This is a birthday salute to the American Board of Family Practice, and it starts with an ear infection and stomach bug.
Flu was a childhood curse, a sudden assault in the middle of the night. I rarely got to the bathroom in time. I would call out and mother, openhearted, would worry along with me as she cleaned the bed and folded a double towel on my pillow. In the morning I heard her make the call.
Soon enough Harold Smith, one of the town’s two doctors, would be at bedside, leaning over me. Dr. Smith had one of those bags – his was black – that doctors lugged around in those days. When he opened it by the bed, vapors of healing poured out – a reassuring medicinal scent, of alcohol and elixirs and mysterious potions – and I knew things would be better.
Herb Songer’s bag was brown. It opened the same way, folding away from the top, the slender top compartments snap-covered. Toward the bottom, among various bottles, tools and gadgets were the covered stainless trays that held hypodermic needles and syringes.
As the doctor loaded his syringe, the vial seemed the size of a milk can, the needle a 3-inch nail. There were pills, too, dropped from one of the bag’s bottles into a small envelope, instructions jotted on the outside.
When not making house calls, Drs. Smith and Songer presided at a small clinic – the doctors’ office, everyone called it – and made rounds at the county hospital, where they performed surgery and delivered babies. They removed tonsils from a lot of young throats, including mine, and in that hospital cared for those who were quite sick, or on the mend.
Our doctors were like others, fixtures in a small town, involved in community activities, and they knew almost everyone and most of their pets. They had children who were playmates and classmates. They were part of us, knew all about us and we trusted them to heal us. It was an era of the town doctor as community principal – healer, father confessor, therapist, life coach, minister to the sick and hypochondriac alike, one who saw all, heard all, and spoke none of it.
By the 1960s, specialties had taken hold in medical schools. Surgery, and its sub-specialties – thoracic, orthopedic, neurologic, and others – were popular. The specialist acquired an elite aura, the faint glow of a halo. General practice was seen as a diminished pursuit, one without fine-tuning. A reality had been lost, or trampled over: the family physician was every bit a specialist, first in the line of know-it-alls.
From one moment to the next, the general practitioner may see an obstetrics, then a schizophrenic, then someone with hypertension and diabetes; next, a well-baby check, a busted foot, a gashed leg, a sore throat, a punctured ear drum, herpes, even a snake bite. For starters. This doesn’t include the beat-down or stressed out who just want someone to talk to. Most ailments and injuries, even psychological pitfalls, can be handled by family doctors without sending patients into the outer world, the vortex of specialized medicine. When a patient presents complications beyond the reach of family practice, something truly puzzling or complicated, he or she may be referred.
All of this had come boiling up in the pantheon of American medicine when it struck home that America’s families were short on family physicians.
In 1969, high status came to a long-neglected discipline, and the American Board of Family Practice was born. It can have other headings – Family Medicine, Family Physicians – but the idea remains the same. Setting family medicine as board-certified confirmed standing for the “general practitioner” as a specialist of equal footing with neurosurgeons, gynecologists, urologists, thoracic surgeons, oncologists and the other expert ranks in American medicine.
The U.S. had put a man on the moon and the local doctor on high ground. Until then, there were 19 specialties in medicine. Family Practice (Medicine) became the 20th.
Herb Songer and Harold Smith retired but lived long enough to see the changes, from country doctor to family practice, the end of house calls and the beginning of family medicine as something special, if less personal and more hurried. What hasn’t changed are the bugs that strike, the bones that break, wounds that need healing, disease that needs attention, the worried looking for solace. When things get complicated, there is telemedicine. Or a sub-specialist up the road.
We have local clinics, if not enough of them, and nurse practitioners and physician assistants have come to help. There is now a university school of (rural) medicine in Salina, a branch of the gargantuan KU complex in Kansas City. The evolution and elevation of family medicine has been slow, and not without its struggles. But the effort continues in the cities and out here in the hinterlands.
For that we give a nod. Happy 50th to Family Medicine, and cheers to the new Herb Songers and Harold Smiths, still trying to make it work.