong to those physicians who deliver caring, humanistic, and compassionate care. That's what family doctors do.

And that's why family medicine will hold a central role in the inevitable transformation of the American heath care system in the new millennium.

Family Practice Stories is a collection of stories told by, and about, Hoosier family doctors practicing in the middle of the last century. It celebrates that time in America considered by many to be the golden age of generalism in medicine. It is a book about a time gone by, a time when professionalism, the art of medicine, and the art of healing were at a zenith. It was a simpler time that conjures up Norman Rockwell's familiar archetypal images of the country family doctor. Writing this book was an important endeavor to accomplish, for it captures those stories before they are lost forever.

May this book be a source of pride for family physicians and portray to the public who we are, what we do, what we believe in, and the proud traditions from which we come.

May it serve as a remembrance of the lives of these family doctors, their style of medicine, and how they touched their patients and communities.

We're family physicians. We're different. And we have a story to tell.

Richard D. Feldman, M.D.

January, 2011 Three Generations of Family Docs

–  –  –

I never thought of any career other than medicine. My dad was a doctor, and I always loved what he did. He would take me on house calls and to the hospital. My father attended medical school in Chicago, and then went to Minnesota where he met my mother and married her. He came back to Champaign IL and established a practice.

He did the first c-section ever done there. Dr. Bergen here in Frankfort urged him to come back, so he came back here in 1921. He was a general practitioner at a time when they really did everything. He did all kinds of surgery, gave anesthesia, delivered babies, all kinds of orthopedics, the whole nine yards. In those days, doing all that was not at all unusual.

We were going to practice together, but he had a heart attack and died in May of that year. I was planning to come back to town in June. I really loved him. My dad and I were really close. The day he died, I think, was the saddest day of my life. It was so sudden.

th I started my practice on my 30 birthday in 1955. Dad had an x-ray machine in his office and a room full of prescription medications he would give to patients. He had a 5x7 card for each family. On one side was the financial record, and the other side was the medical history. So, that's what I started with. After about 2-3 months, people came in to talk about their problems, and I had no idea what they were talking about. I decided that I would have to have more complete record, so I started with regular sized paper and files. Everything was handwritten of course.



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