MADISON, WI--Some of the country's first family practice residents learned from Drs. Eugene and Linda Farley how to make family/community connections in the late '60s.
Today, the Farleys still teach those concepts as emeritus faculty at the University of Wisconsin. They find medical students and residents eager to provide direct care to the area's needy and to raise supportive funds through Slammer Jams and Polar Bear Plunges.
Dan Schaefer, a second-year medical student, helped organize a Slammer Jam in November, dragging community leaders to "jail"--the back section of a popular bar and restaurant--and having them call friends for "bail." The $28,000 collected went to Camp Heartland, designed for children with HIV/AIDS.
"I'm trying to follow in the footsteps of the Farleys," says Mr. Schaefer. "I'm staying active in the community while I'm in med school."
The school's family medicine interest group sponsored a Polar Bear Plunge Dec. 7. Thirty students collected pledges, cut a hole in the ice on Menona Bay, and jumped in. The $2,200 in pledges will help support the South Madison Health and Family Center, says medical student Steven Murphy, a plunger.
The center is one of three medic clinics started by family medicine, internal medicine, and pediatrics faculty and students. The free clinics have two purposes, says Dr. Linda Farley: to provide health care and social services to the uninsured and to expose medical students to the social and health problems of the indigent.
The Farleys have been committed to making family/community connections since their first rural practice at Many Farms, AZ, in the middle of a Navaho reservation. That's where, in the mid-'50s, they conducted the first study of ambulatory care of tuberculosis patients, cosponsored by the tribe, the Public Health Service, and Cornell University in Ithaca, NY. The Farleys also provided primary care there.
On the Navaho reservation, the Farleys filed charts according to Navaho camps, a process allowing them to identify people exposed to patients with TB. Later, in family medicine programs, the Farleys promoted charting according to patients' households, color-coded by area of residence, to facilitate the tracking of illnesses.
As they cared for the Navaho Indians, the Farleys worked with medicine men and sometimes attended a "sing" that the clan, family, and medicine men would hold for a sick person. "The medicine men never separated out the emotional or mental problems from the physical," says Linda. "The idea of harmony and the healing power of friends and family impressed us deeply."
At Many Farms and in their next practice in the small town of Trumansburg, NY, the Farleys came to this conclusion: The difference between good care and mediocre care is knowing how to work with the family and community. "You have to understand the support systems that let the patient develop and function," says Gene. "We evolved into family physicians before we knew what family practice was."
Pioneering in Rochester
In 1967, the Farleys went to Rochester, NY, where Gene chaired the new family medicine department of the University of Rochester and Highland Hospital. Linda worked with developmentally disabled children, served in a community health center, and helped train the residents and medical students.
Gene hired Ted Phillips, MD, who taught there for a year before opening a family medicine department at the University of Washington in Seattle. "We complemented each other," Gene says. "I'd push the psychosocial, and Ted would push to make sure the residents were good generalists in the biomedical. You'd think, 'Those two guys are opposed. They're talking a different language.' We weren't."
Gene first focused on establishing a clinic where the residents and medical students could experience family practice in action. "I called our practices our laboratories and our classrooms," he recalls.
He chaired the new residency until 1978, then served as family medicine department chair at the University of Colorado medical school in Denver. He chaired the University of Wisconsin family medicine department from 1982 to 1992.
Teaching national connections
The Farleys' interest in the community and the way health care is (or is not) provided gives them something to say about the health care system. Linda tells medical students that not-for-profit HMOs devote about 8 percent of premiums to overhead and profit, but for-profit HMOs put 16-27 percent of premiums toward overhead and profit.
Gene warns students, "You will be entering the practice of medicine before we have resolved two things: how we're going to make sure 100 percent of the people in this country are covered for health care and how we can stop having two to five levels of health care, depending on people's pocketbooks."
The Farleys' solution: The government should fund but not run a single-payer system. "Already, 70 percent of total spending on health care comes from the government, from our taxes," says Linda. "One suggestion to consider is to start by extending Medicare to cover all the children in the country. It'd be a federally funded program, and children are cheap to care for, compared to the elderly."
The Farleys find the students eager for information on the health care system. Perhaps the students see their responsibility to improve the system as an extension of the family/community connections the Farleys have taught for 28 years.