A Public Celebration of a Personal Doctor

We are gratified that our essay has prompted so many thoughtful responses from across generations and disciplines. John Anderson’s life has again touched many lives in important ways.

We feel honored to be associated with John and his family.  It was our privilege to report on his memorial that reminded us all what is most important about doctoring and family medicine.  

Isn’t it interesting how we learn and understand – not just from clinical studies – but particularly from biography and stories?  There are, indeed, many ways of knowing.  

Competing interests:   None declared

My great respect to Larry and Bill for their wonderful testimony to our friend... and to what a shining model John's life was for all of us who work in primary care. How special the opportunities that come with staying in one small rural community long enough for all the relationships to mature and the work to come to visible fruition. I will always remember John's quiet, smiling, presence and the wisdom dispensed with humility and humor. We've lost one of our dearest old friends from the ASPN community.

I am already planning to use John’s life as a stepping off point for a discussion of where our community hospital/health system is going. A common problem is the "Electronic Imperative" -- the transition to EMRs dictated by non-clinicians, and with powerful consequences for the quality of care, the importance of adequate patient-specific narrative, and the need for dedicated clinicians to be able to adequately and honestly document the patient-clinician encounter. There are ethical issues (e.g., the role of "templates"), medical student teaching issues (how hollow our focus on patient-specific and detailed narrative) ...as they find on their clinical rotations the opposite of what we in Primary Care have advocated for... and simply the time constraints on us who value adequate narrative who are now required to type ...or use (clumsy) voice-recognition systems to document our work... A highly valued cardiology colleague who works at Dartmouth-Hitchcock told me today that, if in their transition to a more complex EMR (from a very simple and clinically adequate system that I used during my six years with DHMC...that allowed free dictation), they took from him his dictating medical notes, he would simply retire ...it is that critical to many of us... We cannot allow the "Technologic Imperative" to change the entire culture of Clinical Medicine without a fight ...John Anderson would not have stood for it...

Perhaps his memory can be our touchstone for gathering together to make certain that the potential advantages of Electronic Medical Records are not sacrificed to the causes of the Financial Offices and Information Technology people who may not be aware of how these complex new systems can interfere with the central Clinical role of medical records to help Clinicians in the care of each patient who comes before us. I would hope this sad event could be a rallying point around which us older Reptilian creatures might gather and challenge the new Mammalian imperatives that threaten to change the very culture of Clinical Medicine./ Where from here! /jack

Competing interests:   None declared

Through the warm, inspiring story of the memorial for Dr. John Anderson, Drs. Phillips and Green artfully describe the love for and impact upon a small, rural community of a remarkable man whose influence on persons, place and society is evident in this compelling essay. Truly, this was a life that embodied the best of physicianhood.

The interpersonal bonds Dr. Anderson cemented with his patients reflected the affinity they shared. The trust supporting a comfortable intimacy in his patient-physician relationships was evident in the memories recalled. The transformation of a town’s health care services through a doctor’s leadership, supported by so many in town, bespeaks reciprocity of relationship between doctor, patient and community with a continuity of more than three decades. Together, these attributes comprise a case study in the dynamics of the relational model of family medicine and encompass key processes of healing relationships.1,2

However one defines healing—recovery, restoration, a sense of balance and peace, transcending suffering3,4—Dr. Anderson was a healer, helping his patients, students, and peers to become more whole. Their stories celebrate a man who encouraged the best in them, strong testimony that healing is fostered interpersonally through service to one another. All spoke of their special relationships with a special person whose specialty may have been seeing the uniqueness in everyone he encountered.

Dr. Anderson’s vision of physicianhood transcended the mere efficient dispersal of biomedical services. He shouldered not only the healthcare challenges of a small town, but also those of a nation’s need for rural physicians. By challenging the process of medical admissions, inspiring shared vision through founding a rural health association, enabling others to pursue rural practice, modeling the way as an extremely effective rural physician, and encouraging hearts to change lives, Dr. Anderson embodied the best of transformational leadership.5

Every student entering medical school should be provided this essay as an example of what it means to be a physician, the personification of the soul of doctoring. There is much to celebrate in this man who was a consummate family physician, healer, and leader. Thanks to Drs. Phillips and Green for such a moving essay. Thanks to Dr. Anderson for a life so well lived.

1. Carmichael LP. The family medicine, process or entity? J Fam Pract 1976;3:562-3.

2. Scott JG, Cohen D, DiCicco-Bloom D, Miller WL, Stange KC, Crabtee BF. Understanding healing relationships in primary care. Ann Fam Med 2008;6:315-322.

3. Hsu C, Phillips WR, Sherman KJ, Hawkes R, Cherkin DC. Healing in primary care: a vision shared by patients, physicians, nurses and clinical staff. Ann Fam Med 2008;6:307-314.

4. Egnew TR. Defining healing: transcending suffering. Ann Fam Med 2005;3:255-262

5. Kouzes JM, Posner BZ. The leadership challenge. San Francisco: Jossey-Bass; 1987

Competing interests:   None declared

Drs. Phillips and Green,

The story of Dr. Anderson is a truly inspiring story. It captures the essence of the community impact a family physician can instill, and brings to light the importance of rural health care. As a hopeful medical student and family physician, this article struck a particular note. Its resonance only intensifies my beliefs in family practice and to pursue such a career. The story of Dr. Anderson, and others alike, prove that there is no alternative, or equivalent to relentless pursuit and unwavering compassion.

Competing interests:   None declared

A friend of mine, who I met on the street last week, gave me the news. Old and bad news. John Anderson, a rural family doc, died last year of malignant melanoma, too young at 63.

I hadn't seen John in a few years, but he was a constant in my work in health policy in Washington state for most of the 1980s and 1990s. John was a voice and conscience of humane health care and a consummate advocate for rural medicine and family practice. A beautiful essay by two of his colleagues, William Phillips and Larry Green, in the Annals of Family Medicine, written after they attended a celebration of John's life in the Cascade foothills town of Cle Elum, is worth reading whether you knew John or not.

The thing about Dr. John Anderson was that, regardless of the issue we discussed – managed care, certificate-of-need, Medicare reform, whatever – he always, always kept his eye on one ball: what would be best for the care and well-being of patients. No confusion with esoteric goals like "competition" or "choice" or any of the other rhetorical waste thrown around by politicians nowadays like so much verbal confetti.

No, John wasn't hung up on the means, but was singularly focused on the ends: good care, better health. What would happen if our political representatives and professional leaders set aside their ideological weapons – no more "socialized-medicine-skin-in-the-game-consumer-directed- incentivization" – and just kept asking "What would make it easier for the Dr. Andersons of the world to give the right care at the right time to people when they needed it?" And "What are the conditions that would allow that to happen more often than not, and how do we create those conditions?"

Maybe if they – and we – just did that, and brought what we actually know (not just what we "believe") to the job of creating those conditions, maybe we could make real progress in re-forming the U.S. health system into a truly good one that we can afford.

And one that John Anderson would be proud of.

Competing interests:   None declared

The life of John Anderson brings to mind John Berger's timeless classic, A Fortunate Man: The Story of a Country Doctor. Man as myth, man as hero, man as the embodiment of community, man as the hand of God. Medical students are still taught to detach themselves from their patients emotionally and cognitively, not to treat their own friends, neighbors and family. Yet, in the town of Cle Elum with less than 2000 people in the heart of the Cascades in central Washington, everyone that John Anderson treated was friend, neighbor and family. While he knew them as more than patients, he also loved them and they loved him.

In this same issue of Annals of Family Medicine (1), we also learn about the development of a tool to measure complexity, one of the ever present realities (and joys) of the life of a family physician. Family physicians handle far more complexity in an hour than their colleagues in cardiology and psychiatry. Yet, somehow, healthy patients and healthy communities emerge out of the nonlinear dynamics that form complex systems. John Anderson shows us how it is done. The world is a better place because of men like him.

1. Katerndahl DA, Wood R, Jaén CR. A method for estimating relative complexity of ambulatory care. Ann Fam Med. 2010;8:341-347.

Competing interests:   None declared

My thanks to Drs. Phillips and Green for sharing the story of a rural family physician’s life and the impact of this individual on their community. The story of John Anderson is inspiring, yet John did not have any desire to be inspirational. He wanted to be a family physician and accepted this role as a privilege and not a burden. I knew John through our connection as members of the Ambulatory Sentinel Practice Network (ASPN). My practice on the Oregon coast was practice #29, John’s Cle Elum practice was #30. I would see John once a year during the 1980s at our annual convocation of practices in the mountains of Colorado. Members of ASPN represented a group of physicians who wanted do more than see 20 to 30 patients a day and go home. John represented the best attributes of these physicians. ASPN member physicians were curious, wanted to contribute and most of all, cared about the quality of health care and life in their practices and communities. I always walked away from my conversations with John feeling proud about my choice in life to be a family physician.

John’s life documents that as a family physician we develop long-term relationships in our community and become an ex-officio member of our patients’ families. We participate in births, school graduations, marriages, funerals, and passing judgments on new car purchases. It is unusual to see the sustained dedication to a community that John provided. It is sad for his patients, family, and colleagues that they did not get a chance to grow old together, yet, it is a joy to reflect on a life well- lived.

Lyle (LJ) Fagnan, MD Former rural family physician Oregon Health & Science University

Competing interests:   None declared

Drs. Phillips and Green,

I never met Dr. Anderson. I wish that I had! Clearly he will remain someone remembered for his contributions to his community as well as to the legacy of our profession. It is a curious time for myself to read this piece as I begin to look for a position next year practicing full spectrum family medicine. Truth be told, Dr. Anderson embodied the myriad of reasons why I entered into family practice. He demonstrated that practicing medicine must incorporate the new developments of science, but be firmly grounded in the intangibles of personal connection with our patients. He cared for not only the individual, but the entire community as his patient. As a result, his community benefited from improved health outcomes. Primary care research has proven this time and time again. Next year I hope to embark on a rural career in the National Health Service Corps with much thanks to Dr. Anderson for his bravery and courage in leading a path for future residents such as myself.

Thank you for honoring his story and sharing it.

Thank you so much for providing us with the glimpse of this wonderful life. It is the influences of such great family physicians that we should boldly expose to aspiring medical school students and residents. Our communities can certainly benefit from more Dr. John Andersons.

Antonio Germann, MD MPH

Competing interests:   None declared

Larry and Bill; Thank you for this essay honoring our friend John Anderson. As Don Solberg already said, you got it right. Reading this brought back memories of being in that gym in Cle Elum and memories of my first meeting with John 40 years ago; he a second year medical student intent on just this career and I a newly minted faculty member charged with developing a curricular pathway for such students. It was a privilege to know him and others like him long enough to see them accomplish their goals, becoming part of the landscape in communities throughout this region.

This issue of the Annals arrived just after I finished reading Timothy Hoff's book, "Practice Under Pressure, primary care physicians and their medicine in the twenty-first century". (Rutgers University Press, 2010) Hoff, a sociologist, interviewed some 90 family physicians, pediatricians, general internists, medical students, and residents to determine how they were adapting to being primary physicians in the current "transactional high volume business model" of medical practice. (pg 194). He says at one point (pg 129): "The game has changed and it is perfectly reasonable to expect the players to change with it." However, the changes he uncovers include viewing medicine as a job without commitment to a community over time. What a contrast with John Anderson's legacy.

You got it right when you concluded that, whatever the model for medicine in the future, we must preserve for our communities the "personal doctoring" so warmly appreciated by the citizens of Cle Elum in their shared remembrances last year.

Ted Phillips, MD

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I want to thank so very much Drs Phillips and Green for penning the very moving tribute to our friend Dr John Anderson. Like so many others (& no more than any) I had frequent occasions to work with Dr Anderson here in Washington state in venues with the University of Washington, the state academy as well as the state medical association. At all times, he was a selfless, committed, insightful person who reliably offered opinions that made the discourse more constructive. Such a wonderful gift to the family to have the community unite in his tribute locally, and special appreciation to the authors for sharing the event more broadly.

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What was celebrated at Dr. Anderson's Day was his community- not community medicine, family medicine, evidence-based medicine, or even a medical home. He succeeded beyond such potentially mensurable categories of medical practice into the rarified air of stories that become the stuff of heroism. His participation in the life of his community penetrated into mystery wherein communities become the true loci of healing by absorbing each others griefs. This dimension of being there and staying there is hidden from transients, novices, and most recent US medical school graduates, but nothing else merits a community's celebration of a faithful physician.

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I worked with John Anderson when I was a resident -- how fortunate I was!

I was so saddened to hear of his death, but reading this tribute to him was inspiring.

I will take this remembrance with me and care for my patients, teach my residents, tackle administrative work, and care for my family -- all with a little bit more joy today to honor his legacy.

Competing interests:   None declared

Bill & Larry,

Thanks very much for writing this article. John, and so many family docs and others like him, do not just CARE for their patients/patient- families/community/community-leaders/their-own-family -- they RESPECT them.

Why do I write that? I am on a flight from DC back to Seattle (to Bellingham), after testifying in DC this afternoon to the Secretary's Advisory Committee on Human Research Protection about the Havasupai case and recent settlement. Testifying with me was Carletta Tilousi, a Havasupai tribal member and now Havasupai Tribal Council member as well. She is the person who discovered what other research had been done using the blood specimens collected from about 200 Havasupai adults, teens, and young children for diabetes research. The contrast between John Anderson and his behavior and attitude and feeling for his patients, with that of the ASU reseachers toward the Havasupai, was so different. Tears came to my eyes as I read your article, tears both of appreciation of such a life, and also of sadness for the Havasupai who, in contrast, were so DISrespected for so many years by first the researchers themselves and then the State of Arizona that fought the Havasupai for so long before finally settling. It had been a depressing afternoon for me -- and your article was so inspiring. Thanks, again

Competing interests:   None declared

Drs. Phillip and Green,

Thank you for your moving and timely piece that gracefully, albeit posthumously, reminds us of the power of a Family Physician in a town still mourning for him. It is stories like this that drew me to our great specialty, and continue to fuel my passion for defending and strengthening it. Sadly, I did not know Dr. Anderson, but I still feel indebted to him. His sacrifice -- moving to a town other doctors forgot--in the early years of the Health Service Corps, is too rare these days. But more concerning than that, Family Doctors are too rare. While our match rate increased in 2010, we still have fewer residency spots than we did a decade ago. Even before healthcare reform we were projected to be at least 40,000 primary care providers short of what the country needs by 2020.

How wonderful would it be if we began honoring those like Dr. Anderson not after their deaths, but while they lived and practiced. What if we did it publicly, boldly, and unapologetically? Could the worst thing that happened is that some other specialties also decided to celebrate their own? Could young, bright, compassionate youths see these celebrations, and for the first time, consider medicine, or even Family Medicine?

Drs. Phillip and Green, thank you for this reminder. Dr. Anderson, thank you for your service. I think it is high time we began celebrating our specialty and our doctors OUT LOUD!

Dr. Heidi Meyer, PGY-3, University of Arizona Family Medicine Resident Director, Arizona Academy if Family Physicians Resident Delegate, American Academy of Family Physicians

Competing interests:   None declared

I love to hear either Bill Phillips or Larry Green speak; clarity of thought and ability to capture the essence of a subject with simple eloquence can be expected of each of them. This essay is the best of both of them.

I was honored to speak at John Anderson's memorial, and mourn the loss of a medical school classmate and colleague in practice for over 30 years. Yet the essence of Dr. Anderson's life as a Family Physician is captured in this essay less by our personal memories than by the recognition that in this amazing profession we share our stories with our patients in ways that change both of us forever. For John, this defined him; he would have been embarrassed to be remembered for his story, and deeply honored to be remembered for those lives he had influenced.

May we all be reconnected with this essential truth of Family Medicine. Thanks, Bill and Larry, for getting it right.

Competing interests:   None declared

Words, like medicine, have power to heal. They can reduce inflammation, speed recovery, and help re-establish balance. Thank you, Dr. Green and Dr. Phillips, for your words honoring a doctor who lived as an integral part of his community. His life and death profoundly affected the landscape of that community, and of our family. May all who practice medicine be encouraged and challenged to catch the wonder and the mystery, to stop and listen, and to care courageously for those in their own communities.

Competing interests:   None declared

This beautiful tribute to a small-town family physician, John Anderson, reminded me of the process of appreciative inquiry (1), which has been used beneficially to celebrate the systems and relationships in which we find ourselves embedded ouas part of our professional lives. What is most striking to me about the stories told about Dr. Anderson at a time that often seems to prioritize algorithmic efficiency and productivity in medicine is the personal knowledge he demonstrated about his patients, and his creativity in tailoring treatment approaches that honored their individual values and preferences. This was a family doctor who was not afraid to use every part of himself in loving his family, caring for his patients, and serving his community. The portrait presented inspires all of us to be our best selves, and the family doctors among us to strive to make a shared humanity the centerpiece of their daily work.

1. Cottingham AH, Suchman AL, Litzelman DK, Frankel RM, Mossbarger DL, Williamson PR, Baldwin DC Jr, Inui TS. Enhancing the informal curriculum of a medical school: a case study in organizational culture change. J Gen Intern Med. 2008;23(6):715-22.

Competing interests:   None declared

If only all people could enjoy what Dr. John’s patients came to know as usual and customary. How fortunate and happy we’d be. And yet with the best of intentions, much interferes. Cheers to you, John Anderson, who did so much for so many through your relentless attention, dedication, and care. The privilege to know you in our ASPN pursuits was mine. Thanks for sharing, Bill and Larry.

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May I add my appreciation for the reflection and commentary. I distributed it to my 45-member provider group at last night's monthly meeting in the hope of reinforcing our fundamental relational purpose as we plod through the din and distraction of day-to-day. Reading your expressions, I'm reminded of Goethe's admonition from long ago, "things which matter most must never be at the mercy of things which matter least." Thank you.

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John was a mentor of mine and embodied all that is good in Family Medicine. He truly has been part of the landscape for Cle Elum and the state of Washington. Bill and Larry's ability to capture his connection to the community is laudable. It is my hope to weave his life and its "connectedness" to community into the students entering rural medicine. His being part of the "landscape" of Cle Elum is what rural physicians bring to communities. The value to those communities is far beyond simply providing good care and the personal return is what helped John keep that smile on his face.

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I very much enjoyed the remembrance of John Anderson. I did not know him, but as I read it I was reminded of my own family doctor in a small and remote Montana town. As a Family Medicine Residency educator for the last 20 years, I have watched our residents grow and go out to communities to work in ways similar to the stories told about Dr. Anderson. I realize these beautiful dramas are commonly replayed, but they are not widely witnessed and rarely are they published. Thanks for sharing our eternal values.

Competing interests:   None declared