AAFP President Patrick Harr, MD, of Maryville, MO, was in the first class to complete three years in one of the first family practice residencies. In this Q&A, he shares his experiences as a resident.
Q. How did you choose your residency?
A. I was at the University of Missouri medical school in Columbia, and Dr. Gene Farley came from Rochester, NY, to a residency fair. He'd been in rural practice, and we talked, and we hit it off.
So I visited Rochester the last week of December in 1968. I told the faculty I wanted to do OB, Caesarean sections, intensive care work, ER, all the things that would be required of me back home, where the nearest traditional specialists were 50 miles away. Gene said, "You can do it. We've got it. You tell me what you want, and we'll set it up." They did.
Q. What roles did different faculty members play?
A. Gene, as program director, was involved in the day-to-day teaching in the family practice clinic, as were Dr. Jack Froom, of Stony Brook, NY, and Dr. Don Treat, of Keane, NH. Dr. Linda Farley worked primarily in the neighborhood health center. We'd go do well-baby care with Linda and help her with preventive medicine.
Dr. Ted Phillips worked in the clinic and arranged rotations. I gave him fits. I'd say, "I've got to get this kind of training, and if I can't get it, I've got to go somewhere else." He'd say, "Just give me time, and we'll work it out." I was impatient. I had an agenda.
At the time, I didn't understand how blessed I was with that faculty. Now, when I talk to students who are going into family practice, I tell them, "Talk to your faculty. If you find someone who has a history in what you want to do, sometimes you have a perfect mentor, and to be able to spend three years with that mentor in ongoing clinics, it's like an absolute gold mine."
I tell them there'll be things you'll think will be ridiculous, irrelevant, but once you get into practice, you'll use that training. Don't be too cantankerous.
Q. Did you think anything was irrelevant?
A. It was no secret I didn't want to do a psych rotation. I thought it would be a waste of time. I spent most of my electives in OB-Gyn, and several of my residency mates had no interest in that. If they didn't want an OB elective, I'd take it. I ended up having a year out of the three in OB.
Finally Gene and Ted both said, "If you don't do the psych rotation, you don't graduate." So I spent my last three months in psych.
I had some very difficult patients. I was asked to see a lady who became psychotic after her son died of leukemia at the age of 7 or 8. She'd been virtually incommunicative. It turned out that I had taken care of her son on my pediatrics rotation, and when I walked into her room, she recognized me. Our mouths dropped open, and she started crying and gave me a big hug. We just went on from there. She got better and went home.
Now, the way I take care of patients with anxiety, depression, or adjustment disorders stems back to the discussions we had at the residency. I use the same format--asking the right questions, probing, not accepting glib answers, appreciating that a lot of the body complaints we see have a psychiatric cause.
Q. What's been the impact of the Rochester residency on you and on family practice in general?
A. I've always felt a strong bonding to my community, and a lot of that came from Gene's commitment to community. As for the residency's impact on the specialty, if you look at the graduates from that program's first 10 years, they're some of the leading educators in family practice.
Q. Since 1972, when you completed your residency, how has the specialty changed? And what's the same?
A. What's changed is the marketplace. We've gone from almost 100 percent fee-for-service to differing degrees of managed care and discounted fee-for-service. The system has changed from being specialty-dominated to putting an emphasis on primary care in general and family practice in particular. Learning how to adapt to that change is a major shift. Some of our doctors are suffering, some are doing well. What we have to do is identify the areas that create problems and correct the problems.
The need to obtain the broad knowledge that's necessary to be a good family physician is still there. And our basic doctrine--building a trusting relationship with individuals and the family--is still the heart of the specialty.
Editor's note: The Farleys recall Dr. Harr as a "family medicine moralist" during his residency. Many evenings, the faculty, residents from various specialties, and others would pack up laboratory equipment and lights and drive to migrant labor camps to set up clinics. "Pat would be frustrated that internal medicine or pediatric residents didn't know how to take care of a mix of patients," says Gene. "I think he taught several pediatric residents how to do pelvic exams."