50 Years of American Family Physician
Am Fam Physician. 2000 Apr 1;61(7):1974-1984.
Lately, everyone has been focusing on a major milestone—the new millennium. But here at American Family Physician, we're celebrating an anniversary closer to our hearts: AFP's 50th anniversary. Throughout the year, we're featuring glimpses of what it was like 50 years ago for the journal, family practice and medicine in America (see page 1951). And since AFP and I both recently turned the same age, it's made me do a lot of thinking about my own career path to becoming a family physician—which brings me to my dad.
Dr. Siwek senior showed me what it meant to be a family doctor. When I went to medical school at Georgetown, my concept of being a doctor was pretty much to be like him. That's something I'm still trying to do. He's been a family physician longer than this journal or the Academy has been around—more than 55 years now. And he still works harder than me. He loves doctoring and he loves people. So, in planning for this anniversary piece, I thought it might be nice to see how family practice has changed, and how it hasn't, and look at it through his eyes.
Dad is a small town doctor in Harrison, New Jersey. He's in solo practice, and he's a general practitioner in the true sense of the term. Besides caring for children and adults, he has done deliveries—thousands of them. He's delivered the children of children he's delivered. He's delivered the only set of triplets in his county. He's attended weddings where he had delivered both the bride and the groom. And, speaking of solo practice, I remember him driving up from the Jersey shore during the middle of summer vacations to deliver a baby or admit a patient.
Back then, he tells me, OB patients stayed in the hospital for 10 days, for a total hospital charge of $90. They had nine days of complete bed rest, and then they were sent home on the 10th day. After all that bed rest, they were too weak to stand and had to be wheeled out. His total charge for prenatal care, the delivery and postpartum follow-up was $50. Once, he sent an indigent maternity patient home on the fourth day to save her some money, and was roundly criticized for the premature discharge. And to save another indigent woman the hospital fees, he labored with her at her cold-water-flat for 24 hours on Christmas day, finally delivering her of a 14-lb baby.
He did tonsillectomies, at a rate of two to four a week, for a charge of $35, back when everyone, including me, got their tonsils out. He did appendectomies, herniorrhaphies and set fractures. And, he made house calls—lots of them—for $3 each. (Office visits were $2.) My mother, a registered nurse, was his office nurse, receptionist and bookkeeper. They did it all, at a time when the paperwork was simpler, of course.
What else was different then? Infectious disease, for one. That was when whooping cough, measles, mumps, rubella, polio, diphtheria and smallpox were routine. (The family practice residents in our program have never seen any of these once commonplace conditions.) Besides immunizations, antibiotics were a major breakthrough. Penicillin was initially scarce, and dosing was much different from the megaunits of today: 15,000 to 30,000 units of penicillin were plenty in those days. But aqueous penicillin had to be given frequently, every two to three hours. For one house call, my mother and father took turns going to the house every three hours around the clock to give an injection, saving the patient a hospital admission. In addition to the cost of hospital stays, small as they seem today, people were afraid to go to the hospital. Mortality rates were high, and people preferred being cared for at home. Hospital wards were typically multibed units, with double or single rooms rare or nonexistent.
To prolong the effect of penicillin, and reduce dosing, for a time it was mixed in melted beeswax. This was injected in the buttock, and supposedly lasted for up to a day. My father remembers the mixture solidifying twice at an unheated home. Fortunately, procaine and benzathine penicillin came along. But, the technology of the day seems rudimentary by today's standards. Injections were given using glass syringes with reusable steel needles. While I was growing up, living above my father's office, I remember seeing the glistening metal sterilizer container that all those shiny instruments soaked in. When the needles got dull, they were sharpened. In the hospital, rubber tubing was washed, sterilized and reused, and so were surgical gloves. And blood transfusions went directly from one person, through a stopcock, into another. It sure brought the sense of “giving life” closer to home.
In addition to his office work, my father had a busy hospital practice. At age 82, he still does. When I asked him recently how his work was going, he admitted that the hospital practice was “slowing down.” How many patients was he typically following? Only about eight or 10 at a time. (When our family practice inpatient service hits double digits, the three residents who staff it feel like things are getting busy). And if you want to get a good night's sleep, don't visit Dad. He can get hospital calls all night long.
To round things out, my father's been team doctor for the high school football team for 50 years, watching the games from the sidelines. He's also town doctor for the police and fire department.
Turning 50 recently, I took a week off work and my wife and I visited old friends. I also did something I've wanted to do for a while—visit my dad in his office, this time as a family physician myself, and accompany him on hospital rounds, as I did when I was little boy. We made the rounds from patient to patient, and nurses' station to nurses' station, where they all had to tell me what a great doctor he was. One nurse told the story of how this “Miracle Man” abated her runny eyes—a side effect of cancer chemotherapy that doctors at Sloan Kettering couldn't resolve. Several nurses said that if I could be half as good a doctor as my father, I'd be doing okay.
I think my dad thinks I am doing okay—at least I hope so, which brings me back to this journal's 50th anniversary. I've been editor or associate editor of AFP for nearly 20 years now. I have my dad to thank for helping me become a family physician and for showing me how to be one. It's partly with him in mind, and all the GPs of the past and the FPs of today, that my fellow editors and I strive to put together a publication worthy of them and the noble work they do. In many ways, this journal reminds me of Dad, a great American Family Physician.
Copyright © 2000 by the American Academy of Family Physicians.
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