PROCTOR ORAL HISTORY PROGRAM
UNIVERSITY OF FLORIDA
J. HILLIS MILLER HEALTH CENTER
COLLEGE OF MEDICINE
Interviewee: William F. Enneking
Interviewer: Julian M. Pleasants
Date of Interview: February 12, 2001
Interviewee: Dr. Bill Enneking
Interviewer: Julian Pleasants
Date: February 12, 2001
P: This is Julian Pleasants, and I am speaking with Dr. Bill Enneking. It is February
12, 2001. Would you tell me when and where you were born?
E: I was born in Madison, Wisconsin, on May 9, 1926.
P: What did your parents do?
E: My father worked for the Tennessee Coal and Iron Company in Fairfield,
Alabama, for thirty years and then went into business with my mother's brother
and was the first Ford automobile dealer in the state of Wisconsin.
P: What year was that?
E: It was 1923. My mother, who is a native of Wisconsin, had come to Alabama as a
social worker in the coal mines that was part of the Tennessee Coal and Iron
Company. They met there.
P: What was Madison like when you were growing up in the 1930s?
E: Madison was pretty much like Gainesville was when I came here, big university,
small college town, the difference being [that Madison was] also the state capital.
So it predominantly revolved around the university and the state capital. A
country of many lakes, a very nice rural setting six months of the year, frozen
tundra the rest of the time.
P: How did the Depression affect you and Madison?
E: It affected Madison not terribly badly, because the major employers were the
university and the state government, which kept on reasonably well. Because
most of my father's family lived in Alabama and Tennessee, and because we
lived in [a] rural setting outside of Madison actually, we probably had two or three
relatives from either Tennessee or Alabama living with us all that time, because
of the hard times they were having. Many of their children came up and lived with
P: How did it affect your father's business?
E: I do not really know, but we always had a good income, had a car to drive, so I
do not think it affected us terribly badly.
P: In your education, when did you first get interested in science?
E: That is a good question. I really do not know that I could tell you any one time. I
was very much into athletics when I was in high school, and I started at the
University of Wisconsin on an athletic scholarship. Then, when it became obvious
I was about to be drafted into the Army, I enlisted in the Navy. That was 1943.
Enlisted in the Navy and was sent to the Great Lakes training center in northern
Illinois, where we were all herded into a big hall and took a day-long test. After
that, I was assigned, after I finished boot camp, to medical corps training. When I
finished that, I was assigned to a minesweeper up in Alaska as the corpsman. I
had been there a couple of months when I was ordered to go back to Great
Lakes and was told that I had been assigned to the V-12 program, which was a
Navy-sponsored college program, on the basis of this long-ago test that I had
forgotten about. I was sent to Purdue University in Lafayette, Indiana, which was
primarily an engineering school in those days, I guess still is. I got there, and they
asked me what courses I wanted to take. I said, well, I was a physical education
major at the University of Wisconsin when I first went there. They said, we do not
have a program in physical education, but we do have some courses that would
probably tie in with that, but they are in the pre-medicine course. I spent a year at
Purdue, and then I was transferred to the [Miami University] in Oxford, Ohio. I
was there about two semesters when they called me in and told me that I had
been assigned to a medical school as a pre-med student. I really had no lifelong
ambition to become a physician, and I told them that, I said I had not any
particular [interest]. They said, well, you finished all this __ stuff, and you have
been on the list in pre-med since you have been at Purdue. They said, here is a
list of medical schools that the Navy has contracts with, I guess it was. One of
them was the University of Wisconsin. I said, what is the alternative? They said,
you can go to Honolulu and get reassigned to the Pacific Fleet, or you can go [to
medical school]. That was a no-brainer, and I went up to start medical school.
Then, the war ended very shortly thereafter, so I just stayed there in medical
P: At any point, did you request to be in the medical corps or did they just assign
E: I never asked to be in the medical corps.
P: So, in effect, they determined your profession for you?
E: More or less.
P: Talk a little bit about Wisconsin Medical School. What was it like when you were
there, and who were the professors who influenced you the most?
E: As I have said to many people, I am probably one of the few physicians in the
United States who never had a day's instruction in chemistry. I started out going
to high school in a military academy where chemistry was taught in the third and
fourth years, and I transferred schools at the end of my second year and went to
a high school where chemistry had been taught in the second year. When I got to
the university, I was in physical education, which required no chemistry.
Somehow, when I passed through Purdue and Miami, chemistry was always
taught in the opposite time of where I was. By the time I got to medical school, I
probably knew the formula for water, but that was probably the only chemistry I
knew. Old Professor Bradley was the chairman of the medical school's
biochemistry [department], and all the other members of the faculty were in the
military. About two days after the war, I went in and saw him. I actually knew his
family somewhat. I said, Dr. Bradley, I have never had any chemistry in my life; I
do not know what in the world I am going to do in this thing. He said, I have got
some graduate students, and I will get them to work with you. Well, he died very
suddenly and unexpectedly three days [later], and so they canceled biochemistry
for that semester because they did not have anybody else to teach it. The idea
was that they would teach it in the following year, but during the war, the medical
schools were on a twenty-seven-month fast-track curriculum to get doctors
through and into the military. The following year, they went back to the traditional
four-year curriculum that they had before the war, and biochemistry got put back
into the first year. There I was, a second-year student, theoretically having
passed chemistry. That is my background in chemistry, which is obviously not
what you would normally encounter in a physician, but it was a small school. We
only had, I think, sixty-four members of our class. It was very much integrated
into the medical community throughout the whole state. It was the first medical
school to have a so-called preceptorship program in which every medical student
in his senior year spent four months in a family practitioner's office working
with/for him. So, it was very small but had a great feeling of camaraderie and
very close relationships. The students were always very much integrated into the
family, so to speak.
P: Where did you do your preceptorship, and how did that influence your career?
E: I did my preceptorship in the town of Rhinelander, which is a little small
community way up in the north woods. In those days, you had to write a thesis
and be examined by a committee of the faculty to get your M. D. I had gotten
married when I was a second-year student. By the time I got to the fourth year, I
had a child, and my preceptorship was the last rotation of my senior year. By the
time I got to Rhinelander, it was my last four months before graduation, and I had
not even chosen the subject of my thesis. I went to see Dr. Bump. Dr. Bump ran
the preceptorship. He was kind of an old-timey surgeon, family practitioner. His
brother ran the biggest company in Rhinelander. It was the Bump Sump Pump
Company. I said, Dr. Bump, I need some help. He said, what is that? I said, well,
I have been pretty busy with my family and all of that, and I have not started my
thesis yet; do you have any suggestions on what I might write a thesis on while I
am here in Rhinelander the next four months? Oh, he said, we have a very
interesting patient I am going to operate on next week; she has got this unusual
tumor in her arm, and you could read the literature and do a case report and all
of that, and that will probably get you by. I remember that patient's name to this
day. Her name was Jennifer O'Day. She was a seventeen-year-old girl. I did all
of that, and I got examined, and I managed to graduate. Later on, that whole
series of events had a very influential effect on my life, because that is why I
ended up doing what I am doing. It is because of that girl.
P: Did you know you wanted to be in orthopedics before that time?
E: Yes, because orthopedics was also always very closely associated with sports
and because I had originally intended to become a coach, studying physical
education. Why, it was natural that I was interested in orthopedics, and one of my
father's closest friends was an orthopedic surgeon and I greatly admired him. I
am sure he had a large influence on that as well.
P: Would you describe a typical day at the University of Wisconsin Medical School
in your, say, second or third year?
E: Every morning starting at eight o'clock, we had a lecture. The lectures, for the
main part, were given by the dean of the medical school, who was a very
remarkable man. His name was Middleton, and he was one who conceived the
idea that all the veterans hospitals in the country should become affiliated with
medical schools. For some time during the war, he actually was in charge of all
the veterans hospitals in the country. The first day of each academic year, he
would appear for his lecture wearing a brown derby hat, and he published a
schedule of what the lectures were going to be all through the year. His method
of teaching was Socratic in that he never really lectured; he just asked questions,
and we would have discussions. If you could not answer the question, he would
see that you got the hat, and you had to sign your name on the hat. Whoever had
the hat in his possession at the end of that hour wore it around the hospital until
the next lecture. I belonged, and there are thousands of Wisconsin graduates
who belonged to the Brown Derby Club that was founded in his honor.
P: I guess sooner or later everybody got the hat?
E: Oh, certainly. At graduation, at the ceremony, he presented the hat to whomever
had signed it the most times, because you had your name and you made marks
for every time you had signed it. I am sure you know Smiley Hill [Hugh M. Hill,
professor, Department of Obstetrics and Gynecology, University of Florida,
College of Medicine, 1959-present] knows all about every medical student.
Middleton was exactly like that. While I was in medical school, in those days
because of the shortage of people, you could play university athletics, even
though you were in medical school. I had not actually graduated from the
university by the time I got to medical school. I did my internship in Denver, and
he came walking down the hall one day. He was there visiting for some reason.
He saw me, and he came over and wanted to know what an old broken-down
basketball player was doing out here and how my wife was and how many
children I had and so on. It was a very family-oriented kind of friendly place.
P: Did you do grand rounds?
E: We had rounds. We worked almost as preceptees. They had a very large faculty,
and you were assigned to some member of the faculty half the day, in whatever
subject you were studying. We did a lot of rotations away from Madison. We went
on a preceptorship. They had a very, very small because of the size of the
community obstetrical service, so we were sent to Chicago, where, together
with medical students from Marquette in Milwaukee and Northwestern University,
we staffed the Chicago Home Delivery Service, which worked out of an
apartment and went all over the lower socio-economic parts of Chicago
delivering babies at home.
P: You had a lot of hands-on experience.
E: Yes. Oh, medical school in those days was much more hands-on experience
than it is today, of course.
P: What year did you graduate from medical school?
E: I graduated in 1949.
P: Where did you take your internship?
E: In those days, there was no matching program like there is today. The dean had
arrangements with about fifteen other medical schools to send them a graduate
as an intern to that institution, but other than that, you were kind of on your own. I
had arranged to go to St. Mary's Hospital in Janesville [Wisconsin], which is a
small town south of Madison. About a month before that started, the dean posted
his list of where he was sending people, and my name was on the list to go to the
University of Colorado. I think we have here [at UF today] maybe eleven or
twelve associate deans for something or another. In those days, he was not only
the dean; he was also the professor of medicine. The dean's office was in an old
house across the street, and he was dean on Friday afternoons from two to four
o'clock. That was his total administrative time spent as being dean. He would
rally around, get a group of students to walk with him down to the state capitol
when the legislature was considering the medical school's budget. We were to sit
up in the gallery and applaud whenever he made a remark. I said, well, Dr.
Middleton, I have already signed a contract to go to Janesville; I cannot go to
Colorado. He got out this dog-eared book, looked in it, dialed the phone and said,
this is Dean Middleton from Madison; Enneking is not coming. That is how I got
P: It is kind of unusual that the very early part of your career was all determined,
literally, by somebody else.
E: Yes. When we came to Gainesville, it was the twenty-seventh time I had moved
since we had been married.
P: What was Boulder like?
E: No, the medical school is in Denver, and the teaching hospital was the old
Colorado General Charity Hospital. It was another hands-on kind of institution. I
left Denver, and I went into family practice in a little town about midway up called
Stevens Point [Wisconsin]. At the end of the war when it came time to get out of
the Navy, you had to have a certain number of points to be discharged. You had
to have thirty-three points. You got a point for every month that you had been on
active duty, and you got two points for every month that you had been on
overseas duty. I had exactly thirty-three points when the war ended, so I went
down and said, hey fellas, so long, I am going home. They said, no, you are not.
They said, you only have thirty points. I said, what do you mean? I said, look, I
was overseas for three months; I got three more. They said, where were you? I
said, I was in Alaska. They said, that is not overseas, that is part of the United
States. I said, you know, I have been accepted to medical school, and I want to
start. They said, well, you can get out with thirty points if you go in the Active
Reserve. I said, what is that? Well, you got to do something on a weekend once
a month and so on. I said, okay, that is what I will do. When the Korean War
started, I had just gone into practice up in Stevens Point, and about three months
after I got there, I was called back to active duty and sent to Korea as a medical
officer. So, I spent another two years in the Navy, but this time as a doctor.
P: Where were you in Korea?
E: I was the medical officer for what was called a naval beach group, which were
the outfits that made the amphibious landings. We had the underwater demolition
team and a battalion of SeaBees [Navy engineering team] and so forth. Most of
the time, that group was in Japan training for the next amphibious assault
somewhere. I did not have much to do, so I was sent over to Korea as a swing
officer for the MASH [Mobile Army Surgical Hospital] units. Then when they
would have an amphibious landing, I would have to go back with that group and
do that. So, I spent about half the time in Korea working in a MASH unit.
P: Where were your facilities?
E: They were wherever the 1st Marine Division was because the Navy provided the
medical officers for the Marine Corps, so I was here, there and yonder.
P: How far were you from the front, usually?
E: Probably forty or fifty miles most of the time and occasionally about fifty yards,
but we did not do any of that. When I would go on a beach landing, some of
those were in North Korea, trying to get prisoners of war out of the prison camps
up in North Korea. We were right there.
P: The weather was absolutely horrible. I suppose you did a lot of frostbite and
probably had to amputate some fingers and toes.
E: Oh, yes. We took care a lot of the fellows who had gone up to the Chosin
Reservoir and had to walk back to Hungnam to get out there. We pulled them off
the beach there, and that was pretty brutal.
P: How about when the Chinese came in? Were you still over there at that point?
E: Yes, I was still there, but we had very little to do with them. I mean, the North
Koreans you could not tell from the South Koreans, [but] the Chinese you could
tell from the Koreans fairly easily. A lot of the North Koreans would come over
trying to get medical care in the MASH units because they knew there were
some pretty good doctors over there and we had no way of knowing who was a
farmer from North Korea or South Korea. Once in a while, for one reason or
another, a Chinese would come, and it was pretty obvious who they were and
how they spoke and so forth.
P: They would come over as if they were civilians and then get treated and go
P: Not POWs?
E: No, these were civilians.
P: How effective and how difficult was that surgery? You have to do quite a bit
under rather severe conditions, I imagine.
E: Mostly, I mean, if you go and watch M*A*S*H. [a program about a MASH unit in
Korea during the war] on TV, that is a little bit different than the actuality of how it
was. Mostly, a surgery was temporizing, trying to keep people alive to get them
air-evacuated out of there. We did a lot of amputations. We did practically no
abdominal surgery, no chest surgery. It was mostly extremity surgery because
they had a very good air-evac[uation] system, and they had big hospitals in
Japan and in Okinawa. If a guy got shot in the abdomen, he could be getting
operated on eighteen hours later in Japan, rather than some tent out in the
middle of nowhere that had no facilities.
P: What was your opinion of Douglas MacArthur [famed World War II commander
and leader of UN forces during the Korean War]?
E: I thought that he was kind of a martinet. He most of the time acted like he was
the right hand of the good Lord Himself, and he did not much brook any
interference from anybody else. The Japanese people, when we were in Japan
were, of course, very antagonistic towards all the American military people who
were there, and he was caught at the epicenter of their antagonism. That all kind
of rubbed off on us. I do not remember anybody who liked MacArthur. I think
everybody was afraid of him. Some people respected him, but nobody liked him.
P: Do you think [President] Truman [1945-1953] was correct in firing him?
E: Absolutely. If you had taken a vote, it would have been ten-to-one.
P: I think what helped him to some degree was the success at Inchon [S. Korean
Invasion Site, 1950], and everybody thought, well, he is still a good general.
E: Yes, but when he decided he was going up to the Yalu River [border between N.
Korea and China], there was not a soul who thought that . nobody looked
forward to that with any anticipation.
P: What impact did that war experience have on you, both as an individual and as a
E: When I had finished at Denver and gone back into practice, my purpose in doing
that was to make enough money to do an orthopedic residency. In those days,
the resident's salary was $30 a month plus free food in the cafeteria, and I had a
wife and, by then, three children. I wanted to go into practice and earn enough
money to be able to be a resident. When I went into the military I did not have
any place to spend any money. The GI Bill [providing money for veterans to
acquire education] came along, so I knew that I would be able to do a certain
residency the minute I got out of the military. Because a large part of the stuff we
did in Korea was orthopedics, I was interested in orthopedics, and because of
[my] interest in sports. Actually, I came home on leave one time, and I went
around Chicago until I found a job as a resident for when I got out of the military.
P: So you got the kind of practical experience you never could have gotten
anywhere else, in terms of your surgical skills.
E: Yes. I had, I guess you would say, the opportunity to do a lot more advanced
surgery than a normal person in my status would be doing. When I went to
Korea, I had only been out of medical school a little less than a year. As an
intern, I had gotten to do assists in a lot of surgeries and then to do some minor
surgeries, but I never was prepared for what I had to deal with when I got there. I
just kind of learned by doing it.
P: How did all the suffering and the death affect you?
E: Well, that would be hard to say just in a word. For a long time, I had a hard time. I
just put it out of my mind. I really had a hard time with it. I lost a lot of friends. My
wife's brother had died during World War II in the military. He was captain in the
Marine Corps. Really, I just never could say much to my wife about it because I
knew it would upset her, so I just tried to put it out of my mind. To this day, I do
not like to hunt, I will not go to a movie that has anything to do with war and that
kind of stuff.
P: Should we have fought that war?
E: I could not say that I have a very strong opinion one way or the other. I believe it
was probably fairly effective in stopping the spread of communism down into
Southeast Asia for at least a time, but I really do not have a very strong opinion
P: 1952, you came back and you started your residency in orthopedics at the
University of Chicago. Why the University of Chicago?
E: My wife's home was in a little town outside of Chicago, Geneva, and when I got
this leave and I knew I was going to be able to afford to be a resident, why, I had
a classmate who was a resident in radiology at the university and I just went
down there to say hello to him. Actually when I got back, we got snowed in at
Chicago and could not get out to her town, so I had a couple of days I was not
occupied. I went down to Billings Hospital at the university and looked him up. He
said, what are you going to do when you get out? I said, I want to go into
orthopedics. He said, you ought to go up and talk to Dr. Hatcher, who was the
chairman of orthopedics, because they are short-handed. I went up and talked to
him. It was a kind of interesting experience, because his method of interviewing
people was to take them up on the wards at rounds and ask them questions, quiz
them to see what they knew. He took me up onto the ward and he said, we have
a very interesting case here in this room; it is a girl who has had this unusual
tumor on her arm. I looked at the name-plate on the door, and there was Jennifer
O'Day, the girl that I had written my thesis about.
P: Same woman?
E: Same woman, now twenty-two years old with a recurrent tumor in her arm, sent
from Rhinelander down to Chicago. So, he said, tell me what you know about
fibrosarcoma. I kind of closed my eyes and turned to the first page of my thesis,
and after about five minutes, he said, stop, that is enough. So, he said, well, as
soon as you get out, come on and get started. I never told him the story until I got
to be a senior resident. He thought that was the funniest thing he had ever heard.
P: What would the odds be, that she would be the patient he would present?
E: Yes, incredible.
P: In retrospect, was that a good choice to be at the University of Chicago?
E: Yes. It was a little different kind of place. The emergency room was about as big
as this office. It was all a referral practice of very complex problems, and their
motto was that, if you can learn how to do the difficult things, why, you can kind
of teach yourself how to take care of the easy things when you get out of here,
which is, I think, probably pretty sound reasoning. I got out of the military in
November and the academic years in medicine are July to July, so for that next
six months, I was assigned to work in surgical pathology with a very well-known
surgical pathologist, Eleanor Humphries. I really liked surgical pathology. In fact, I
strongly thought about maybe changing from orthopedics to pathology after that
experience, but I did not. But that started me with an interest in pathology, which
I maintain to this day. I had no interest, and really not much knowledge, in
academic medicine. I was just there to become an orthopedic surgeon, and I
always thought I would probably go into private practice somewhere. Then
towards kind of the end, I began to do some experimental surgery with a problem
we had. When I finished, I had about 100 pairs of what are called parabolic rats,
in which you actually sew two rats together and they become Siamese twins,
develop common circulation and so forth. I was interested in studying the
relationships in these animals, and I had spent a lot of time and effort in them. I
was going to leave the hospital, and I wanted to finish that work. I had planned to
go into practice in Rockford, Illinois. I went to the hospital administrator and I
said, have you got someplace in the hospital, I would like to bring some animals
with me and finish some experimental work. He said no, we do not do that kind of
thing here. I was a little dismayed by that. Then, I got an offer from the University
of Iowa, where a friend of mine had gone on the faculty. He said, you ought to
come down here and talk to the chairman, so I did. He offered me $4,000 a year
with a wife and now four children. I said, Dr. Larson, I just cannot do that. The
University of Mississippi had a two-year school in those days, and they were just
starting a four-year school in Jackson. The fellow who was the dean at the old
two-year school used to come to Chicago in the summertime, because he was
working at a Ph. D., and we had gotten to know each other. He knew some of my
family and so forth. He came down one weekend and he said, what are you
going to do? I said, I was going to Rockford but that fell through, and I could not
afford to go to Iowa. He said, would you think about coming to this school down
in Jackson? This was about a month before I had to go...I said, you bet I will think
about it. So, the long haul of it was my wife and I went to Jackson when they
opened the doors of the new teaching hospital at Jackson.
P: Did you get a better salary?
E: Oh, yes. It was a lot better salary. I made the magnificent sum of $18,000 a year.
P: That is quite a difference.
E: A big difference.
P: What was Jackson like? This is, I guess, the mid-1950s?
E: It was 1955.
P: So this is right in the middle of civil rights activity.
E: You bet.
P: What was it like during that time?
E: I started to say in some ways it was typical Old South, and in other ways it was
slowly evolving. When I went, Jackson had four floors and two wings on each
side, so it had eight different, distinct wards. It had one of everything; it had black
women, black men, white women, white men's wards, white children's wards,
black children. I mean, the bubblers were segregated, and so forth. It was very
much the Old South, which I knew some of through my family. When my father
and mother moved up to Wisconsin, they took with them a live-in servant, an old
black woman, Geneva Cochran, who, my sister and I, she literally grew us up.
So, I mean, I did not have any problem with all that. My wife was a little taken
aback by some of it, but we found Jackson to be a very fine community. The
relationships between the blacks and the whites were much better then than they
are today. I worked hard when I was there. I put in, probably, at least four or five
eighteen-hour days a week, sometimes more than that. If we would go out at
night, I would be so tired when we got home from the movie, my wife would take
that babysitter down to the black community, drive right in the middle of the black
community at midnight all by herself, never had any apprehensions. It was a
much different kind of time.
P: What was the quality of the medical care for the African-Americans?
E: It varied from lousy to wonderful. I mean, in Mississippi, they had a system of
charity hospitals. The state was divided up into eight districts, and each two
districts had one charity hospital, which was primarily for the blacks. The per
diem there was $3 a day, they got black beans and rice, and the care was really
awful. On the other hand, the university hospital in Jackson, where any of the
charity hospitals could transfer a patient if there was room for them, the care was
excellent, so that if they could find their way to the university hospital, they got
probably better care than most of the white people in the state got. I used to go
up to Yazoo City. I do not know if you have ever heard of Yazoo City, but it is
about thirty miles north of Jackson. It had a black hospital called the
Afro-American Hospital, and the blacks paid $0.25 a week for medical insurance.
That entitled them, if they got sick, to go to the hospital. I did some volunteer
work in Nigeria, and Yazoo City was considerably below the Nigerian standard. It
was just unbelievable, but that is where those types went.
P: If I can go back: our Oral History Program did some interviews with some
African-American Korean War veterans, and I was just wondering how they were
treated in the M*A*S*H. units. Were they segregated?
E: We did not see many of them. The few we had were not segregated. I mean,
there was not any way of doing that in practical terms, in any event. The Army
was segregated in those days. The 24 Division was the all-black division. Before
the war started in Korea, Korea was where you sent all the bad actors in the
regular Army. There were a lot of black soldiers, and they did not distinguish
themselves in resisting the first drive south out of North Korea, not because they
were black, but just because they were unprepared and poorly equipped; they
were not much of a fighting unit to start with. The general feeling amongst the
military in Korea was that these guys are not very good fighters, and so they
mostly were at the southern part [of Korea] doing administrative and kitchen
duties and that kind of stuff. We did not see many blacks.
P: How would you assess your four years at Jackson?
E: It was wonderful. It was a brand-new school, had no tradition, no history. When I
went there, I was the professor, the chief resident, the intern, and a medical
student, all rolled into one. I could do basically what I wanted to do. I worked
hard. We had rather unusual facilities there and a lot of really fine guys on the
staff. We liked Jackson very much, still do, still go back, still have a lot of friends
P: In 1960, you decided to come to the University of Florida. Why?
E: At that time, they were just beginning to recruit the clinical faculty here, and
Chairman of Surgery Ed Woodward [Professor of Surgery, UF, College of
Medicine, 1957-1985] was a resident friend of mine from Chicago. George Miller
[Chief of Urology, UF, College of Medicine, 1958-1978], whom he brought with
him, was the head of urology. Andy Lorinez was in the pediatric department.
Another was in the neurology department. There was a whole cadre of people
from the University of Chicago that George Harrell [dean of the College of
Medicine, UF, 1954-1965] had recruited to come here. In Jackson, orthopedics
was a division of general surgery, which was rather restrictive to some of the
things I wanted to accomplish. I went to the dean and I said, orthopedics needs
to be a department, not a division. The neurosurgeon at Jackson felt the same
way. We more or less told him, if he could not see that, we were thinking that we
would probably start looking around for another school. Ed Woodward called me
up and asked me if I wanted to come down here and interview, and so I did,
because most of our friends were here and the opportunities here were a lot
better than they were in Jackson.
P: Talk a little bit about Dean George Harrell. One of the things I have been told is
that when he started staffing, he wanted to hire young faculty who were
innovative and would be able to develop as the school developed. Is that the way
you saw his hiring practice?
E: Yes. I think, when I came here, I was the youngest chairman of orthopedics in
the country. That was 1960, so I would have been thirty-four years old. When I
went to Jackson I was the chairman, four years before that. Actually, I was
twenty-nine years old when I went to Jackson. Considering the fact I had been
off-and-on in the military for five years, I was probably the most inexperienced
orthopedic surgeon in the world. You know, Dr. Harrell had sold the legislature on
the idea of producing family doctors here-that was his early pitch-much like they
are doing up in Tallahassee today [justification for the FSU Medical School]. His
interest was in having specialists run the various departments, because he
recognized he had to have that, but he wanted people who were willing to do
general medicine as well as their specialty. In fact, all of us were assigned to at
least a half a day, and in some instances a day, in the outpatient clinics, seeing
general medical problems as a non-specialist. There were not a lot of specialists
in those days who were too interested since they had gone into their specialty,
but I had done some family practice in Stevens Point.
P: Let us talk a little bit about what the medical school was like when you came.
What were the facilities like?
E: The hospital was here. It was the original 325 beds. There was no orthopedic
surgeon here on the faculty; there was not an orthopedic surgeon in the
community either, so when I came, I was the first orthopedic surgeon in
Gainesville. I frequently would go over to Alachua General Hospital to take care
of people over there, because anything that required any kind of complex
orthopedics was in those days sent to Jacksonville or to Orlando.
P: Were these private patients?
P: So, you were able to do both....
E: Well, you know, Dave Cofrin or Henry Babers, anybody in town who had an
unusual orthopedic problem, they would ask me to come over and look at it with
them. I never charged the patient fees or anything like that, but I worked over
there a lot, operated on people over there, just because I liked to. The medical
school, of course, this first class was a small class. We knew all the students real
well, and the camaraderie of the whole faculty was very good. I mean, they were
all young and eager. George had a lot of leadership qualities. We worked
together extremely well. We used to have a party at our house for the entire
faculty, once a year, in which we would set up a little thing we called cro-golf, in
which we made a little mini-golf course. You played with croquet mallets and
balls. We would have the whole faculty [join in]. That would probably, in the
beginning, be less than 100. Even towards the end of the 1960s, when it got so
big we could not do it anymore, it was probably less than 300. If the department
of medicine was interviewing a new faculty member, he would go around and
interview with everybody, the OB [obstetrics] people, the surgeons and so forth.
Nowadays, of course, that is all gone. The executive committee and the faculty -
and Dr. Harrell was a great believer in having the faculty participate in all the
policies rotated non-department chairmen through the executive committee, so
the younger faculty felt like they had a say-so. We had a poker game that met
every Friday night for probably seven or eight years continuously, and I would
say that 90 percent of the policy decisions were made on Friday night. That was
really how the school ran. The chairman of radiology, neurosurgery, orthopedics,
general surgery, medicine, Lamar Crevasse [Lamar E. Crevasse, Professor of
Medicine, UF, College of Medicine, 1959-1997] and a couple of other guys from
medicine, pediatrics it was actually all the chairmen who played poker together
once a week. You know, because we were all busy the rest of the time, we just
naturally would talk over those kinds of things; it was not any kind of cabal that
was meeting to overthrow things. But our relations with each other were one of
the finest things about the whole institution.
P: Has Shands always been a referral hospital?
E: In theory, because George's agreement with the doctors in town was that we
would not take a patient who was not referred. You could not very well ask
somebody who is bleeding to death in the emergency room who his referring
physician was, so that never really applied. Some of the departments had very
good relationships with the doctors in town, and [with] others it was a little more
testy. There being no orthopedic surgeons in town, I had great relationships with
the doctors in town. Up until probably not too long ago, every orthopedist in
Gainesville had trained here at the University of Florida. They were all my
residents, so we had great relationships. That same relationship did not exist in
all the other areas. We never had any problems really. I took care of all the
athletic teams when I first came here. Sam Langford was the trainer, "One-Eyed
Sam," and Dr. McCutcheon, who lived in the house right across [from] the tennis
courts [and] had a fused knee, was a GP [general practitioner] at the UF
infirmary, who had taken care of all the athletic teams, just out of the goodness of
his heart. He was so glad to see me come, he did not know what to do. The
doctors in town, if I needed help, would help me, and if they needed help, I would
help them. We had a great relationship.
P: What was the emergency room like when you came? Did you do any work there?
E: Oh, yes. It was not much of a facility, actually, because the vast majority of
emergencies went over to Alachua General, as they had always done. Their
emergency room in the beginning was much better than our's was, as far as the
facilities were concerned. It pretty quickly settled out that all the private patients
went over to Alachua General and all the charity cases came here. We did not
take care of a lot of people in town; most of our patients came from the
surrounding communities around here. But so much of it was our personalities;
some doctors on the faculty got along well with the doctors in town, but there
were some pretty testy people on both sides of the fence, and they did not get
along so well.
P: When you started, what were your initial responsibilities?
E: I ran the orthopedic department, took care of all the scholarship athletes, ran a
service up at Raiford at the prison.
P: Taught in the medical school?
E: Oh, yes. I mean, we all taught medical students. That was a given. I also had an
appointment in pathology, which I still have actually. When I went to Jackson,
there was nobody in Jackson in the pathology department who knew very much
bone-and-joint pathology, and because I had worked in pathology up in Chicago
and was interested in it, the chairman of pathology in Jackson said, would you
mind teaching the pathology to the medical students until we get a full-time
pathologist in bones? I said I would like to do that, and for the four and a half
years I was there, they never bothered even trying to recruit one because I was
doing it for them for nothing; they did not need to spend any money hiring
another doctor to do that. So when I came over here, I said to George Harrell that
one unusual thing that I wanted to do was to have an appointment in pathology.
Josh Edwards [Joshua Leroy Edwards, professor of pathology, UF, College of
Medicine, 1955-1967] was the chairman of pathology. I talked to Josh. They did
not have anybody here either, [and] he welcomed me with open arms. Then, they
recruited Victor Arean, who was a real sweetheart of a guy who knew a lot of
bone-and-joint pathology, so Victor and I worked very closely together for all the
time he was here, until he left to go down to Tampa. Because of that, I spent a lot
of time in the pathology department. [In fact, I used to take autopsy call to this
place, do general autopsies.]
P: Did you have time for research?
E: Oh, yes.
P: How were the research facilities in the beginning?
E: They were pretty good, actually, because that was one of George's big strong
points when I first came here. George knew that one of the reasons I was
interested in coming here was because I felt that we needed departmental status
in Jackson and he said, we are not going to make orthopedics a department here
for about five years and just in the natural growth of things. I said, that is fine with
me, because I knew Ed Woodward real well. That was no problem at all.
P: Ed Woodward was chairman of surgery at the time?
E: Yes. Ed had a great lab set up upstairs on the sixth floor, and anybody in the
department could use it [for] animal surgery. He brought Dr. Dragstedt in, who
had been at the University of Chicago. Ed and I had known Dr. Dragstedt real
well, so it was fine. We had a nice set-up out where the new conference hotel is,
[where] were there was a big animal farm and veterinary service. It was very
good. There was a lot of cooperation amongst the faculty.
P: Talk about the medical school curriculum. Was that pretty traditional at that time?
E: Yes, I would say it was sort of in-the-middle. It had a few innovative things. I think
having specialists work in the general outpatient clinics was a little unusual in
those days, and that kind of died out after George left. Eventually, they got a
department of family practice, and then it completely died out. But the curriculum
was, I would say, fairly traditional, the way the basic sciences were organized.
We had an excellent basic-science faculty.
P: So Dr. Harrell trained the med students in his basic concept, he wanted them to
be general physicians first and then specialists later. Is that right?
E: That was the plan. The plan did not follow through very well, because as each of
the units got developed, they started residency programs, and you have to have
a certain volume. Say if you are going to have a urology residency, you have to
have a certain volume of urology cases and certain amount of facilities and so
forth. Well, in order to develop those residency programs, it took away from any
time to try and develop the family practice, and there was no family-practice
model in and of itself; there was no family-practice department. Secondly, most
of the referral problems we got were not family practice problems. They were all
complex tertiary-care problems that the smaller towns around here wanted to
send down here to get specialty help. So between trying to organize a residency
program and taking care of those kind of patients, there was not a lot of
P: Discuss your relationship with the nurses. The nursing school was operating
when you came, is that right?
E: Yes. The nursing school was run by....
P: Dorothy Smith, was it?
E: Smith, yes. She was a piece of work. Everybody liked her. She looked a lot like
Eleanor Roosevelt. You know, the students put on a skit lampooning the faculty
at the end of every year, and she was always the butt of everybody's lampoon,
but she took it very gracefully. She was a very academic lady, and she was not
terribly interested in teaching nurses how to be nurses. She was more interested
in the academic aspects of nursing, and we had one of the earliest bachelor
degree nursing programs in the country. There were not a lot [of them] in those
days. Most girls who wanted to be nurses went to high school, and then they
went to a hospital for their nursing school, did not get a college degree. Dorothy
always envisioned herself as training the nurses who would kind of run the
nursing stations and not actually carry the bedpans and so forth. Well, for those
of us taking who were taking care of patients, that was not always a favorite
subject. So there was some controversy about that in the early days, but we had
so many other problems to worry about that it never got to be a serious thing.
The relationships between the nursing school and the medical school was
always, for the people who were taking care of patients, quite good.
P: Did you have enough nurses, and were they well-trained?
E: We had a lot of bodies. Oftentimes, the nursing students were not terribly
interested in taking care of patients. They were here to become a nursing
administrator. Many of the students in those days actually had been out doing
nursing and came back to school to get a degree, so they could go up through
the ranks in the nursing profession.
P: So you did not have a lot who just wanted to LPNs [licensed practical nurses]?
E: We had a lot of LPNs. When the VA came, the nursing at the VA was
considerably better than the nursing was here.
E: Well, they were nurses. They were interested in taking care of patients.
P: Better pay?
E: Yes, I am sure that helped and Florida is a nice place to live. The minute they
built the VA over here, they put it on the bulletin boards all over the VA system up
north that there were jobs in Florida. They were flocking down here. They were
mature, patient-oriented nurses. Pretty soon, a lot of the nurses here started
going over to the VA, and that was when the nursing philosophy here changed
P: What was your relationship with Blanche Urey, who was head of the nursing
school after Dorothy Smith?
E: I did not have much to do with her, not nearly as much as I had to do with
Dorothy. Dorothy and I were very close personal friends. Blanche, I never knew
very well. I did not have much to do with her. She did not come on the wards
hardly ever. I just did not have a lot to do with her.
P: One of the things that changed over a period of time is they started doing some
of these multi-disciplinary rounds. What did you think about that concept?
E: I thought that was a two-fisted death grip on a loser. Most of the specialty
services needed really good specialty nursing care. In the operating room, we
could not stop and teach the nurse the name of the instruments every two weeks
when they rotated somebody else in there, so the group finally just demanded
that we have specialty nurses in the operating room. They acquiesced to that
pretty readily. I mean, that was obvious. Most of us brought in technicians in the
operating room from the military, because there were a lot of guys who were very
well-trained in the military, just as operating room nurses, because that is all the
military had. They did not have lady operating room nurses; they were just
technicians. These guys were just terrific. In fact, we still have some of them
P: How has the nursing profession changed in your career?
E: When the demand for services got greater, the hospital started to enlarge. The
hospital then got reorganized, and that changed the nursing a lot because prior
to that, on any one floor, you might have plastic surgery, orthopedics, urology,
general medicine. In fact, in the last days before they enlarged the hospital, there
was such a pressure on getting beds, you put your patient wherever you can find
an empty bed. I mean, I have had patients on the medical service, the OB
[obstetrics] floor, everywhere. When they enlarged the hospital, then they had to
reorganize the nursing service, because all the patients on our floor were
orthopedic patients and we did not have any general kind of nurse requirements
anymore. They changed the relationship between the school of nursing and the
nurses in the hospital. That is when nursing really changed, because in the early
days, the dean of nursing was also the head nurse in the hospital. When that
separated, then the attitude towards taking care of patients changed a lot.
P: What is the emphasis now? Is it more on academic or practical training?
E: If by now, you mean in the last seven or eight years, I could not answer that
because I have not been taking care of patients on the floor since I stopped
operating, so I could not tell you. But just before that, it was taking care of
patients first. For awhile after it began to change, there was kind of a requirement
that the academic nurses come on the floor and do floor duty a certain number of
times, to kind of keep their finger in it. We all dreaded that when they came. That
gradually got phased out.
P: In the medical school when you started out, did you have any courses in ethics or
pharmacology or courses like that?
E: We have always had pharmacology because that is part of the basic curriculum
in basic sciences. I knew Ken Finger [Kenneth Finger, dean of the College of
Pharmacy,UF, 1968-1979; vice-president of JHMHC, UF, College of Medicine,
1979-1997] very well from his days in Madison, so I always kind of knew what
was going on, just because I knew Ken quite well. But dentistry, we were all kind
of looking forward to, because we all had patients with dental problems. While
there were some good dentists in town who would come over and help, there
was really only Josh Jurkiewiz, the first plastic surgeon here, who was also a
dentist before he went to medical school. So he was the one to call for problems
you had with teeth and to do all that kind of work. He was very much instrumental
in helping the dental school get organized, because he did not want to have to do
the dentistry. The dental school was really welcomed with open arms by the
medical school, because the relationships were much better. They helped in the
emergency room. [There were] always good relationships between them.
P: A question about the course work for the medical students: any sense of trying to
instill ethics in the students? Did you have a formal course, or was that done
E: I would say there may be now, that I am not aware of, but there were never any
formal courses in ethics. On the other hand, it was something that we kind of
informally talked about a lot. George Harrell felt very strongly about ethics and let
you know that you ought to be a role model for the medical students as far as
ethics were concerned.
P: How do you feel about the privacy of patient records?
E: Patients' records should be completely private.
P: May be changing.
E: Well, I know they are trying to change it. You see, medical ethics has changed a
lot. I got censored by the Alachua County Medical Society because Dave Cofrin
sent me a patient who had gas gangrene, who also had a heart problem that
preceded his gas gangrene. Because I needed to get some things going pretty
urgently on a weekend, I got Jape Taylor [William Jape Taylor, chairman of
cardiology, UF, College of Medicine, 1958-1997] to come see the patient about
his heart problem, without calling Dave Cofrin. You would have thought I stole his
wife. I got censored for having referred a patient to a fellow member of the faculty
without consulting his referring doctor as to which cardiologist he wanted him to
see. Those days cannot go on forever, but, I mean, the changes are so great that
it is hard to compare what happened in the early days and what happens now.
P: How do you feel about euthanasia?
E: I have two minds. Since I am a practicing Roman Catholic, I have the Catholic
attitude towards euthanasia. On the other hand, I am a very strong believer in
having a living will and honoring the patient's wishes. Sometimes those two
things come into conflict, but my practice has been to ask a non-Catholic doctor
to take care of those patients.
P: I guess it is pretty clear your view on abortion then. Should a teaching hospital
like this ever perform abortions?
E: Yes, they perform abortions. I would say the chances of them performing social
abortions is not great. They also probably do a lot of surgical prevention of
P: Tubal ligation, I guess it is called.
P: Talk about your teaching career. What makes, in the medical profession, a
E: I am not quite sure I understand the question.
P: In academics, you are teaching a different kind of concept, and teaching medical
students is obviously a question of life-and-death. I just wonder what qualities it
would take to be a great teacher in medicine.
E: I do not think it is very much different than [from what] it takes to make a great
Kindergarten teacher or physics teacher. If you are interested in students and
can communicate that interest and have a genuine love of interacting with
students, I do not think there is any difference. Medical students like, for the
clinical aspects of it, to be taught by clinically competent people, so you [have]
got to be a good doctor. If you are not a good doctor, you do not have the
respect. There are on all medical faculties, including this one, some people
whose interests are in research, who are not particularly clinically-oriented, who
do not make very good teachers in clinical medicine, which is pretty obvious. But
other than that, if you like teaching and if you like students, it is a piece of cake.
P: Jape Taylor told me he did almost all of his teaching at the bedside.
P: Is that generally true, or in the operating room?
E: Well, it varies from area to area. For example, orthopedics has always been a
so-called elective here. Not every student is assigned an orthopedic service, and
there are several others: neurology, neurosurgery and so forth. In the third year,
everybody takes general surgery, and then the fourth year, you have to choose
two of the five elective services. Having been in general practice, I felt kind of
badly for the kids who had to go out in general practice and never had a day of
orthopedics, because I knew they were going to see a lot of orthopedic problems.
So, we organized a Monday night teaching session in orthopedics, from seven to
ten [o'clock] every Monday night, that was done in a conference room with a view
box for X-rays, without any patients at all. Practically every medical student for
the ten years we did that came, whether they were on orthopedics or not,
because they knew, by the same token, that was those were cases they were
going to have to deal with. Different people have different styles. I suppose
because I was so fond of my first dean in medical school, I tend to be a person
who says we, we are going to talk next Monday about subject X; you better learn
something about it. Then I ask them questions, and we have an interchange.
That is the kind of teaching I like to do. There are other faculty in the orthopedic
department Bob Vandergriend is probably one of the best lecturers I have ever
encountered in any kind of medicine; he is absolutely superb. He is not worth a
toot questioning people. It is just, you know, what is your bag.
P: You were the chief of orthopedic surgery from 1962 to 1974, is that correct?
E: I started the department in 1960 and I resigned as chairman in 1980, so I served
a twenty-year sentence.
P: How did your job and your responsibilities change over those twenty years?
E: It changed a lot. I mean, when we started, I brought one other fellow with me and
we then recruited a third faculty member, but for ten years, we only had three
faculty members and were a division of surgery. The budget was not a problem.
We were not dependent on our practice income to support it the state
supported it so each of us probably devoted two-and-a-half-days a week to
clinical work and two-and- a-half-days a week to research or teaching or
whatever. It was a much more academic department than it is today.
P: So, you had more administrative duties as time went on?
E: Well, we had one dean. George Harrell did not have any associates or assistants
or anything else, so you could transfer information between the departments and
the dean in a heartbeat. I mean, it was just a whole different way of life.
Obviously, that has become so much [more] complex now that most department
chairmen, if they get a day a week to practice medicine they are feeling pretty
lucky. On the other hand, the school has become so dependent on the clinical
income from the faculty, that if the faculty get three hours for academic
endeavors other than bedside teaching in a week, they are pretty damn lucky.
We used to have a whole battery of people who did both research and clinical
work. Now, all the research, for the most part, is done by Ph.D.s, clinicians do the
clinical work, and the two meet in the hall occasionally. It is very different, and
that is true of every place in the country. That is just the way things have evolved.
P: I would assume, particularly in the early years, there was quite a bit of
competition for money between the departments. How did you work out those
E: I would not say that. There was much more sharing in the early years than there
is now. You know, some departments are traditionally not great income-
producers like pediatrics does not make much money, internal medicine does
not make much money, surgeons generate lots of money, radiologists generate
money. We never thought twice about having the dean take some of our money
and giving it to pediatrics. Now, the pediatricians try and get a buck, and they get
to walk through a hail of bullets.
P: Could you take me through a fairly typical day, say in 1970. What it was like,
what you spent your day on and what were your different responsibilities?
E: In a department of medicine, for example, their faculty has always been much
larger than any of the surgical departments, and many of their faculty members
spend nine months in the lab and three months on the ward. When they are on
the ward, they are on the ward full-time, and when they are in the lab, they are
full-time. For the surgeons, they operate all year long, so they are on the wards
all the time, and they may have Thursday afternoons or whatever to work in the
lab. It is a very different kind of existence. If you go onto any surgical ward and
say to the patient, who is your doctor, he will tell you. If you go on the medical
ward and say, who is your doctor, uh, well, I am not sure I see a different doctor
every day. It is a very different kind of lifestyle. For us, most of us had either two
or three days a week when we operated. We would get here at six-thirty in the
morning. We would have our morning teaching conference from six-thirty to
seven-thirty. Eight o'clock, we would start operating, and we operated all day
long. On many days, we operated until eight, nine or ten o'clock at night because
we had more cases to do than we had facilities to do them in. The next day, we
would see outpatients. We would probably see in a day forty or fifty patients,
about a third of whom might be new patients; the other two-thirds were
follow-ups. The next day, we would operate all day, as we had the day before.
One thing that George Harrell, very cleverly, I thought, is that he arranged the
location of the departments in relation to the facilities where they worked, so that
the surgeons were on a floor where the operating room was, so you could run
back and forth between your office in between cases, you did not have to hang
around the operating room and change your clothes and do all this kind of stuff.
We did a lot of teaching and go to the lab and do some work in between cases.
We got a lot more done than a lot of places, where the research is in a building
over here and the hospital is over there. Almost all the surgeons do their teaching
early in the morning, before they start operating, because the time you would be
free during the day is so unpredictable that you cannot very well schedule the
class for three o'clock, stop in the middle of a case and go for an hour and come
back. Surgeons are used to getting up early. I used to ride my bike to the hospital
and start our conference at six-thirty and start operating at eight and operate all
P: How do you develop the energy and the focus to operate all day long? You must
be very tired at the end of the day.
E: There are no surgeons who do not like operating. I mean, how do you get
enough energy to play tennis? Well, you like to play tennis; you do it because
you like it. You never get tired of what you like. I mean, there would be days
when you get tired, obviously, get fatigued, but it is something you like to do.
P: Why did you step down as chair in 1980?
E: For a variety of reasons. I started probably in the 1970s, early on, kind of
sub-specializing in tumor work, partly because of my interest in pathology and
partly because most orthopedic surgeons are not accustomed to taking care of
patients who were going to die, and in those days, most of those with malignant
tumors died. It is very hard to do that kind of work on an elective basis. I mean, if
you are scheduling a total hip, you can say, well, we will do yours three months
from tomorrow, and three months from tomorrow you do it. A patient comes in
with a malignant tumor, you cannot say, well, you come back in three months
and we will take care of it. So, when we had developed probably one of the
largest tumor practices in the United States, the pressure of that and, in the
meantime, all the administrative stuff had really begun to pile up with all the
compliance programs, and the size of the faculty had grown from three to fifteen.
In order to represent those people adequately at the next level, that took a lot of
time. I just got to the point where I could not do both. I said, well, I got to make up
my mind; do I want to be a doctor or do I want to draw back from clinical
medicine? That was a no-brainer as far as I was concerned, so I decided to
concentrate on taking care of patients and teaching and get out of the
P: When you look back on your twenty years, what would say were your most
E: Do you mean to the institution as a whole?
P: Well, primarily to the orthopedic profession.
E: In the early days, the executive faculty committee, which George and the
succeeding deans often used for setting policy, was dominated by the basic
sciences, because there were more basic science departments than there were
clinical departments. It became fairly obvious that a lot of the policies were not
doing very much for the patient care departments, so the clinicians as a group
said, look, we need an equal voice in things. Orthopedics, anaesthesia,
ophthalmology, neurosurgery all became independent departments, and that
changed the mix in many different ways. That allowed each of us to develop our
own programs at a much different pace. When I stopped taking care of the
football team and all the athletes, Ed Kissom was a nice guy and good friend of
mine in town and had the time and the interest to do it. Well, it became pretty
apparent that, as we developed a division of sports medicine within orthopedics,
that we ought to have some full-time faculty people doing that kind of work. Well,
trying to get a basic- science dean interested in having any influence with the
athletic department was about like spitting in the ocean. Because I had a lot of
good friends up there, I could say, look, we need the full-time faculty in the
medical school, not Ed Kissom doing this. When Ed retires, we want that
position. That was no problem. We have always had that position since then,
and it has meant a lot to the faculty and the medical school. Well, you can do that
from departmental status, if you had to go through a chairman and he through
the dean and the dean through some other dean and so forth, it was not a very
satisfactory way. That departmental status meant a lot.
P: When you were operating we talked about the sports medicine did you have
specialities? Would you do ACLs [anterior cruciate ligament], or would you set
E: Man, at the beginning, we did it all. I mean, I did hand surgery, scoliosis surgery,
athletic surgery, everything. Then we began to see, towards the 1970s, at the
same time we got the departmental status, that we needed to stop being all
things to everybody, but this happened in orthopedics all over the country. This
was not unique to us. We started organizing divisions. We have a hand surgery
division, a spine surgery division. When total joints [total joint replacements]
came along, we were the first ones in Florida to do all the total joints. We quickly
had so many people lined up to do total joints that if we did nothing but that we
would have filled up every day, so we had to organize in a lot of different ways.
That obviously changed the kind of people we recruited and so forth.
P: Let us take something like hip replacement. How has that changed? Obviously
the technology is extraordinarily different than it was originally.
E: Probably 90 percent of the patients who were really disabled by an arthritic hip
used a cane or a crutch and took a lot of aspirin and did not do very much and
were miserable. There was not a whole lot to do for them. There were some
attempts at surgically correcting them that were not very successful. When the
first generation of total hips [total hip replacement] came along, they were not
very successful. There is a program that is jointly sponsored by the American
Orthopedic Association and the British Orthopedic Association, in which they
would pick out five young surgeons from America and sent them on a
three-month tour of Britain, and on the alternate years they do the reverse. I was
selected to go in 1965, and I met the surgeon and became close to him who
developed total hips in Great Britain, John Charnely. He did the first generation
which had some problems, but when he worked those problems out, he wrote me
a letter and said, this is really going to work; you better get your butt over here.
So, I went over, and I spent a month and learned how to do them. In those times,
the FDA [Food and Drug administration] would not approve the use of the
cementing substance that is used to secure them in place, so we had to literally
smuggle it in. We had various routes of getting it into the hospital without getting
caught at it, fortunately. The orthopedists down in Tampa were not quite so lucky;
they got caught at it. In any event, we were the only ones doing any total hips
between Atlanta and Miami. As the word kind of got around, why, we were under
tremendous pressure to do these cases. At that time, then, everybody put the
heat on the FDA to put approval on the fast track. We held seminars here for two
years; once every two months, we would bring community orthopedists in and
teach them the new techiques so that it very quickly diffused out into the
P: The quality of the replacements now are pretty remarkable, are they not?
E: Curiously enough, they have not changed very much. The original Charnely total
hip, the components of which costs $35, the long-term results have never been
P: Is the operating technique less invasive?
E: Not appreciably changed. John Charnely could do one of those things lying on
his back in an hour, I could do one in an hour and fifteen minutes, and it has not
changed very much.
P: Let me talk a little bit about your specialty. Obviously, one area we talked about
earlier that you are interested in is tumor surgery and clinical pathology. I looked
at your articles, and a huge number of articles have been on that subject area,
and one of the things you developed was this tumor-staging classification
system. Could you tell me what that was about?
E: First of all, the kind of tumors we deal with are not very common. Back in the
1950s and 1960s, 99 percent of the people who got a malignant bone tumor got
an amputation, and that was it; 80 percent of them died within a few years. It was
not a very attractive kind of way to spend your days. Staging systems for the
various kinds of tumors started back in the early 1930s. I think the first staging
system was for carcinoma of the cervix in 1929. All during the 1930s, staging
systems for various kinds of cancer were developed. As of 1970, there was no
staging system for sarcomas, which are the kind of tumors we deal with. The
mortality rates were terrible, the survival rates were terrible, and so forth. The
only places you did not get an amputation were people who just said, I refuse,
and the kind of surgery that was done for them, the results were bad, except for a
few isolated areas. One of them was Memorial in New York, another was the
University of Chicago where I trained. Dr. Hatcher was a very accomplished
tumor surgeon and had much better results, so he had this huge tumor practice;
the whole Middle West ended up at the University of Chicago. I became
interested in that, and I had a fair amount of technical experience with it, even in
those days. Because I got started in the pathology department down in
Mississippi when I went there, when I came here, I kind of had a running leg up
on that. Because it is not the kind of practice that was in those days very
attractive to the average community orthopedic surgeon, anybody in Florida who
saw a kid with a tumor shipped him to Gainesville. So we started a very large
tumor practice right off the bat. We then started an annual seminar, because it
was pretty obvious that one of the problems was that the surgeons in practice
simply had no experience. I mean, the average orthopedic surgeon will see one
of those cases every three years, so that we started an educational program. The
seminar this year will be the thirty-eighth consecutive year for community
orthopedists and orthopedic residents discussing what to do for the occasional
patient you see with a tumor. Most of the people who come for the seminar come
from the Southeast, so when they went into practice, and saw a patient with a
tumor, this is where they sent them. That is when I decided I better stop being a
chairman. We had the biggest bone-tumor service outside Memorial, the Mayo
Clinic, and M. D. Anderson in Houston, and we still do. So, we had the clinical
material from which to base a staging system. We also had a pathology
laboratory to do the technical part of gathering the data for the staging system, so
we probably had the best setup in the country to develop a staging system. At
that point, Suzanne Spanier (whose husband John I am sure you know quite
well) had finished a pathology residency, and she wanted a part-time job. She
had done an elective with me in sarcomas. I said, well, Suzanne, we need to
develop the data for a staging system. She and I sat at every conference, and we
collected the data for ten years because we had this large volume of patients.
We published it in 1980, and it very quickly became the recognized staging
system. The AJC [American Joint Committee on Staging Systems], the
grandfather of all staging systems, adopted, and it has now become the
international staging system. It is not any stroke of genius. It is mostly common
sense. All staging systems are built on the natural history of the disease, and
the natural history of sarcomas is different than for other more common types of
cancer. In order to evaluate the kind of surgery that needed to be done for those
patients, since in those days there was no chemotherapy or radiation therapy to
speak of, we made these huge large sections of the entire specimens and then
studied microscopically where we had done it right and where we had done it
wrong, in order to develop the parameters to develop the guidelines. That is what
the purpose of the staging system is. We had one of the three laboratories in the
country that could make those kind of sections, so we not only had our own
clinical material here and the specimens from them, but the special pathology
facilities to acquire the data.
P: I realize this is an ignorant question, but what is the difference between a
soft-tissue tumor and a bone tumor?
E: A soft-tissue tumor starts in your muscles or other connective tissues, where a
bone tumor starts inside your bone.
P: But as far as the metastasis ...
E: The natural history of a fibrosarcoma in your soft tissues behaves just like a
fibrosarcoma in your bone.
P: So when you were first dealing with this, it was your objective, I presume, to try to
save the limb or the use of the limb, and so you had no alternative but surgery at
E: Yes. In other words, we found out from all these microscopic studies what the
natural growth-patterns in the various anatomic locations were. In those days, we
did not have CT and MRI [magnetic resonance imaging] and bone scans and all
that; we just had plain X-rays. So we developed a way of knowing how close you
could get to it and get it all out and still salvage a limb. I would say probably one
out of three patients we saw in those days, after we developed all of this, we
could do a limb salvage while we were still doing two-thirds amputations. Then
MRI and CT came along together with all the technical improvements in
reconstructive techniques so that today probably eighty-five out of 100 patients
who come in with sarcoma get a limb-salvaging procedure.
P: And you now can use the chemotherapy and radiation.
E: Yes. Chemotherapy has made it possible to do a limb salvage, and we have
always had a very good department of radiation therapy. They are probably one
of the leaders in the United States in radiating these kinds of tumors in
conjunction with the surgery. Rod Million and I were very close friends and still
are. We developed a fellowship in tumor surgery here; it was the first one in the
United States, actually, started in 1970. We have trained probably more than half
of the orthopedic tumor surgeons in the country in the fellowship here.
P: Did you do many bone transplants?
E: We started a bone bank in 1978. Before that, we used to transplant bones from
one part of your body to the other, but there is a limited supply of that, and so we
started a bone bank! We did the first donor over at the Alachua General
Hospital about two o'clock one morning when they had a motorcycle victim who
died, and Henry Babers called me up and said, Bill, I got a donor for you. We
went over there, and Henry and I harvested all his parts, and we transplanted
them the next day into a patient we happened to have in the hospital.
P: They worked okay? What is the rejection rate?
E: Well, it did not work so well, but we learned a lot from it. The recipient died of
metastasis; on autopsy, we found what we had done wrong. When I stopped
being chairman in 1980, I took a sabbatical, because I thought it would be a nice
idea for the new chairman not to have someone hanging around making
suggestions as to how he ought to run his department. I went up to
Massachusetts General and spent three months there as they had best
transplant program in the country. Then I went to Holland, and spent the rest of
my sabbatical there writing a book and studying their transplant service, so when
I came back we really got ours thing going.
P: What is the biggest problem, blood supply?
E: No, the biggest problem actually is donors. You see, the surgeons who do organ
transplants have to have what are called heart-beating donors. I mean, you
cannot take a kidney out, put it in a bank, and go back and get it a year later, or a
lung or a heart or any kind of vital organ. Bone, on the other hand, you can take
out and freeze and take it out of the bank a year later. The technology of that has
become extremely sophisticated. I would say up until the early 1980s, 90 percent
of the bone banks were little mom-and-pop affairs in each hospital. With the
onslaught of AIDS [Acquired Immune Deficiency Syndrome] and some of the
other problems that complicated it, the technology became not only much more
sophisticated but very expensive We had planned to build our own bone bank
here in the 1980s, and it was going to cost us about $2,500,000 to build a
state-of-the-art facility and we had only about $25,000 in the bank. So we formed
a consortium called the Muscular Skeletal Transplant Foundation that now has
twenty-two medical schools and about forty organ procurement agencies in it and
with a central bank up in New Jersey, because of the air transportation facility
there. It still operates, and I have been involved with that since its onset. The
results have improved accordingly. So, the biggest obstacle, like in all transplant
programs, is the donor base.
P: Does it work better if it is a relative's bones?
P: It does not matter. What is the biggest problem in treating bone infections,
osteomyelitis, things like that?
E: Fortunately, osteomyelitis is like polio and a few other things, a thing of the past.
P: It is gone, yes.
E: I mean, we rarely see a fresh case of osteomyelitis, per se, probably we do not
see two or three a year, where we used to see 200 to 300 a year, partly because
of antibiotics, which are vastly improved, partly because of the technical way of
delivering the antibiotics, partly because there is just a diminution in all infectious
diseases since most osteomyelitis came secondarily through me blood stream
from an infection somewhere else in the body. Other than surgical wound
infections and compound injuries, osteomyelitis is a very small segment of what it
used to be.
P: Talk about scoliosis. How has the treatment of that changed?
E: We ran a big scoliosis service, still do. Most of the children got put in braces, and
they were kept in braces until they got to be young adolescents. Then if their
curve was sufficiently stable, they went through life with a moderate deformity
although it did not, other than the cosmetic appearance of it, [become]
particularly painful or disable them. The ones who were more severe, we put in
long periods of traction and casts and wedged the casts and eventually did
operations on them and fused their spine in as much correction as we could get.
Now in the last fifteen years, the technology of that surgery has improved
absolutely dramatically, and there are devices to internally correct and stabilize
them. It is a much less disabling situation now than it used to be.
P: What about lower back injuries? There is a tendency I do not know the
numbers if you injure your lumbar vertebra, you would sometimes have to fuse
them. Is that still a viable approach?
E: Oh, yes. Although if you look at Teddy Dupay [shooting guard for the UF
basketball team who had back surgery during the 2001 season], the recovery
period after the surgery is dramatically shortened.
P: My next question.
E: I knew that was coming. Do you remember Wayne Peace?
E: Wayne Peace had the same operation Teddy Dupay did. The year Wayne Peace
was a senior, we played in the Gator Bowl. He got operated on December 10,
and he played in the Gator Bowl. During the halftime show on TV of the Gator
Bowl in those days, each university was given fifteen minutes to extol its virtues.
The University of Florida spent their whole fifteen minutes following Wayne
Peace through the operating room and how he was playing football afterwards.
The surgeon who operated on Wayne was the same one who operated on Teddy
Dupay, Art Day.
P: He is world-class.
E: Sure. Everybody feels like Teddy Dupay is some modern miracle, but Art has
been doing that for a long time.
P: Why has that operation become so much more effective?
E: It is not any more effective; it is just done, literally, through two or three little tiny
incisions with an instrument that you suck the damaged tissue out of instead of
having to do a great big incision, reroute lets muscles, take away some of the
bone, and takes months to heal. It also avoids having to do a fusion a lot of
P: That was only alternative at that point.
E: Yes. A lot of the fusions that used to be done were not done because of the
disease; they were done because of the tissue that had to be removed to get at
it, and then you had to fuse it to re-stabilize it.
P: Over the years, when you were working with these kinds of research projects,
how much funding have you been able to get from the federal government?
E: In the early days, funding was never a problem. First of all, it did not cost us
much to do it, particularly in orthopedics. There is a foundation called OREF,
which stands for Orthopedic Research and Education Foundation, and it is
funded by donations from orthopedic surgeons. It was the first such foundation
created solely by doctors and funded solely by doctors. It dates back to the early
1960s. So, young orthopedic surgeons who aspired to do research have always
been funded by this organization. Many other specialties now have such a
foundation, but it is far and away the most well-supported by the profession itself.
Nowadays, the National Institute of Health and the National Cancer Institute have
come into play, but their funding has become more and more restricted to the
kind of research done by Ph.D.s. Our type of research was done by M.D.s who
had a problem and worked at trying to solve it. Nowadays, they hire a Ph.D. Well,
to set up a Ph.D. in a lab, pay his salary, try and get competitive grads, it is a
$1,000,000 enterprise. In the meanwhile, the state of Florida, the federal
government, and every other governmental agency has, as they always do,
dipped into educational funds to dip in to pave the roads, so that funding for
research has dropped absolutely dramatically, while the cost of research has
gone up. For a good young investigator to get started on an academic career is a
real trial. That is why you do not see very many people with an M.D. going into
P: From the point of view of the patient, what is the best solution for their health
E: Well, I am embarrassed to say in this country, it depends on their economic
background. The wealthy people get the best care; the poor people get the worst
care. A third of the country still gets what we classically thought of as private
care. Then the next third get what we call managed care. The lower third get
what we call no care, emergency care. The quality of medicine for the lower third,
with some obvious exceptions, is not nearly as good as it is in most of the other
developed parts of the world.
P: I have just learned this weekend that a large portion of young children in Florida
do not have any health insurance at all, and their only medical option is the
E: Yes. When I came to Florida, there was a thing called the Crippled Children's
Commission. The state was divided up into districts. They created a district for
the university here so we could take all the complex things that they could not do
in Leesburg and Port Charlotte and similar communities. The University of Miami
had another one, what they called a super district, and when Tampa got a
medical school, they made another one in Tampa. We got a budget from the
state. The budget started in July. Our funds were usually all spent by the end of
October. So from October until the next July, we just stacked them up like
P: Is the answer national health insurance?
E: Sure. Absolutely.
P: Is that possible, politically?
E: Politically, it does not look like it.
P: What is your view of HMOs [Health Maintenance Organizations]?
E: Dim. That is my age, too, speaking. When I took care of the Crippled Children's
Commission's patients. I got X amount of dollars to take care of all these
children for a year. Believe me, I could squeeze a lot out of a buck worth of
medical care. I mean, we would do three times as much work for a buck,
because we had all these children and limited amounts of money. Now, when I
have to call some nurse practitioner with a Cuban accent in an HMO in Miami
and plead with her to please let me do this for the patient, and she says, well,
Doctor, you have to be conscious of the costs. I say, Lady, I have been
conscious of the costs since before you were ever conceived, okay? And I
probably know more about how you can squeeze a dollar's worth of medical care
out of the system than anybody around. So, my attitude towards the HMOs is just
not very good. But the good ones are good, and there are some good ones. The
bad ones are bad, and there are a lot of bad ones.
P: What about the future of Medicare and Medicaid?
E: Medicare is just a kind of half-assed national health care system. It has got all the
bad features and very few of the good ones. I mean, for a certain group of
patients, it is all they have, but it is not very good. Curiously enough, the
American College of Surgeons has endorsed the concept of a single national
payer. The AMA [American Medical Association] is dead set against it, and they
are very politically influential. It depends on where you sit in the spectrum. But
doctors are overpaid. I mean, it is ridiculous.
P: What would be the difference in what you could make in academic medicine and
what you could make in private practice?
E: It used to be about three-to-one; now, it is about six-to-one. It varies specialty to
P: Where did your salary come from, for the time you were on the staff here?
E: When I first came, it came just as a direct salary from the state. Then, as we
began to earn clinical fees, they were put into what was euphemistically called an
academic enrichment fund, which meant that the state did not have to pay your
salary, you got paid out of that. Gradually, the state's proportion went from 100
percent to less than 20 percent. So, the state puts almost nothing into the faculty
of the medical school, and that is why nobody has very much time to do any
research and precious little time to do any teaching, because they have to earn
the money to keep the place going.
P: Is that one of the reasons for the recent problems with the budget at Shands?
P: Let me get you to talk about some of the more fascinating cases you have had.
Doctors talk about an extraordinary panorama of patients. Can you tell me some
either poignant or amusing stories about patients?
E: Oh, I could make you cry, I could make you laugh.
P: How about doing one of each?
E: Well, the most dramatic I could tell you concerns a girl who was fifteen, a
beautiful girl who lived up in Montgomery. Went out skiing in Colorado, fell down,
an X-ray was made out there. Had this benign-looking defect in her bone, just as
an incidental finding; it had nothing to do with her fall. Her father is a very
well-known OB-GYN [obstetrics-gynecology] fellow up in Montgomery. When
they got back to Montgomery, he asked around, and the people up in
Montgomery told him to send her down here. He brought her down here, and we
took what X-rays we could do in those days. I said, yes, it looks benign. This
was right before Christmas. It looks benign, and there is no rush about it; go
home and have Christmas and come back. He said, is there any chance it is
malignant? I said, no, I think it is very, very unlikely. No, it will not make any
difference. Okay. I do not think so. So, they came back in the middle of January,
and we did a fairly simple, straightforward clean-out of it, put some bone graft in
it. About ten days later, Ray Hackett called me up and said, I got some bad news
for you; that thing is malignant. I called her dad up. I said, you need to come here
and talk. The family came down. I said, it is malignant; chances are she needs to
have her leg amputated because we have kind of stirred the whole thing up; we
did not do the operation in the way in which we would have done it had we
thought there was any chance of it being malignant. He said, well, let me talk to
her. He came back and said, she does not want her leg amputated. I said, well,
the choice is obviously yours and hers. He said, I cannot sign a piece of paper to
have my daughter's leg amputated; I just cannot. I said, okay, well, we will do the
best we can. So, we did a risky limb salvage, and she did okay. It was in the very
early days of allografting, and we put an allograft in and it was rejected. She had
a chest X-ray, and she got a spread of the tumor to her lung. She came back,
and we took that out. Turned out not to be a tumor of her lung at all, turned out to
be just a little pulmonary embolus. We did another allograft on her, and then we
followed her along. She did quite well. She got a very nice result from her
allograft. She was a junior at Auburn when her father called me up and said, I
want and he had been back and forth so many times, and he and I both liked to
fish, so we had become pretty good friends by this time you and Margaret to
come up and spend the week with us in Montgomery, because Anne is going to
be the queen of the Mardi Gras in Montgomery, which is a big deal in
Montgomery. So, we went up, and she was absolutely beautiful. Of course, the
whole town knew what her history was. A very emotional thing. She is now thirty
years old, has got two children, married to a minister and lives down in Orlando.
She just is the most outgoing, kind of bubbly, effervescent kind of patient you
could have. Every time we get a family that is having a lot of emotional problems
handling this kind of news, I call Anne up and say, listen, I have some people
who are going to come down and talk to you.
P: There was a former student of mine named Steve Sutherland. I do not know if
you know about him, but his entire family had bone cancer. Five or six people in
his family, brothers and sisters, died from bone cancer. Is that not rather
E: Yes. There are two kinds of bone cancers. One is the kind that comes from the
actual bone substance itself; the other is what comes from the bone marrow.
What that family had was the bone marrow kind, which is a much more common
kind and it often has a genetic predisposition. So, in the kind of things we deal
with, it would be practically unknown, but in the marrow, that is more common.
P: Have you got any amusing stories about patients?
E: We have all kinds of amusing stories about patients, but I would say the most
amusing was a boy who actually came from Mississippi. He had his thumb and
his index finger blown off by a firecracker that he lit, could not get rid of it quick
enough and it blew his thumb and his finger off. I knew the family, so they sent
him over here. We transposed his third finger to become his thumb, shortened it
so he had a hand as if you were missing two or three fingers. He could do all
kinds of funny little tricks with it, including giving the bird, in a sense, in a more
sophisticated fashion. He had a brother who was kind of the black sheep of the
family, and he developed a tumor in his pelvis. His family at first refused any kind
of surgical procedure because his mother was a psychiatric nurse, and she did
not think his psyche could stand all the problems that would go with that surgery.
We treated it with radiation, and it did not heal. Finally, it got so painful, he just
had to have it operated on. He came down here, and because of the delay we
had to do a kind of bizarre procedure. Then they kind of fell off the earth. I did not
see them for awhile. One day, I got a letter from a doctor up in Atlanta. He said, I
just want to send you a follow-up of this boy that I saw as a patient, because I
thought you would be interested in what happened, and he sent me all the
information. In that interval, we had developed a rating system, a functional
evaluation, so I said, I am going to send you a form, if you would not mind filling
out the form. He said, well, I do not know, I may not see the boy again. He said,
the reason I saw him is because Saturdays I go down to the jail, and I see
patients that they want me to see in the jail, and he was actually a prisoner. So I
said, well, what happened? He said, oh sure, I could tell you his functional
evaluation; it is wonderful. I said, what do you mean? He said, well, he was
robbing a house, and he jumped out the window and ran down the street, and it
took them ten blocks to catch him running. That is the best functional evaluation I
P: Talk about an issue that is always important for doctors, and that is malpractice.
How is that best evaluated and by whom?
E: My take on that is probably a little different than some, because I had a
classmate in medical school who was an assistant state district attorney in
Wisconsin, who came back to medical school to get an M. D. so he could go to
work for the Fort Wayne medical protective insurance corporation, which in those
days was the largest malpractice insurer in the country. His name was Jim
Boren. I guess it was in probably the early 1970s when our tumor service had
gotten into high gear, he called me up one day and he said, we are trying to
defend a malpractice suit against a doctor who is being sued over a bone tumor
case. He said, your name came up in the discussion; would you evaluate it? I
said, yeah, Jim, I would be glad to help you out. He said to stop down, and
afterwards, he said, we are going to form a group of doctors around the country
to advise us when to settle them and when to defend them, and we would like
you to do the bone tumor cases, if you would be willing to. I said, yeah, I will do
that. So I have been doing this for probably thirty years, long before the current
climate arrived. It is a very, very debilitating business for medicine, in many ways.
Thirty years ago when surgeons would sit around the locker room between cases
and talk about things, we were always talking about operations, how you did
them better and diseases and subjects like that. Now, the conversation has
changed. It is not about medicine anymore at all. It is about the economics of
medicine, and the foremost subject is the malpractice situation. For a doctor, a
malpractice suit is a real professional stigma. I mean, he feels like he has been
branded with a big scarlet A. Whether it is justified or not. So the emotional
trauma for the physician is really very hard to appreciate. It is beginning to
change a little bit, because the suits have gotten so common [that] it is not quite
as emotionally debilitating as it used to be, but it affects their lives in so many
different ways. I can always remember a case I saw when I was a resident, when
my professor operated on the wrong knee, and I helped him. He just made the
incision and flat made it in the wrong knee. He marched right out of the operating
room, went down to the lobby, got a hold of the parents and said, look, I made a
mistake; I operated on the wrong knee, and I am going to go right back up there
and operate on the right knee; I have malpractice insurance, and you should be
compensated for my mistake. And that is why doctors have malpractice, for the
patient's protection; it was not for their own protection, it was for the patient's
protection. Nowadays, you would never dream of going down and being honest
with somebody and telling them that. In the first place, the institutional risk
assurance man would not let you, even if you tried. So, the toll of it is far beyond
just the monetary part of it. I have seen so many good doctors get tagged with a
malpractice that has changed their attitude towards medicine, it has changed
their attitude towards patients. They just turn into different people.
P: There are obviously some cases of clear-cut malpractice. I read not too long ago
where a man who operated was on cocaine when he operated, and it was in his
system. But how do you deal with a circumstance like you have just given me. If
you make a mistake but you do not really do critical damage to the patient, then
how is that to be compensated and who should decide?
E: There are instances of real malpractice, no question about it. The medical
profession had not done a very good job of taking care of those internally. Part of
it we have brought on ourselves, but that is a very, very small segment of it. All
the big insurers will tell you that 85 percent of the malpractice cases have no
merit. What to do about the real malpractice cases, well, a repeat offender ought
to be just thrown out. There are a few examples of that, but precious few of them.
The problem with that is that the doctors who do that, and there are a few, that is
the way their mind works. They are thinking malpractice defense; they are about
three steps ahead of you all the way. There was a doctor over in Daytona Beach;
the fellow should have been thrown out thirty years ago. Various doctors have
stood up and testified against him. He has got a good lawyer, and he is one
step ahead of them every single [time, and] he is still practicing over there. Thirty
years, they have been trying to put him out of practice. It is a difficult problem.
The year I practiced in Holland, where they have virtually no malpractice, there
are some shortcomings in that system, too, because there are guys over there
who are bad doctors and they just keep on being bad doctors. There is no way of
P: What do you think about publishing a physician's record and listing if there have
been malpractice suits or problems?
E: I see both sides of it. I think it would help with the chronic offenders, of which
there are a few, and I think it would hurt the doctors who get the spurious
economically-based [malpractice lawsuits, of which there are a lot.
P: What about restrictions on lawsuits, or the amount that can be awarded?
E: Again, the amount of income that is generated by a malpractice lawyer, they do
all these things on the contingency fee, if they knew their contingency fee was
going to get down to the point where it was not as great as their cost of
preparation, I think you would see a lot of the spurious suits disappear.
P: How about the British system, if you lose, you pay? Maybe that would discourage
E: The kind of health care system they have, not only in malpractice but their entire
system, lends itself to that being reasonably good. In our system, it would not
work worth a toot.
P: How about the idea of a patient bill of rights?
E: Well, we have a patient bill of rights, but that is no better than the doctor who is
taking care of you.
P: But there is some sense that, if it is spelled out, that it might require physicians to
be more responsible.
E: I do not think spelling it out is the answer. The answer is having doctors who do
not practice bad medicine.
P: In the self-regulation, how does that work?
E: Poorly. It does not work very well.
P: Who ultimately passes judgement? There is a state medical board?
E: Well, the department of professional regulation, but you got to have doctors blow
the whistle on you. You do not get much of that.
P: Let me ask you one or two more questions. How do you view the expansion of
Shands into Jacksonville and Alachua General and rehab centers?
E: Well, it is the product of its times. Shands or the College of Medicine, because
the two are essentially the same thing, although administratively they are
different, is dependent on the income from patients, and without it, it would just
stop tomorrow. When it became apparent that Columbia was making a pass in all
these hospitals and that they would then become part of the Columbia system, it
was an economic threat they could not ignore, so they bit the bullet and bought
them. Whether they will be able to make it remains to be seen.
P: Particularly Jacksonville Hospital was in trouble anyway.
E: Yes. It was either that or be in such an economic disadvantage. A quick check
with the state system and the Board of Regents revealed there was absolutely no
help coming from them, it was either sink-or-swim and they bit the bullet and did
P: Your view of the new FSU [Florida State University] medical school?
E: It is a cycle that repeats itself every so often. There have been, to my
understanding, about fifteen different institutions, two of them I have been
associated with, which were founded on the premise of increasing rural medicine
and family practice. Not a single one of them has achieved that goal. Most of
them are better-conceived and better-funded than the one in Tallahassee will be,
and I think it is an example of the interface between politicians and education at
P: If you needed more physicians, you could expand the existing medical schools,
E: Well, do you know what the PIMS program is?
E: It is a program between FSU and UF in which students start their basic science
work up there and come here for their clinical education.
P: Oh yes, I do know that.
E: Every one of those students, to a man, is against having a medical school in
Tallahassee. The medical community in Tallahassee is totally opposed to it,
because they have no clinical facilities for these students, we have no teaching
hospital. The Mayo Clinic is in this up to their ears.
P: Oh, are they?
E: Oh, yes, and they are one of the political motivating forces behind it because
they want to have in Jacksonville a set of residency programs, and their
operation over there is a money-maker for them. You cannot start new residency
programs unless you have a medical school affiliation.
P: And that is what they will use.
E: Few doctor's wives wants to live in a rural setting and have her children go to
school in small rural schools. She wants him to practice in Jacksonville or
Gainesville or Tallahassee and have the lifestyle she has envisioned when she
married this young doctor. It is just as simple as that. Very few doctors who are
trained in modern medicine want to practice in small rural community hospitals.
They want to have an MRI, a CT and all the things that you practice good
medicine with. So, that is not going to fly. There was a program in Mississippi to
increase rural practioners, and heaven knows they have a much worse problem
of rural medicine than we do in Florida, in which they paid students to go through
medical school, and for five years they had to practice where the state sent them
in rural communities, the only exception being that if they wanted to they could
buy out by paying the loan back.
P: Which they all did.
E: All but 12 percent. Tennessee had a program in that same way, same result.
Meharry, the black [medical] school in Nashville, had a similar program to get
people to go to the ghetto, same result. I mean, they could walk into any bank
and say, I am a young doctor and I want to go practice in Jackson, and I need to
pay back $150,000; will you loan it to me? And they say, how can we help you,
P: And they can pay it back the first year.
E: Yeah, they pay it off and practice wherever they want to, or where their wives
want to, is about what it amounts to.
P: Is there anything that we have not covered that you would like to talk about or
E: No, not really. Like everybody, I am concerned about how the interface between
medical education and the marketplace is developing, because more and more,
what happens in medical schools which describes all medical schools with
about ten exceptions that are so well-endowed privately they do not have to
worry about money (Stanford, Harvard, the University of Chicago, Washington in
St. Louis, and other privately-supported schools)- [is] the school are so
dependent on the faculties' fees for practicing medicine that the faculty does
virtually nothing but practice medicine, with very little time to either teach or do
research. We ran a better educational program in orthopedics at UF with three
faculty members in 1975 than we run in 2001 with twenty-one faculty [members].
We did a better job of teaching medical students then than we do now.
P: What is the future going to be like?
E: I do not have a crystal ball, and most people my age tend to be a little bit
pessimistic and cynical, so I would not take anything I say very seriously. But,
medical students are changing a lot, and not for the better.
P: In what sense?
E: Well, there is a survey that shows 60 percent of medical students at some point
in time have cheated. How does that grab you?
E: Yes. The principal motivation for going into medicine now is money.
P: That is not surprising.
E: No, that does not surprise me, but it does not impress me very favorably either.
E: And the specialty students chooses to practice has a one-on-one relationship
with the average income in that specialty; i.e., we have so many
ophthalmologists they advertise on TV. It is not their love of the challenge of
measuring people's vision. As a result the under-served parts of medicine are
getting more and more under-served. As is usual in capitalism, the rich get richer
and the poor get poorer, and that is happening in medicine as well.
P: So, ultimately, if the doctors are less well-trained, less motivated, people cannot
afford to get medical insurance, the quality of care for the average American is
going to be much less.
E: Well, I would say the quality of care for the lower third of Americans. I mean, I am
sure the middle class ... the good HMOs will survive; the bad ones are going to
gradually weed themselves out. If they allow malpractice against HMOs and
make them accountable, a lot of the bad ones will be gone tomorrow, because
they will not be able to stand the heat. You know, the Kaiser Foundation is
probably the best example of a good HMO. They have been doing this for
forty-five years since World War II, and they are damn good at it. They practice
good medicine, and it does not cost very much. As quick as they get the
bottom-line out of the HMOs, and I am sure they will fairly soon because those
guys are not making a lot of money anymore, those entrepreneurs are going to
go off to something else, oil business or whatever. They will get the hell out of
medicine, and medicine will be better off for it. The middle class will get
HMO-kind of care, and it will be pretty good care, the rich people will get the best
private care, and the lower class will gradually get into the not-so-good HMO, but
at least that will be better than what they have now, which is nothing. So, I think it
is going to get better.
P: But the quality of medical care in this country at the best facilities is certainly as
good or better than anywhere else in the world?
E: It depends on who you are. Okay? I mean, we got the eighteenth worst infant
mortality rate in the world. Less than Costa Rica. For a country that has got the
best of everything?
P: But if you are wealthy and you got a heart problem, you can go to the Cleveland
Clinic and get great care.
E: Sure. Oh, absolutely. Of course. It is very frustrating. You know, in 1960 when
the polio vaccine first came out, a doctor had to give it. You could not go have a
nurse give it; you had to give it by a doctor. All the counties between here and
Cedar Key, in that general area, many of them had no physicians in them. The
Alachua County Medical Society got together and said, we will furnish physicians
to go vaccinate people against polio in all the counties that do not have doctors in
them, and so every one of us was assigned. I got assigned, fortunately, Cedar
Key, so I went down to Cedar Key. I was busy doing the vaccination, and a man
sidled up to me and he said, listen, Doc, when you are done, would you mind
coming over to my house and seeing my aunt; she has had an infected foot since
she cut it with an axe a year and a half ago. Well, at the end of the day, I had
developed a pretty good practice. I had about fifteen people I went around to in
Cedar Key. I remember thinking, where am I? I am in the middle of Honduras or
someplace. This is terrible. If you go talk to people in Cedar Key, it is not a whole
hell of a lot different today. The economically disadvantaged folks just do not get
very good care, and when they get it, they are sick as hell and it costs about
three times as much to take care of them.
P: Almost no preventive care.
E: No. I think there is not much chance that this will change very soon, because to
the well-connected, it will be a big economic threat. I do not see Mr. Bush or his
crowd very interested in solving that problem. Most of the people who are really
interested in it are kind of tagged as stupid, liberal pinkos [socialists], and they do
not have much political clout. Unfortunately, I do not think the medical profession
is totally very interested in it; they are more interested in their own income than
they are in the welfare of the folks.
P: On that note, let us end the interview.
E: Yes, that is kind of a dead end there.