The cover from LIFE in 1998, together with David’s reflection in 2026
David Loxterkamp’s work as a family physician was the subject of a 1998 LIFE magazine photoessay, “What makes a good doctor?” , an NBC Nightline documentary in 2000, and the 2015 PBS documentary “Rx: The Quiet Revolution” by award-winning film-maker David Grubin.
David Loxterkamp, M.D. is a family physician who has made his home in Belfast, Maine for the last 41 years, along with his wife, Lindsay. They have two children, Clare and John, who live nearby. His stories and essays have appeared in the New England Journal of Medicine, Journal of the American Medical Association, the British Medical Journal, and the Annals of Family Medicine. He has authored A Measure of My Days: The Journal of a Country Doctor (University of New England Press, 1997) and What Matters in Medicine: Lessons from a Life in Primary Care (University of Michigan Press, 2013), and has contributed to several anthologies, including including A Life in Medicine, edited by Robert Coles and Randy Testa (The New Press, 2002) and The Country Doctor Revisited: A Twenty-First Century Reader, edited by Therese Zink (Kent State University Press, 2010).
David Loxterkamp with his daughter Clare. From the LIFE photoessay 1998.
David grew up in rural Iowa, attended Creighton University and The University of Iowa College of Medicine, completed his family medicine residency in York, PA ((1982), earned an MA in the Social Sciences at the University of Chicago (1984) and a fellowship in Family Medicine at the University of California, San Francisco (1994). He is is co-founder of Seaport Community Health Center and its Recovery Program. interests include running, choral music, local history, architecture, and potato farming.
Watch the video of the interview below or on Youtube or listen to the podcast on Spotify and all the major platforms
John Frey is an Emeritus Professor of Family Medicine and Community Health at the University of Wisconsin who engaged in many jobs over a 50-year teaching career. He loves books, coffee with colleagues, having wonderful trips with wife Cathy, grandchildren and friends. He was a liberal arts major in college and snuck into medicine because he was born a year before the post war baby boom officially began. He is also a very good garden weeder. A full life, no regrets
The Essay “Being There- On the Place of the Family Physician” appeared in the Journal of the American Board of Family Practice in 1991.
Hello, I’m John Frey and welcome to MedicsVoices where we talk with key opinion leaders from all aspects of health and medicine. Today we’re talking with David Loxterkamp, who is one of the great writers and essayists about practicing medicine in the community over the last 40 years. He’s published essays in the British Medical Journal, JAMA, The Annals of Family Medicine, BJGP, and many other journals over many years. He’s also the author of two books about his work in rural Maine, and his connections with the history and spirit of doctoring.
In your, 1981 essay, called Being There, you wrote that “practice is a splendidly colored canopy, where the stories of physicians and patients enter a branch, where changing rules and evolving relationships of community life provide shelter for the long run. It’s mostly about being there, a presence over time, about knowing our place and holding ground.”
That was at the beginning of your career, and I wondered if you’d talk about your journey from rural Iowa to rural Maine, and a little bit of reflection on that particular piece of writing which was early in your career and how it has felt over the years.
David Loxterkamp: I grew up in a town of 750 people, a town that I didn’t know at the time, or maybe didn’t want to believe, was slowly dying, as were all of the small farming communities in the upper Midwest, and probably in many places. I see that happening also here in Maine.
And then my father died. My father was a general practitioner. My mother a nurse and my sister became a nurse. From an early age, I just knew that there was something important about medicine, especially in a small town, and being an integral part of a community. That idea became very important to me. I got into medicine, I always say, as an arranged marriage. When I was leaving for college my mom made a comment to me that, if I should decide for some reason not to go into medicine, that she would have felt as if she had let my father down. I didn’t see that as manipulative in any way at the time.
And I suppose, like many arranged marriages, this worked out to be the perfect lifelong choice. It allowed a person with awkward social skills to delve into the lives of others and, in a professional way, become a friend to them, a witness for them, a companion to them and their struggles.
I wanted to practice in Iowa. I did my family medicine training in Pennsylvania and desperately wanted to get back to Iowa, but to first spend a year in Chicago just living the city life, a city which you know well. It was a wonderful experience. Great food, great culture, and I studied for a masters at the University of Chicago while I was waiting to go back to Iowa. And, like many men make their significant life choices, I met my wife to be, and she was from the East. When it became clear we were going to leave Chicago in the same direction, I said I’d go anywhere rural, and she would go anywhere East. And we ended up in Belfast, Maine. Maybe the third best choice I made in my life. The first was to marry Lindsay. The second was that we decided to have children, and then we ended up here.
David and family at the Maine half marathon and with the potatoe harvest
DL: As a reflection on the reading that you provided at the outset, I guess I’ve spent my whole writing life, repeating myself because I feel pretty much exactly the same way now. I’m in the right place. I’m caring for neighbors and friends. I know this community and they, importantly, know me. I get so much support every day when I walk into a hardware store, or the post office, or just downtown, having a conversation with people, that we’re friends and, even if we are maybe on the opposite side of the political aisle, or go to different churches, or whatever, that all falls into the background of years of knowing each other.
So, I’m still holding ground and I don’t intend to leave this ground. Some people who have moved to Maine find it’s a hard place to get an anchor sunk. People are suspicious initially, or at least in rural places, suspicious that you’re going to stay for a couple of years and then leave, and they’re waiting for that other shoe to drop. Finally, when they realize that you’re here to stay and that you’ve earned your spot, it doesn’t feel like you would ever want to leave. You know you’re here for good. And my wife feels the same way, luckily. And our kids, surprisingly, after living in other parts of the world, have joined us here.
Our 30 year old son is living eight miles away and our daughter is within a half an hour drive. We’re lucky, we found our home, and, and it’s a big one that includes all the people in town and even our children.
JF: When did you realize that you were a physician and a writer, that writing was going to be a part of your life as long as medicine has been part of your life?
DL: I think I got lucky in that early on I got guidance from one of the great writers, a mentor to both of us, Gayle Stevens, who patiently helped me work through the process of learning how to get a great idea, a wonderful feeling, into words that reflect that honestly and authentically.
It took me a number of tries, he was very patient and finally he said “this is worth publishing, let me help you”. So, early on, I was lucky in that I had a mentor, and I was lucky that I had some early success. And once you find the magic using words and using this as your creative outlet in life, or at least one of your creative outlets, it really is deeply rewarding. It’s instructive. It’s a confessional. It’s a home place. It’s a conversation with myself that I hope others might deem worth listening to. That’s always been the way I’ve approached it that, if I can be honest to myself, others might find that interesting or helpful to them. I’ve never pretended to be, or tried to be, the voice of the rural family physician, but just one guy living a pretty good life with ups and downs, confronting the injustices I see in the world and with my patients and trying to reflect that in words and trying to make the words as truthful and as beautiful and as compact as I can. So, I’ve been lucky and I’ve had great mentors and support all along the way.
JF: There was this line where they asked William Carlos Williams about how could he practice medicine and write poetry at the same time. And his response was- one rests the man while the other exhausts him. And I think of you all the time when I think of that, because you’re doing simultaneously difficult work in both of those areas.
DL: He has always been a great inspiration to me as well. And I remember, maybe in his autobiography, him reflecting on how he worked in writing into his busy life, much busier than mine, I suspect. And I think he said something like that he would even write down a few lines at a stop sign. If he can do that, I can ‘waste’ an hour or two hours in front of a computer, trying to capture a feeling or a thought or a reaction to a situation. Much of my writing has always been that. It’s the life of a family doctor, isn’t it? We react to whoever walks in the door and the problems that they bring to us.
An image from the LIFE photoessay-“The Delivery”
JF: Over the years, you’ve had a pretty consistent interest in a couple of people. One was, or is, Ernest Ceriani, a rural family doctor in Kremmling, Colorado, that was the subject of this remarkable, photojournalism essay that W Eugene Smith did in 1948. (https://www.life.com/history/w-eugene-smiths-landmark-photo-essay-country-doctor/) The photos from that essay are some of the most compelling there are in medicine. And the other is, John Berger and Jean Mohr and their work with The Fortunate Man.
I wondered if you could speak about each of those, especially since you were the subject of a photo essay in Life, 50 years after the original 1948 photo essay. If you could talk about Ernest Ciriani and how you became interested in him, and how you ended up being the subject of a similar kind of essay.
A photojournalism essay by W Eugene Smith in 1948.
Above is the cover of ‘A Fortunate man”by John Berger and Jean Mohr .
Follow the hyperlink below to a background piece by Gavin Francis published in 2015 in The Guardian.
DL: First, Ernest Ciriani. Yes, the photographs were beautiful. And I don’t know who first told me about W Eugene Smith and his photo essays, but I was handed a 1948 Life magazine and I was captivated. He was, at least pictorially, everything I wanted to be. I wanted to be that country doctor. I’m an idealist. I picture myself in situations way beyond what I can probably realistically handle. He was there as a solo practitioner and I knew I couldn’t be that. But, it was him and those photographs certainly propelled me, in some dark moments, to become a better family doctor, to stay in this small town, and make the best of my life.
Its a long story. My daughter and I took a trip to New York City, to the Time-Life building, and we were invited to meet one of the editors who had written a book about Maine. I had written him a fan letter and he said, any time you’re in New York City, I’d love to meet you.
So we did, and one of my questions to him, and this was 49 years after the original essay was, what are you going to do to commemorate this 50th anniversary coming up? I know that we no longer have W Eugene Smith around to do another essay but what are you going to do, it was such a beautiful essay, it should be memorialized. And, he looked at me and he said, “isn’t Doctor Ciriani dead?” And I said, “yes, but there are other doctors out there.” That was the last I heard of it until I got a phone call from the managing editor of Life magazine, who said, “would you be interested in, in being the subject?” She had just read my book ‘A Measure of My Days”, that had just come out in 1997. And she said that, “if it all works out, we would send a photographer and a journalist to spend three weeks with you. They’ll be in your home, they’ll be in your face, they’ll be in your office, they’ll be around town with you. It’ll be a great imposition. But are you interested?” And I was. To be connected to W Eugene Smith and to Ernest Ciriani was just an honor for me. What was really important too, and this relates also to John Berger’s story of John Eskell, given the pseudonym John Sassall, in the book A Fortunate Man, is that years later I learned who these people were, and that was really important to me, to be able to go and meet and to converse with the sons of Doctor Ciriani and to travel to Kremmling, Colorado, where he lived and where that beautiful photo essay was filmed, with one of my mentors, Gale Stephens, who accompanied me to Kremmling to interview his nurse and other people in town.
I’ll just say this, and this kind of relates also to that, to John Berger’s story of A Fortunate Man that, in my life, with my children, with my friends, with the patients who come in to see me, I know them in such a thin veneer. I don’t know really who they are. I’m struggling to find out who they are. And the more you peel back the pages, you get a better picture of who they are. I learned who Ernest Ciriani was, and I learned how his life ended in a broken marriage, with one son liking him, the other not, with people in town feeling grateful to him for all he had done. But, he couldn’t accept the younger doctors who were coming into town with their newer medicine. It’s a feeling I have right now, as we’re seeing family medicine change so much. I wanted to get to know who the real Ernest Ciriani was and I did find that out and wrote a little about it in my second book.
And, in the same way with John Berger’s A Fortunate Man; what a vision to be in that little town of St Briavels taking care of the foresters, and written about so beautifully. John Berger told me in person when I visited him outside of Paris a number of years later than the Life magazine piece, that this was his favorite essay, his favorite book. And he told me a little about what he knew about John Eskell. It turned out he also idealized John Eskell and even though he knew the full story, he kind of put it together in his mind in a positive way and, to my way of thinking, with no serious reflection. I don’t know if John Berger ever read my piece in the new book “What matters in Medicine”, where again, I reflect on John Eskell and John Berger, but I felt satisfied that I had gotten to know a little bit better who he was and how important that is to keep looking deeper as I try to do in my own life, to try to look deeper. I don’t know if this has been true in your practice, John, but I expect every generalist, every family physician, discovers that it’s through our care with patients that we learn a lot about ourselves and how we react to them, how we learn about them, how we let them into our lives, how we care about them and care for them. And so, I suppose this is a wonderful thing that William Carlos Williams also learned when he talked about that for one, its your bread and the other it’s what exhausts you. They’re intertwined and one can’t do one without the other and I think that’s always been true for me. Medicine has taught me to look deeper, listen more carefully, spend more time, don’t jump to conclusions, don’t judge. And it’s helped me in my own judgment of myself: Give myself a break. Take some time. Let this let this cool off. I’ve not learned as fast as that with patients. It’s harder to do that.
An images from the LIFE photoessay- “On a house call”
But these were two monumental people in my life, both the real people and those who wrote and photographed them. These were big inspirations for me. I think too, if I can be honest, that people like them, people like William Carlos Williams and Gayle Stephens, are more important to me because I lost my father at an early age. My dad died when I was 13 and that loss, of not knowing how to become a man, how to be a man, how to be a father to my own children, and a husband to my wife, not really feeling confident that I could, I’ve needed people, people like you, other colleagues in my life, my professional partner Tim Hughes, have always been so important to me. I’ve never quite felt like I had two legs to stand on. I was standing with one and a crutch. So it’s taken a long time. But now, for the last, ten years since Doctor Hughes left the practice, I am on my own and it feels comfortable for me. And my wife is a big support. My kids are a big support. I’m still learning how to find out more deeply who it is I love and care for.
JF: That’s really wonderful. I think that you are continuing, even though you took a break from your practice, to go back and be with people and patients, and part time, and help out. It makes me understand that that work is essential to learning about yourself, but it’s also essential for all of us who are clinicians, to go in there and to listen and to understand and reflect. In the sense that you’re now in another stage of your life, which has to do with a little more control, a little more opportunity to do other things, but staying engaged with and helping the practice in the community that you lived in, is really remarkable. You still offer us an opportunity to think about our own lives as we age. So I really appreciate that.
DL: I feel lucky. I feel lucky that I found a vocation. I found my home. And, this is a form of an apology to all the patients I took care of for the previous 35 years, I feel like I’m practicing the best medicine in my life. Maybe I’m not as sharp and as quick and I probably don’t read as much as I used to, but I do spend more time, and I have time to look up things after I leave the patient. I think every general practitioner must feel at a certain point, that they’re on a treadmill, and it keeps going faster and faster, and you have more and more patients to worry about. And I got to the point at the end of my official career where it was hard for me. My patients were aging with me and it was hard for me to face their death, their final struggle. I couldn’t. There were so many of them, I couldn’t do it all. So, I used the opportunity to teach for three years as a way of easing out of that, what I felt was a burden to me. Coming back, for some reason that slate has been kind of wiped clean. I see many of my older patients struggling, dying, ending their life. I can look at it differently now. I don’t know quite why that is, but I don’t feel responsible for saving them. I suppose it has something to do with no longer feeling responsible for saving family medicine or saving the world or such other idealistic whims that I had. I feel only responsible for being there with them.
Described by David as “The Old Duffers Club”
Maybe getting back that original statement I made many years ago, if we would only listen to ourselves rather than just, prophesize and spout off to others, I might have had an easier life. But I do feel like I’m giving them the time that they need now and giving myself that time. I’m not happy personally with the way family medicine has changed, but I suppose this is like all older generations seeing the younger generations coming up, doing things differently. We can’t adjust or we can’t adjust easily, we can’t adjust freely, and we have to just hand on the baton and hope that, in their goodness, in their desire to do good and to do good for others, they will find a way to make it right. A way that I can’t imagine and I can’t visualize, I can’t participate in, they will make it right. And I see that in the people around me who are on the treadmill that I was on and I feel sorry for them. I do have the chance to talk to colleagues like yourself, like Doctor Hughes and others, about the changes going on in family medicine, the loss of continuity, the loss of comprehensiveness, the loss of ownership and not just financial ownership, but the loss of emotional investment in a practice, the desire to move on after a couple of years in this revolving door of not locking oneself in a community, not holding ground, but moving on. That troubles me. But, it’s happening. It’s the reality. And I can either grumble about it, and I do, or I can work with those who I still can work with. My preference is to do what I can and to let the world decide on how it’s going to handle all the rest. What I can do is to give more time to people who are at the end of their life, or at the beginning of their life and struggling with addiction, struggling with homelessness, struggling with mental illness, struggling with marriage and commitment. I can help them by giving them the time that they need. I do that at the expense of having to spend a lot of time documenting outside the office, something I thought I would never do, but one does what one has to do. And so I try to give. I don’t have a lot of time left but I have some time and I have time to give. This has allowed me to be the doctor I wanted to be all along, and I’m still here in a community that has recognized me for 41 years as one of their doctors. So I’m very grateful for that.
JF: Well, this has been wonderful. I really appreciate the time you spent with us. And, all I can say is, there are a lot of people in this world who have used to what you’ve written as a kind of safety vest that you can put on when you feel like you are drowning. I certainly think people have reached for what you’ve written to help them through the similar kinds of things. And, I give what you’ve written to younger doctors all the time. So, I think there’s hope there that others will see its value and be grateful. Thank you, David. Thank you so much.
David and family in Ireland, when he had an opportunity to visit the ‘real’ Belfast
Editors note: In 1998, when passing through an airport in the US on the way to a conference, I came across David’s photo essay in LIFE. As a family doctor in Belfast (Ireland), it resonated with me in so many ways. I’ve often used a photo of the cover to illustrate talks and lectures over the last 25 years. It’s been a privilege to publish this interview in MedicsVoices and to share his story.
I invited David to write an addendum to add further background…
Addendum:
The story of how I came to be featured in a LIFE Magazine begs a longer explanation. It has had an outsized impact on my life, opening doors to interviews, documentaries, and speaker invitations. It also encouraged me to imagine myself as a small, true voice for rural medicine.
In January, 1997, I discovered a wonderful book by Dan Okrent in the remainder bin of a nearby bookshop. The Way We Were looked at family, work, and community life in New England during the 1940s– literally through the lens of the Standard Oil photographers who were paid to capture it. Okrent went back, forty years later, to find the people who came alive in those luminous, transcendent black and white photographs. And the stories he told were as moving as the photographs themselves. I wrote Mr. Okrent a fan letter and sent it to his publisher, who forwarded it to the Time-LIFE Building in New York City where Dan was now an editor.
I saved copies of our letter exchange, in part because of Dan’s invitation…”If you would like to continue the conversation over lunch or a drink the next time you are in New York, please do not hesitate to call me.” As it so happened, I had been planning to take a trip with our daughter, Clare– the kind of one-on-one, parent-to-child adventure that Lindsay and I tried to arrange with each of our children. I called the number that Dan had provided, and a month later he was introducing Clare and I to the staff of LIFE Magazine, including its new editor, Isolde Motley. I asked her the important question: How did LIFE plan to commemorate the 50th Anniversary of W. Eugene Smith’s iconic photoessay, “Country Doctor.” She replied, flatly, “Isn’t the doctor dead?” Well, yes, I stammered. But there are other doctors out there…”
I returned to Belfast, mesmerized by the experience. And several months later, I received a phone call from Robert Friedman, assistant managing editor at LIFE. Everyone at the organization, he emphasized was still enthralled with the work of W. Eugene Smith. Ms. Motley had read my book, “A Measure of My Days,” and was intrigued. Would I be willing to allow a journalist and photographer to invade my life for three weeks so that LIFE could attempt a remake of “Country Doctor?” Understand, he made clear to me, that only a small number of assignments ever make it to publication. But they would send two of their best– writer Claudia Dowling and photographer Lynn Johnson– to Belfast and give it their best shot.
Though Claudia and Lynn had rented rooms at a local motel, they seemed to be a constant presence in our lives, at times obsequious, invisible; at other times bubbling over with questions and observations. Since starting my practice, I had grown accustomed to the little voices in my head, or sat on my shoulder, who steered the conversation with patients and challenged my motives. But here they were in flesh! And over the three weeks that Lindsay and I spent so closely with Claudia and Lynn, we grew to trust and love them, and maintained a correspondence over the years.
In the weeks that followed Mr. Friedman and I exchanged a barrage of emails to clarify names, check references, and make sure that a background check on “David Loxterkamp” would not embarrass the magazine. Then suddenly a phone call: “Not to give you a big head, doctor, but the editor wants to put you on the cover of the June issue. It will be in black and white, in keeping with the original photoessay. And she’s thinking of calling the piece, ‘America’s Best Doctor.’” PLEASE DON’T, I literally shouted into the phone. That would ruin me. But like everything that rests in others’ hands, I had to trust that LIFE would do the right thing.
That the photoessay was ever published is something of a miracle. In the middle of the printing run, Frank Sinatra died. The magazine had been preparing for this eventuality and had a full story ready to print. But the run had passed the half-mark and the publisher determined it would be too costly, too disruptive to halt the presses and start over. So they decided to print a commemorative issue for Ol’ Blue Eyes a few weeks later. When the June issue finally hit the newsstands, my masked face was on the cover in the middle of a delivery, with the bold, white letter that asked, What Makes a Good Doctor?
The LIFE Magazine photoessay changed little about my life in Belfast. Patients and friends already knew me. Most of the townspeople were excited about the publicity it brought to the community, but very few new patients came joined our practice because of it. Sales of the June issue must have been brisk, at least at local newsstands, because later, as people cleared out their file cabinets, I was inundated with a mountain of copies. I don’t doubt that some of my colleagues were bewildered, even perturbed, that I was chosen for the cover story. Wasn’t I just an average doctor in an unremarkable practice, with no local leadership role or professional prestige to my name? But that, I believe, was the editor’s intent. It was not the individual who mattered, but the small town values of the profession.
If I had regrets any about the photoshoot, it was my portrayal as a solo practitioner in the mold of Ernest Ceriani, the doctor from Kremmling, Colorado who W. Eugene Smith had catapulted to fame. When Tim Hughes and I started our own practice in 1985, we had studiously tried to avoid that trap, the one that burdened and isolated so many of our colleagues, including my father. But LIFE Magazine had its own agenda, just as it did under Henry Luce in 1948.
