John Dier, November 18, 2022

Item

Title
John Dier, November 18, 2022
interviewee
John Dier
interviewer
Daniel Carter
Date
2022-11-18
Subject
Basset Hospital
Cooperstown, New York
Education
Glens Falls, New York
Glens Falls Medical Mission
Healthcare
Internist
Internal healthcare
Rural Healthcare
Lake George, New York
Medical Missions
Medical Practice
Nueva Santa Rosa, Guatemala
Physician
Tucson, Arizona
Description
John Gordon Dier practiced internal medicine for many decades in a rural setting. Dr. Dier was born in Glens Falls, New York in 1950. Growing up, Dr. Dier accompanied his grandfather, the town physician, on house calls. Living in a small town and seeking to pursue a career in medicine, Dr. Dier chose Williams College, where he earned his undergraduate degree in chemistry. He completed his medical education at the University of Rochester School of Dental and Medical; where he also met his wife, Mary Jo, and her family at Genesee Hospital. Dr. Dier first came to Bassett as a fourth-year medical student. After his experience he decided to apply for an internship and ranked Bassett Hospital first. Throughout his career he continued to come back to Cooperstown and Basset Hospital.

Dr. Dier has practiced in a variety of locations, primarily in rural settings. He has practiced in Glens Falls, New York; Tucson, Arizona, and at Cooperstown's Bassett Hospital. Dr. Dier treated patients and acted as an educator as a mentor and preceptor to fellows(interns and residents) and medical students. Throughout the interview, Dr. Dier elaborates on his life as a physician, where he shows how his upbringing has led him to practice healthcare in rural communities. He discusses his experiences in the hospital and the changes he witnessed in the medical field. He tells the story of his mission trips to Nueva Santa Rosa, Guatemala and Tucson, Arizona. In addition, Dr. Dier provides insight into what made him come back to Cooperstown throughout his life and retire in what he called a “vibrant community.”

I interviewed Dr. Dier at his home in Cooperstown, New York. In his words, he is an “almost retired internal medicine physician.” Dr. Dier spoke clearly throughout the interview. I have chosen to edit out some filler words like, “so,” “you know,” and “and.” In addition, I chose to remove false starts of the sentences, where he might have restarted when framing an answer. I have chosen to preserve grammar to the best of my ability; however, researchers are encouraged to listen to the audio recording.
Transcription
Cooperstown Graduate Program
Oral History Project Fall 2022

JD = John Dier
DC = Daniel R. Carter

[START OF TRACK 1, 0:00]

DC:

This is November 18th, 2022, interview of John Dier by Daniel Carter for the Cooperstown Graduate Program’s Research and Fieldwork course recorded at Dr. Dier's home. To start, could you describe your early childhood in Lake George?

JD:

Early childhood was growing up in a small town. Five brothers. I’m the eldest of five. Actually, because my father was in law school, I grew up with my grandparents. My mother and I. My father was away. My grandfather was the town physician, as well as the coroner, and the health officer, and everything else. So I had early medical, not medical, but I had early experiences going to nursing homes and house calls with him.

[TRACK 1, 00:59]

DC:

Can you describe to me some of those experiences going out on call with him?

JD:

I can remember going to the county home, which was and still is in Warrensburg, New York, and I can remember it’s right on the Schroon River. I can remember him saying that as we drove over the bridge to get there, pointing to a window and saying that's going to be my room when I need to be in a home because I’ll be able to fish out my window into the river. So that gives you a little flavor of what those trips were like. I remember going to see people that he would never, ever be paid [by]. He might get some eggs or something from folks that just had nothing. Also, what's interesting, as an aside, is that his nurse, who wasn't really a nurse, but his medical assistant, who took care of me when I was a little boy, eventually wound up being my patient years later. It was a very pleasant experience for me as a little boy, I think.

[TRACK 1, 2:33]

DC:

What was it like being the oldest of five brothers?

JD:

There are a lot of years between us. Part of that was because my parents wanted a girl and my mother had some miscarriages. There were a lot of pregnancies and probably more children than they would have had if they had had their girl. There is like four or five years between me and my next brother and my youngest brother is fifteen years younger than I am. They were spaced out. My early years, I didn't have all these brothers. I was in college and some of them were still in elementary school.

[TRACK 1, 3:45]

DC:

What factors ultimately led you to choose Williams College?

JD:

Small town. I very much like the people that I met there. I wanted to play sports. It was a very small school, At least I had a prayer of making, a team and playing. But it was primarily because I was comfortable in the environment and because of the people I met. I liked the students I met; I liked the faculty, coaches. Once I had gone there, if I could get in, I wasn't going to go anywhere else.

[TRACK 1, 4:25]

DC:

What sports did you play in college?

JD:

Football and baseball.

DC:

Was there any particular moment in either of those sports that really stood out to you?

JD:

There were many moments, but it really was the camaraderie. I certainly had given up any hopes of being a professional baseball player once I saw what the real world was like. It's the camaraderie of the folks that played. There was a group that played both football and baseball. I think that our southern trips which were fun and not as disciplined as they might be. There were a lot of good memories from there. The best game I ever pitched was a no-decision game for me. It wasn't all about winning. It was about the people.

[TRACK 1, 5:23]

DC:

What did you study at Williams College?

JD:
Chemistry¬—and a lot of other things. There were two majors, two chemistry majors. So-called light major and a research major. The pre-meds would generally take the light, non-research major. I took a lot of English as well as chemistry. Those were really my [foci] and a smattering of everything else. [It was] a liberal arts school, and I stuck by that.

[TRACK 1, 5:55]

DC:

Can you tell me about the decision process on when choosing the University of Rochester Dental and Medical? [University of Rochester medical school?]

JD:

Right, it was primarily the people I met when I went to interview. I certainly wasn't afraid of living in a big city, Although Rochester didn't seem as large as New York, Boston, and so forth. I liked the people that I met, the students, the interviews that I had, I was very comfortable with the interview. The people who interviewed me.

[TRACK 1, 6:35]

DC:

What other schools did you apply to?

JD:

I applied to Tufts, Albany, and Harvard. Those are the ones that I was interested in plus Rochester. Once I went to Rochester and I think I heard by Thanksgiving that I was accepted. I got a telegram actually, that's how they did it. I didn't continue; I just accepted and that was the end of my interviewing.

[TRACK 1, 7:10]

DC:

Can you discuss the interview process at Rochester versus the other schools that you interviewed at?

JD:

The information that they needed, they were the same wherever you went, somebody had to meet you and talk with you. Make sure you could put a few sentences together and had a reasonable attitude and so forth. When I met with the OB-GYN [obstetrics-gynecology] guy I met with in Rochester, we went to the snack bar and had coffee. It was more comfortable. The internist I met with there had a similar background, I think, or at least that was my sense as I did. I was comfortable in spite of the fact that it was a pretty high-powered institution with a lot of research and smart folks. I just was more comfortable there.

[TRACK 1, 8:22]

DC:

Can you tell me more about your wife, did you guys meet at Rochester University?

JD:

We did. I met her during my pediatric clerkship; she was working in the pediatrics part of Genesee Hospital. We started dating. I had dated prior to that. But her family was there. She’s has an extended Italian family, and it was again a very comfortable and warm family. That added something that was certainly missing in my years as a medical student.

[TRACK 1, 8:05]

DC:

What factors led you to become an internal medicine physician?

JD:

Right, that has to do with Bassett here in Cooperstown. I was going to do family practice, I thought. I was actually thinking about pediatrics, primary care pediatrics, because I liked that too. I ruled that out by doing am pediatric oncology rotation, which was just too heartbreaking to consider doing pediatrics. I came to Cooperstown to do internal medicine in the hospital here between my third and fourth years of medical school, and I loved it here, met people that are still my friends that I met that summer. At that point, I decided I would do whatever it took to get to Cooperstown if I could get into their program at that time. I ranked Cooperstown number one and two. Internal medicine first, rotating internship second, and dropped all the others. Figuring if I didn't get in, I would just have to scramble and find a place.

[TRACK 1, 10:20]

DC:

Before going to Cooperstown and coming here, was there anywhere else you worked as a licensed physician?

JD:

No, before that, I wouldn't have been licensed; you don't get a license until after your internship. That's when I was here at Cooperstown. After that, is that the question?

DC:

Yes.

JD:

I've practiced in Glens Falls, New York, and I practiced back here in Cooperstown on the faculty in the [nineteen] eighties for a while. Then I worked in Tucson for a number of years, and then I was back in Glens Falls and ultimately came back here to finish up my career.

[TRACK 1, 11:16]

DC:

In Glens Falls, can you tell me more about any mission trips abroad you did?

JD:

Actually, the places where I did missionary type of work were Tucson, where I actually went to a place called St. Elizabeth, which was a charity clinic for Native Americans, Hispanics, whoever else couldn't pay. When I was in Tucson, I joined the Flying Samaritans and made actually just one trip to [Kino Bay] a little town on the coast of Mexico and in the process we flew in in small planes. We were met at the airport by people with automatic weapons and so forth and so on. That was a positive experience. I didn't have the opportunity to do that very often. I practiced in Glen Falls, but never had the time in that practice to do anything. When I came back to Cooperstown around 2002, I then had time because I had regular vacations and regular continuing education time that was set aside. That's when I took the opportunity to use that time to go to Guatemala.

[TRACK 1, 12:50]

DC:

Can you tell me more about going to Guatemala? What organization was that run through?

JD:

Glens Falls Medical Mission Foundation, which was actually founded by one of my first partners in Glen Falls because he adopted a little girl from the mountains, highlands of Guatemala. He saw what it was like, where she came from and thought, gee, maybe we can do something to help in that little rural community. That organization actually has a website and recruits from all over the country. The first time I went down I remember there was a dermatologist who went there from Iowa and people mostly from the Northeast, but scattered around the country. We'd meet at the airport, get on a bus and go up through Guatemala City. Thank God. Go up to a little place called Neuva Santa Rosa.

DC:

What were experiences like at Nueva?

JD:

The people were wonderful. It was dangerous and it still is; the country's tainted. We were protected by troops or local police or departmental or county police depending on the year. They were part of the political process that protected us. The governor of the department of Santa Rosa, which was like a big county here, was our sponsor, so people would not mess with us because of the political consequences of interfering with his organization. I'll leave it at that; there's a criminal element to all of this that dates back to the civil war that went on for years.

[TRACK 1, 15:13]

DC:

Did you see any differences in the rural and urban healthcare of Guatemala?

JD:

I didn't actually witness urban health care, as I met a geriatric fellow from Boston, who was Guatemalan. Sat with him on the plane, his father was receiving high-level I.C.U. care on a ventilator in Guatemala City, which sounded very similar to everything that we have here, As opposed to the folks that we would see up in the mountains who didn't have any regular healthcare. There was a little hospital that was forty-five minutes away that we toured but didn't work in and was pretty grim, until they brought residents from Guatemala City up to work in the hospital, then it was better. It was pretty grim.

DC:

What were those conditions like?

JD:

Well, there was crowding. Some of the people we met and one in particular who, I'm not sure what his credentials were, I really didn't know what he was doing. [Unclear] he was a political appointee, if you will. Who, once it was made known that we had issues, disappeared. Didn't see him after that year. There were some questionable credentials. There was one Guatemalan physician that we worked with year after year who was wonderful, took good care of the patients, who was an excellent doctor. I still get occasional communication via LinkedIn or Doximity. I can’t remember which one. The resources were in the city or with people that had money, not a lot different than the United States. The resources were minimal up where we were.

[TRACK 1, 17:29]

DC:

Did you ever feel a danger traveling back and forth between the city?

JD:

We were well-guarded all the time. The dangerous point I'm told, although we never had any trouble, was when our guards left the bus on the way down from the mountains. There are episodes of bandits boarding buses, robbing folks, taking people, and so forth. Never had a problem. Guatemala City is a dangerous place to be if you don't know where you're going. If I went anywhere, I went with people that knew where they were.

DC:

Did you ever have to practice in a hospital in Guatemala City or it was solely in the hills?

JD:

It was up. We had our own place in the courtyard behind a Catholic church, where set up shop.

[TRACK 1, 18:35]

DC:

Coming back to America, is that when you came back to Cooperstown, or were you still living in Glens Falls at the time?

JD:

I was in Cooperstown. I'd go for a couple of weeks, ten to fourteen days. You’d go in the spring or in the fall. I went in the fall, I think. You'd go back the next year and the next year, and the next year. Some of the people you'd see you actually remembered. I did that for a number of years and then stopped as I got older.

DC:

How Have you seen Cooperstown change over the years and grow?

JD:

Cooperstown is…
[Wife Enters the Room]
This is being recorded, the recorder is on. My wife Joey. Dan Carter.

DC:

Nice to meet you.

JD:

If you want to be recorded, you can talk to us all you want. We'll be done in a little bit. [Short conversation]How has Cooperstown changed? That was the question? I won't say a sleepy little town. It's a town that's had a lot of advantages because of the Clarks and the Coopers. It's been a pretty town with nice architecture and well-kept stores and so forth. When we first here in the mid-seventies, it was a pretty self-contained town with pharmacies and grocery stores and pretty much everything you needed right in town. That's not true now. My wife has just come back from shopping in Utica because that sort of store doesn't exist here in Cooperstown anymore. There are some stores, I don't mean to be too negative, but in fact, it's changed. Also, the Dreams Park, with the influx of all these children, kids, Little Leaguers in the summer and their parents and thousands and thousands of people that are coming to town has changed the town itself. The type of shops that are there and so forth.

[TRACK 1, 21:00]

DC:

In regards to that dynamic of people coming in and stores leaving what would you say the biggest downfall or a negative consequence to that is?

JD:

Just from a selfish standpoint, when we were here in the seventies and eighties, the town seemed like it was ours. Not so much now. Of course, we don't live in the town now. But not so much now. It just seems busier, certainly in the summer. The winter not so much.

DC:

You raised your kids in Cooperstown. Correct?

JD:

The kids were little when they were here. Their junior high and high school was in Lake George, the Lake George school system. It was not until they were in college that we moved.

[TRACK 1, 22:00]

DC:

Moving back here, what was that like? Did you feel that there was a big difference already in the town?

JD:

Yes, we hadn't lived here for fifteen, sixteen years. The hospital had changed, the town had changed. Of course.

DC:
Outside of your medical practice, how did you stay involved with the community?

JD:

At the gym, I was in different leagues and things. We have a lot of friends. I'm not active in town government, I never really wanted to be. I'm from a family where my father's job was political, had to be reelected. I had no desire to be part of any of that. I am the health officer for the town of Middlefield and have been for years but that doesn't entail any work to speak of. It's an old regulation that doesn't apply actually. If there's a problem, it's taken care of by the county health department. Other than seeing friends and going to other folks' houses. When I was here before, I was a Little League coach, but not now. My kids are grown.

[TRACK 1, 23:35]

DC:

How have you found it in the Cooperstown area? Has there been any specific problems that you might feel passionately about?

JD:

Not anything that I think I could. I certainly couldn't blame Cooperstown for the problems. A lot of small towns are struggling with the same issues of not being able to support the really small businesses—although there are a lot of small businesses in town. I think the hospital has changed dramatically. That was my primary source of connection with the community. But that also is something that is occurring everywhere, from the practice, I had in Tucson to Glens Falls. The people I talk to, it's all the same. The same issues of financial viability, reimbursement, that sort of thing.

[TRACK 1, 24:37]

DC:

Can you describe some specifics of the hospital's changes as you came here as an intern?

JD:

From a training standpoint, as an intern and resident, there wasn't nearly as much supervision as there is now. I'm not saying that's good or bad. We work much longer hours, and I'm not saying that's good or bad either. I was part of medical education here at Bassett for years. You know, it's not a good idea to have a very sleepy resident taking care of a patient. On the other hand, there's not enough time to learn what you need to learn to practice medicine during your residency. If you're there for less time, you don't see as much, it's arithmetic.

[TRACK 1, 24:50]

In your internship and residency, what did you think was most beneficial about coming here to Bassett and practicing in a rural community?

JD:

What was most beneficial was being in a small program. where I had a tremendous amount of responsibility and knew the attendings personally. I think there were opportunities; there were no fellowships. There are now. There were no fellowships, so I was not competing for procedures or patients with fellows. It was really all about us, the residents. I think it was very intense, yet comfortable because of the folks who were here that you came to know personally.

DC:

When you were in this position, did you have to practice any other forms of medicine outside of being an internalist?

JD:

Have I done that? If that's the question, yes, but I shouldn’t. I did a week for many summers up in Rocky Mountain Biological Laboratory up in a community of, I don't know, maybe eighty, ninety people doing research in the Rockies back range. When I volunteered there, I would see whoever came to the door. Whether it was a kid or an adult. I didn't do G.Y.N. exams, but there were potential G.Y.N problems that we handled up there. I did everything that I thought I could do confidently. I didn't like seeing the kids because I didn't have the experience. I’d look in ears and look at throats, that sort of thing.

[TRACK 1, 27:47]

DC:

Do you see a difference in that rural health care versus that urban health care in Rochester? Were there differences in practicing and learning there versus coming to Cooperstown and learning here?

JD:

The last time I was in Strong [Strong Memorial Hospital] in Rochester, I had to go outside and find out where I was in order to figure out where I was in the building; it was much larger. During my third year, there was a major addition, a whole new hospital was built, basically. It was much more complex as far as the various specialties that we participated in or observed. Also, the patient mix was dramatically different at Rochester. There are not many Blacks here and this area is pretty much white and Rochester saw all sorts of folks. Which actually, just like practicing in Tucson, I enjoyed that. I enjoyed the cultural variety, although I like the geographic environment here better.

[TRACK 1, 29:20]

DC:

Can you talk more about the dynamics of practicing with these different groups of people?

JD:

Could you be a little more specific?

DC:

Right, so you mentioned that you liked practicing ultimately with the different ethnic backgrounds, can you give a little bit more of that?

JD:

Rochester isn't as good an example as Tucson because in Rochester I was a student, and

[START OF TRACK 2, 0:00]

JD:

I basically didn't know much. You related to the patients regardless of what their background was in a different way. I mean, sure you'd see people, but there was always somebody else seeing a patient who was really in charge. It was more observation. There was some participation, but less participation. I did a research project between my first and second years, which was part of the Rochester Adolescent Maternity Project. The idea was whether or not more intensive care of adolescents, particularly inner-city adolescents, resulted in better pregnancy outcomes. The first patient I had on my own, whom I followed, was a pregnant twelve-year-old Black girl. Which was a bit of a shock coming from Upstate New York, mostly white. That following summer I did, the research had to do with doing what are called “Denver Developmental Exams” on toddlers in their homes. I worked in the inner city, made appointments going to different houses doing exams. They weren't really medical exams; they were developmental exams, just seeing how the kids were doing and did that for an entire summer. Eventually, that was published with a bunch of other data. I was not an author, I was a data gatherer. That was very different for me seeing these kids that were raised in a different environment certainly then I was. I actually enjoyed that too.

[TRACK 2, 2:11]

DC:

Was there any particular experience of visiting these kids that stood out to you?

JD:

No. I do recall locking myself out of my car in the inner city in Rochester. Because my car was so old and broken down, there was a way you could jiggle the passenger side window and get it down so you could reach in and open the car. I remember being watched as I was doing that by some families on the block. Nobody gave me a bad time, but I think they were laughing at that probably.

DC:

What do you think the results of that research contributed to ultimately?

JD:

It was not a tremendously positive result. I finally saw the paper, it was years later. I think because of the matriarchal society that these kids were in, these young adolescent, pregnant, mostly Black women, they had great care at home. The kids had care; they had a grandmother that was helping, sometimes a great-grandmother. I was not surprised looking back as a more mature physician that, in fact, they did pretty well, as far as their development, because there was a lot of love and caring. I know that's not always true.

[TRACK 2, 3:55]

DC:

In your time at Cooperstown, did you also have to make a lot of home visits or did patients primarily come to Bassett?

JD:

They primarily came to Bassett. I did make a few house calls, but there's none that really stick out. I made more, I think, when I was in Glens Falls.

DC:

How have you seen Bassett and the medical field change over time in Cooperstown?

JD:

Like most hospitals it went from generalists, taking care of most everything to generalists being more of an entry point into the system with multiple specialists being involved in care. A chart now will have entries from four, five, or six different folks that are involved in the care. Whereas early on, it was primarily the doctor taking care of the patient.

[TRACK 2, 5:01]

DC:

Do you see Bassett's growth in the community as beneficial, especially to rural health care and giving access?

JD:

I think, yes. I think Bassett did with their health centers. I've forgotten how many there are now. I actually worked in one in Richfield Springs years ago, part time. The rest of the time was at the hospital. I think bringing that care, and the school health program. Chis Kjolhede, and his group has been wonderful. The school district we're in, Cherry Valley-Springfield, and they're just now adding a school health program there. These kids will be able to see a doctor while they're there rather than having to come into the clinic or come into town. I think that's a wonderful program for the kids.

[TRACK 2, 5:59]

DC:

In what other ways has Bassett provided this access, if any?

JD:

I think the access to the community has been primarily through the health centers. There are a lot of people that still come directly to Bassett to be seen as well in general pediatrics, internal medicine and so forth. They certainly have expanded. They built their clinic building in the mid-nineties, I believe I wasn't here then. Prior to that it had all been across the street. They've expanded their facilities and they've brought in more specialty care for folks that need it. So they don't have to go to New York, Boston, Albany, or Syracuse.

[TRACK 2, 6:48]

DC:

As a doctor in Bassett, has there been any times as they've grown that you've felt to push back on or you haven't necessarily agreed with?

JD:

I'm not a not much of a push-back type. There's a dichotomy. When I was practicing, for example, in Glens Falls, I did a lot of I.C.U. and C.C.U. care that I would never do here because there are specialists. You do it because you have to. Because there aren't other people that we’re doing it at the time. I liked that; I like acute care. I like being able to do that in the hospital. But it's also exhausting, there is a lot of night work. A lot of weekend work. It's hard to come back to Bassett, where as a generalist I'm protected from most of that and complain too much. Everybody likes to complain but I came back here and immediately was in an academic environment. Keeping up when you're running full speed out in a community hospital is hard to do. Being here and having residents and students working with you forces you to keep up. Both the educational part of it and the reduction in call was a real relief, particularly as I was older at the time.

[TRACK 2, 8:36]

DC:

Were you able to perform any research at Bassett like you did in Rochester?

JD:

No, the only research that I participated in here would be to supervise some of the residents’ research and basically have my name on a project that they were doing. It's sort of quality control, but not my own personal research. There are people that are doing research here, but I was not. It's not something that I particularly care for. I'd rather do education or see patients.

[TRACK 2, 8:11]

DC:

Can you describe a little more of this educational experience that you gave students?

JD:

First of all, the whole institution has Columbia-Bassett students, ten a year. I was a mentor for those students and a preceptor; there's a little difference. Preceptor for those students for years. They would see patients with me in the clinic. For example, I would meet with them about other things that were personal. Very bright students, challenging my fund of knowledge and abilities all the time, which is a really good thing. The residency program was different and that I was part of the administration of. I was a Assistant Program Director for years and also before that I was still part of that program. Basically, that's supervising residents either in the clinic or in the hospital when I was doing hospital rotations.

[TRACK 2, 10:28]

DC:

With those students challenging you, how did it help grow you and them?

JD:

Well, I think for them to have to be accountable to me. If they’re going to have a plan to take care of a patient. I might have to ask, well, why do you want to do that? I might ask them, why do you want to do that, just to make sure that they are firm with their convictions. On the other hand, in order for me to be able to do that, I have to read and keep up with things constantly. It's forced me to be accountable as well. You learn more trying to be an educator than you ever do being a student. If I have to give a talk or do a seminar, I really have to know, I can't fake that.

[TRACK 2, 11:28]

DC:

Has there ever been an example where you might not have known or a student might have come at you with more information or have given you a hard time over something like that?

JD:

Well, the students and residents for the most part were very respectful. I’m no fool. I knew when they knew more. If it’s something simple you can use some of the tricks of saying, well, what do you think about that? Why don't you look that up and get back to me? Meanwhile, I’m going back to my office and frantically looking things up. I just tended to be honest most of the time and just if I didn't know, I said, I don't know because that's medicine. If you don't know it, you just have to know how to find out or if you can't do it, you need to find somebody to do it or help. That's the game.

[TRACK 2, 12:27]

DC:

Touching on honesty and what are some other ethics that you ultimately included in your own practice throughout the years as a physician?

JD:

The ethical questions. Well, I think just being honest, telling your patients the truth, whether it was good or bad or a mistake. I think that’s part of it. Part of it is not talking to people, anybody, including your wife about the cases and personal things. I remember that growing up I heard this. My grandfathers knew all the secrets of this little town and my grandfather’s best friend was the Episcopal minister, although, he rarely went to church, and they were drinking buddies. Incidentally, the minister was another one of my role models as well as my grandfather. Between them, they knew all of the dirt for this entire town but they had nobody to talk to about it because they couldn't talk to anybody. So they would commiserate. That's what their sessions were about. I learned actually from a very early age sort of the concept, you didn't understand as a kid. Now here I think most of it was just keeping your mouth shut and staying off social media. We have issues, since social media is a part of life for most people. We'd have to be very careful with students and residents. Advising them that, really, they can't have anything on social media. That doesn't quite answer the question. Where there ethics problems that I encountered? I don't recall there being any issues aside from the social media issues that we had to deal with residents occasionally. But not very often. They got the message because they could be let go if there were HIPAA violations, of course.

[TRACK 2, 15:04]

DC:

You mentioned how you've always delivered the news, good or bad. Has there ever been a difficult time delivering that news that you can describe?

JD:

Oh, yes, I mean, well...

DC:

Within reason of HIPAA.

JD:

We teach the residents; there are courses in delivering bad news, and I can't think of it. I’ve delivered a lot of bad news. Terrible biopsy reports and you know basically illnesses that were going to take one's life. I think the most important thing about delivering that information is having an understanding of what your patient and their family is actually hearing or capable of hearing. It’s often not one session and it's not over the phone and it's not in an email. Although now with MyChart system where information is delivered to folks before I may even see it or would have seen it when I was practicing, there are some issues there, but there are also restraints on what goes out into MyChart. There are sensitive things that won't go until the doctor, PA [physician’s assistant], the nurse practitioner sees it.

[TRACK 2, 16:34]

DC:

Now moving into retirement, when did you believe was the right time to retire from Bassett?

JD:

I was getting tired in the middle part of my sixties. I felt with the new computer system coming in and because I’m not of a mind to, or capable of, sitting and talking to you and typing. What went from days that ended between six and seven, often those days ended between eight and ten, because I no longer could get my documentation done while I had the patients here. Normally, if I was in an old office where we had written notes, I’d have that done by the time the patient went out the door because I was jotting things down. Those notes were for me, not for an institution. So I didn't have to have six paragraphs; I could have something like this. Here, early on, it was just dictating notes and I’d do that so quickly that I’d come out of a room and I had the note dictated in three minutes. About when the computer system came in and provided more structure, I found that if I did a dictation, because they'd outsourced your dictation to who knows where, I’d have to read the dictation so carefully for terrible errors, errors from a medical legal standpoint that could get you into trouble, it took me less time to basically use one of the templates and sort of fill it in typing. Almost to everyone’s day, it added an hour or two at night. I was thinking that I still like seeing the patients; I like my colleagues, but I really don't want to do this for another ten or fifteen years. I started to taper down my practice and then became more involved with medical education, which was more regimented, although some of the problems were just as difficult. From there, I went to just medical education, so all the documentation was pretty much gone. And from there, I went to doing physicals for NYCAMH [New York Center for Agricultural Medicine and Health] out In the community. We’d go out. That's how my career ended, basically back in the community in firehouses doing histories and physicals on a whole host of different people and different types of environments and writing brief notes and referring them on if I found something that I thought it was worrisome. I faded away. I didn't stop, I really faded away.

[TRACK 2, 19:46]

DC:

Have you been involved in the community since then in your retirement?

JD:

Not really. I’m not so much of a loner, well, I am a bit of a loner, but part of it is because I didn’t talk to people about what I did for forty years, or however long I was involved in medicine. We have loads of friends here; we go out to dinner and do things. I elected not to try to become part of the local government or do things. I’ve been done for a year and a half. I might change, but probably not. I mean, I’m active, I’m busy. I have lots to do in my property. We have family that we now can go visit, and I don't lack for things to do. I’m a little bored, but that's because I’m not immersed and don't want to be immersed. I don't want to schedule. That’s what it is, I don't want to have a schedule.

[TRACK 2, 21:01]

DC:

In your retirement, how have you seen the COVID handled in the community and kind of looking back like, is there anything that you would have done differently in hindsight?

JD:

I don't know. I wasn't involved. When COVID really struck, I was visiting in Tucson. My daughter lives in Tucson and we have a bunch of friends there. The clinics that I was doing stopped at that time for a couple of months. We weren't going out into the community, so There was no pressure for me to come back and work. I was in touch with Doug DeLong, who was then the Chief of General Medicine. I said, “Hey, do you need help?” He said, “No, we're okay right now.” Eventually, we came back from Tucson, which was the best drive of my life because there was nobody on the road. It was great. We came back from Tucson and Bassett seemed to have things in control. Now the in-patient was different. There were some very sick people in the I.C.U. and the practicing internists were doing much more hospital work so that the hospitalists could do the I.C.U. work. I was one step removed from that; I had been out of that part long enough. I guess if the clinic had been overwhelmed, I would have gone back and worked in the outpatient clinic. But people weren't coming in to the outpatient clinic. There were televisits. I mean, there were phone visits and then tele-visits and so forth. People weren't coming in; they didn't need me. Then time went on and the further away I got from it, the less comfortable I would be doing that sort of work.

[TRACK 2, 23:00]

DC:

Towards the end of your career, did you ever have to do any tele-visits or adapt to that technology?

JD:

I didn’t have to do it. The irony of that is that, you know, you put a computer monitor up and you look at a patient, you talk to them. Now you can charge. For years and years, at the end of my office hours I was sitting at my desk talking to people on the phone. I just couldn't see them. You didn’t charge for that. Didn't think of that. They were a patient, so that was part of the service. I don’t see that communication as being an awful lot different and sort of the routine things.

[TRACK 2, 24:12]

DC:

I guess just in terms of services, is there anything else that you found easy or difficult to adapt to as the technological field of medicine changed?

JD:

I loved when the computer first came in and I didn't have to actually we had it in Glens Falls. I didn't have to walk down to a laboratory to get a result. I could sit at the nurses’ station and then when the x-rays came up and I didn’t have to walk down to radiology to look at films that was a tremendous time saver. When the documentation part of it came in; it isn’t the amount of time. Different personalities who weren't as compulsive wouldn't have let the time be as big an issue. The idea that you're taking what used to be personal little notes, and putting it into a template with a lot of verbiage, that wasn't mine, that’s a computer’s. I don't like that, that’s the lack of the personal part of it that I did enjoy. On the other hand, I admittedly wasn't facile with a keyboard. I took typing in high school, didn't do very well because it was boring. If I were facile with a keyboard, I might have been able to engage a patient and get more things done. Once again, the data gathering part of it was wonderful, no question about it. The notes that I got from subspecialists tended to be of the same ilk, meaning, long, multiple computer-generated parts. Some cut-and-paste stuff that really shouldn’t have been cut-and-pasted, but everybody did it. So it was hard to wade through these notes. Whereas previously you'd get a phone call. I find that the technology is a double-edged sword. I think in general, the amount of information that you have at your fingertips is great. What it's done to the doctor-healthcare provider community is probably not as good as it could be. It was designed to capture charges. People will deny this, but it wasn't developed to make my life easier. It was developed as a tool for capturing more charges.

[TRACK 2, 27:11]

DC:

In our remaining three minutes, is there anything else you'd like to say about yourself or about the medical field or in Cooperstown?

JD:

No, I still think that the community is a vibrant community. I mean, we go to concerts, we enjoy the Fenimore Art Museum. I think the people here, particularly in the physician community are usually here because they like some or all of the same things that we enjoy, small town, outdoors, exercise at the gym, seeing people on the street that you know, that sort of thing. I think in general, in spite of the naysaying, the community remains an open and friendly community, albeit there is a town-gown division. I think the hospital is doing the best it can dealing with really very difficult issues as far as the politics in medicine and the financial part of medicine. I think it's difficult everywhere in medicine right now. I don't think Bassett is necessarily any worse at dealing with these issues than anyone else. I guess that's a little bit wishy washy, but that's how I feel.

DC:

Alright well, thank you very, very much.

JD:

Well, my pleasure. I got to rehearse it.

DC:

Of course. Thank you.
Time Summary
Track 1, 0:00 - Early Childhood
Track 1, 3:45 - Education
Track 1, 11:16 - Medical Mission
Track 1, 18:35 - Community
Track 1, 24:37 - Bassett Hospital
Track 2, 8:11 - Educator
Track 2, 12:27 - Ethics
Track 2, 16:34 - Retirement
Track 2, 21:01 - COVID-19
Track 2, 23:00 - Technology
Creator
Daniel Carter
Publisher
Cooperstown Graduate Program, State University of New York at Oneonta
Rights
Cooperstown Graduate Association, Cooperstown, New York
Language
en-US