Tuesday, November 25, 2008

The Case for Family Medicine

Newly received: the transcript of the oral history interview with Dr. Laurel G. Case, M.D., retired general practitioner, founder and former chair of the OHSU Dept. of Family Medicine, and past president of the Oregon Academy of Family Physicians.

Dr. Case received his M.D. from the University of Kansas in 1949. After a stint in the Navy and few years of general practice in Kansas, Dr. Case moved with his family to Medford, OR, in 1955. In 1969, Dr. Case relocated to Portland, becoming the first chair of the new Dept. of Family Medicine at the University of Oregon Medical School. Under his direction, the department began a residency program; the first residents entered the program in 1971 and the University's family practice residency served as the state's only residency in the field until 1994. He served as a member of the Advisory Council established to assist in the formation of the University of Oregon Health Sciences Center, which incorporated the schools of medicine, nursing, and dentistry into one university. Dr. Case was also the first medical director of the Physician Evaluation, Education, & Renewal Program of the Oregon Medical Association.

In his interview, conducted as part of the history of medicine in Oregon documentary project, Case takes listeners from his earliest years in Kansas to his predictions of medicine in 2025. In two excerpts below, we hear about the infamous Dust Bowl storms of the 1930s and about Case's decision to enter medicine:
Case: I started to high school at Little River, Kansas, at the same town where I was born in the hospital. And I went there, I started there as a freshman in let’s see, what was it? Hmm, well, anyway, I graduated in 1940. So it had to be like ’36, you might say. Four years. The only thing is that I didn’t finish there because we had dust storms in Kansas. And we lived during that time when we had no rain for a number of years, and the wind would kick up dust storms from Oklahoma and bring them up to Kansas. It was sort of like dumping snow on top of a fence row. Only it was dust, all dust, instead of snow. And we had those for oh, about two years. We had no rain for two years. And so it was a little bit difficult.

And so my parents decided to move to Eastern Kansas, because they didn’t have all these dust storms. They had good crops and fields and trees. We had flat, just flat Kansas soil, most of which ended up in our house during that period. [laughs] So it was not really a pleasant kind of life at that time. However, we did move when I was a sophomore or a junior, the middle of my junior year, we moved to Eastern Kansas. And I transferred to the high school at Osage City, Kansas, which is about fifty miles south of Topeka. And down there we had a river on our farm, and lots of trees, and no dust. [laughter] It was fun.
Kronenberg: What made you decide to want to be a doctor? What factors were involved?

Case: Well, I think, it’s hard to know for sure whether what happened is the reason why I ended up going in medicine or not. But when I was in grade school, probably seven years old, my father had a heart attack out on his farm. And we had, the doctor, in fact, the doctor that delivered me was still practicing in that little town. And he came out to the house to see my dad. And it happened to be on the day, two days before Christmas. And he was in bed. And he came out and saw him and left, and left medicine for him. And he didn’t get along very well.
And after maybe a few weeks in bed at home with my mother trying to take care of him, she called to see if the doctor would come out again and look at him, because she was worried about him. So he said to her, “Well, I trust that you will have the money to pay me for this.” And she didn’t. And he didn’t come.

And there was another doctor there in that same town, a newer doctor, and a younger. And so my mother called him and he came right out. Didn’t even mention anything about the pay. And he made house calls after that until my dad was better. And he got well. He recovered completely. So everything turned out fine.

But I was just at a very impressioned age, at an age where I was very, very worried about my dad. Maybe six, seven years old. And somehow or other my mind took that in. I just couldn’t believe that somebody would refuse to take care of a sick patient because they didn’t have the money to pay for it. And that’s when I started my heading toward medicine. And I never varied from it from that point on.

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