Thursday, March 28, 2024

John Frey | Thought Leader in US Family Medicine and ‘Faculty Whisperer’

by Editor

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

“A colleague of mine who’s a coach… he’s an executive coach.  He gave me his card and on the bottom it said :”Executive Whisperer”.  And, I thought, that’s what I’m doing.”

“Education needs to start in communities not hospitals, you negotiate with hospitals to work with hospitals, and work in hospitals, but the focus has to be in communities not in hospitals.… most family doctors are not even doing hospital care, and if you’re not doing hospital care, why spend two-thirds of your training in a hospital?

Enjoy the conversation, watch the video, listen to the podcast, read the narrative

 

Read about John Frey in this link STFM Foundation

You spent time with Julian Tudor Hart, a legend in Family Medicine…

JF:  It happened because I was a junior faculty member in the first stage of my career and a colleague of mine slipped me a journal article. We used to tear pages out and send them around. So, he put it in my box and said, you might be interested in this.  It was an article that Julian wrote in the Lancet. Unlike Julian, it had a dull title the – relation of Primary Care to Undergraduate Education. 

It was one of the few things that he had written about the responsibilities of general practice education. He was always a teacher in many ways but never an academic in the traditional sense, in an academic role. It was the most extraordinary piece of writing I’ve ever read.  It talked about the duties of general practice education and it touched on everything that I was going to do as a teacher.  His address was Glyncorrwg, near Port Talbot in South Wales, and I thought – who describes their town as being near another town.  I had no idea who he was and I didn’t know anything he had written.  And, a long story but, I needed a break in my life. I had been going in a flat out since I was in kindergarten and I wanted to take a sabbatical.

I wrote to him and said – could you use somebody, could I come look at your health center, could I come and see what’s going on in general practice in the UK?  And, he wrote back and said, you’re welcome to come and I can arrange for you to visit other places, which he did.  And so, I took my eight-year-old son and my wife and we went over and lived in council housing in Glyncorrwg and spent nine months there.  I was the first American residency trained GP to get licensed in the National Health Service. I didn’t get paid, but I saw patients and for me it felt more important to be part of the experience of general practice rather than be a visitor and look at it from afar. It was a remarkable experience and the way changed my life was so much due to Julian’s passion for the National Health Service, his passion for service to communities and, his belief that the research that should be done in general practice and family medicine, should be done in the place we work, which is in our communities and in our practices. 

There was no strong research tradition at that point, in 1979, in America. We were getting started and doing some very cursory studies, and a few really good studies but, to watch what he was doing and how he was doing it, was just amazing.  I spent nine months practising, visiting people like Graham Watt in Glasgow and John Horder in London.  He sent me around to all the people he knew and I had a wonderful time.  

It changed me because I still quote Julian and that article, which I could almost recite from memory:  The three things that we’re supposed to be doing in academic general practice are teaching about uncertainty- how to help physicians make decisions with incomplete information, which is still one of the key things that general practice/family medicine has to do; the second is to change medicine at the level of the communities in which we work. Julian was a big believer in changing Glencorrwg for the better, which he did, and;  the third thing he taught which is germane now, is that we have to teach disciplined anger. Anger, not at people but at the things that impede the care we know patients should be having.  That’s the source of a lot of moral distress in medicine, in primary care/family medicine/ GPs all over the world. It’s a sense of our inability. Our anger is at systems that will not change to meet our patients’ needs.  Julian would always advise – let’s get together, let’s go arm and arm, shoulder to shoulder, and make the changes.  And, that’s been inspiring me all my life, and that’s 45 years ago. 

DMacA: Julian was a tremendous activist and certainly a great advocate for the National Health Service and for community practice, but it’s interesting that you picked out that article on education because I know that you feel residency education needs radical reform.

JF: My first identity is as a family doctor, my second is as a teacher, and I put those close together.  One of the things you see, and I’ve seen over my life, is that much of residency education, which is a postgraduate education in the U.S, hasn’t changed much in 50 years.  I keep telling people that education is a very conservative field.  They say professors and educators are all very progressive.  And I say, no they’re not.  They may vote that way but they don’t act that way.  One of the problems is that, when you say to people we have to blow up this whole thing and kind of start all over again, it terrifies them instead of excites them.  Because, people in education are more comfortable with being comfortable.  They work very hard and I admire everything about them and they’re really thoughtful and brilliant inside of a box. I don’t know enough about current general practice education but I suspect that if you look at how it was when you trained and now, there is probably not a lot of difference.  My sense is that we all are getting stuck.  We start something out and say- we’re going to change this with time, and we’re going to be flexible, and we’re going to be thinking about new things. That gets lost because we’re so concentrated on making sure the box gets checked.  There’s so much supervision and so much oversight and all this kind of stuff

What I’m trying to say and, a group of us are writing about it, is that education needs to start in communities not hospitals, that you negotiate with hospitals to work with hospitals and work in hospitals, but the focus has to be in communities not in hospitals. In the US, all the money from the federal government, and all the other things that come to graduate medical education, come to hospitals.  We are talking about Family Medicine located primarily in communities and having a relationship with lots of different agencies, and institutions, and schools, and public health, and work sites, and hospitals.  But the trend is, except usually in rural areas, that most family doctors are not even doing hospital care, and if you’re not doing hospital care, why spend two-thirds of your training in a hospital?  Change is probably going to happen after I’m gone but I think the main thing is if we can light a fire underneath a lot of younger people saying, you’ve got to take responsibility for the future of this discipline.  It’s not what it is now, it’s what you can imagine, and there’s a lot of young people with wonderful ideas and terrific energy.  I’m hopeful, but it’s been very hard to try and get people to think differently.

DMacA: You’re clearly inciting a group of covert radicals, maybe covert senior radicals!  I’m also interested in what your feel is the role for senior academics.  You have described yourself as the ‘Faculty Whisperer’.  Tell me how you see the role for senior academics.

JF: Its a great question now because, there are 200 of us around the country who are the first cohort of people in Family Medicine from 1971. I had never heard the word retirement or senior or anything like that because the people who started Family Medicine were in their 30s and 40s.  But as I got older I started to realise that a lot of the people I really respected and admired couldn’t figure out what to do next after they were out of leadership.  Leadership was the crowning jewel of their careers but, as one of my teachers said- it’s a job you do, it’s not who you are. So, when I got out of a leadership role, I realized that what I enjoyed most was spending time with Fellows or young faculty members.  A lot of my colleagues, transitioning out of leadership roles, didn’t know what to do next, or they couldn’t figure out what to do next, or they were scared of what to do next.  So, I started spending time, physically, or on the phone, or in other ways, with young people.  I’d take them out for a coffee and say – how are you, what’s going on in your life.  I had no power, I had no authority, but I had a lot of experience.  And, what was interesting is that some of my colleagues, when I said what I was doing, said- don’t they turn you down sometimes?  In 10 years no one’s ever said no.  And now that I’m retired I say they gotta buy the breakfast! I feel that I’m using the skills that I have, and the experience that I have, as long as you listen and not tell.  It’s been a wonderful time of my life.  I’ve enjoyed it more than almost any time I remember.

A colleague of mine who’s a coach, there is a lot of coaching going on in the world these days, he’s an executive coach.  He gave me his card and the bottom it said :”Executive Whisperer”.  And, I thought, that’s what I’m doing.  I haven’t gotten a card yet that says Faculty Whisperer.

When I moved back to the Midwest from being out West for a number of years, I introduced myself to all the programs around here, introduced myself to the Chairs, most of whom I knew and asked, how could I be helpful.  And they said, I’m not sure.  And I said, how about if I just have a coffee with some of your senior faculty or talk with some of your team. And they said, that would be wonderful.  So, I’m having a lot of coffees and enjoying it very much.

Julian wrote these unbelievable things. He wrote about the “peripheries of excellence” which is one of my favorite phrases of his.  The idea of coming from the community back into academia. I can talk with folks because I have enough experience, and they know me, and what I’ve done, that I think I could be helpful.  That’s a long explanation but it’s been just a wonderful experience, and senior people all over the world can do that.  I had lots of senior teachers but nobody ever called me up and said – let’s talk about how you’re doing.  Its a safe place to talk about how your career is going, how you are, things like that.

DMacA: What you’re describing is fascinating because it’s a whole new cohort, a whole new third age of Family Medicine academics.  I was going to ask you another question but I think I probably know the answer.  When you meet junior faculty, and when you meet the academic faculty, are you hopeful for the future?

JF: When I meet the individuals I am.  I am on a phone call every week with a really wonderful and distinguished group of people and we’ve been friends all our lives.  We can bemoan many of the things that are happening, and a lot of things that are happening are terribly problematic, but each of us can tell a story of a person, usually a younger person sometimes not, who has just been inspiring, has all the right ideas, and is trying really hard and is resilient and all those things. So, when I spend time with people one-on-one, what I see is the best in people. I see their hopes and I see their dreams. My job is to say: Go get them. Go give it a try, and I’m happy to help you in whatever way I can. But mostly, what I want to say is to try, convince people that you want to try something new. So the optimism I have comes from individuals. Gail Stevens wrote 40 years ago, that the biggest challenge for Family Medicine going forward was not going to be the other fields of medicine, it was going to be ourselves.  And I think that’s something that appears to be true on an institutional level these days.

DMacA: John it’s always a pleasure talking to you. Long may you remain a radical activist whisperer.  Thank you very much indeed.

Related Articles

Leave a Comment