Eugene McGregor, MDEugene McGregor, MD

Gene McGregor was born in 1916, six years after Abraham Flexner published his reforming report on the weak condition of medical education in the United States and 3 years after the founding of the first medical specialty organization, the American College of Surgeons. His life has spanned a period of enormous change in the science and practice of US medicine, most of which he has observed from the vantage point of Lisbon, New Hampshire—his birthplace and the site of his medical practice of some 40 years. Spare of words and direct in response, Dr McGregor's alertness and power of recall belie his more than 80 years. He sits comfortably on the porch of his green-shuttered white house on Main Street in Lisbon, recalling his days in practice, some 14,000 of them. He apologizes for the regular interruptions in his reflections caused by the gearing up of lumber trucks passing noisily out Main Street and by his occasional trips inside the house caused, he explains, by diuretics.

He reminisces about life as a general practitioner in northern New England, about the days well before beepers and cellular phones, when his wife would wait out front to flag him down as he sped by or the local telephone operator would ring all over the county to locate him for an emergency. He thinks medical life for a country GP got easier as the century progressed with the arrival of surgeons and obstetricians to share the load, but he has mixed feelings about the advent of medical insurance and is deeply suspicious of Medicare. He doesn't see how managed care will work in rural areas and thinks many in the younger generation are "gypsy doctors," moving from place to place, looking for the best deal.

Dr McGregor is no gypsy, having left northern New England only for 2 years of medical school and 4 years in the army. His lifelong practice in his hometown is atypical by today's patterns but represents a genre of traditional practice that is an important line of heredity to the values of current generalists. Continuity, community, intergenerational care, and home visits were all part of the work of Dr McGregor. He never used a horse and buggy, but he is a bridge to those generations past, their fledgling science and their powerful art.—F.M.

In 1948 I came back to Lisbon, New Hampshire, the town where I was born, to start medical practice. I was getting older, and my children were getting older. A woman in Lisbon offered to lend me a sum of money to buy a house and to start a practice. I decided I'd better do it. I was going to be 32 that year, which I felt was too old. Lisbon had three doctors in the 1930s, but only Dr Pickwick was left and he was getting older. This woman didn't like Dr Pickwick very much. He was a very crusty character and I'm sure they quarreled.

Coming home to start practice was nice and it was bad. It was nice because I knew the backgrounds of a great many of the people I saw, and I didn't have to spend a lot of time trying to figure them out. But I'd been away 15 years, and there was quite a turnover of people. I realized that I didn't really know as much about these people as I thought I did. Many of the names were familiar, but much of the social activities had changed during those 15 years.

My parents were still living in Lisbon, and I think they were glad to have me home. My father had been a banker and my mother started as a schoolteacher, but later she stayed home to take care of the family. Both of their families came from this area. I had two great-uncles who were physicians, but the idea of becoming a doctor didn't really occur to me until the 1930s when I was in high school. I think one of the reasons, probably, I went into medicine was the Depression and watching my father struggle. Banking in the early '30s was a difficult, sad business, and he had a very hard time. I think the idea of being a physician and being one's own boss was extremely important to me. It may also have been the fact that physicians didn't have to bear arms if we went to war, and certainly there was some suggestion of war in the '30s. I liked chemistry and the sciences and did reasonably well at them.

When I graduated from high school in 1933 a lot of my classmates couldn't go to college because they couldn't afford to. I found that with the scholarship that Dartmouth offered, I could go there cheaper than I could go to the University of New Hampshire. Dartmouth also had a program that required only 3 years in college before starting medical school, so I entered Dartmouth in the fall of 1933. I worked all the time I was in college, and summers too. I "hopped" bells every summer at the Mountain View Home, which was a big resort up in Whitefield. For those of us who worked, there wasn't much of a social life. The premedical curriculum was very much prescribed. We had only a few elective courses so I took history, which I enjoyed very much.

That was a tough time. I think the main worry was the question of war. There was a war in China at that time, a war in Ethiopia, and a war in Spain. A lot of people had to worry just to exist. When you have 24% unemployment in this country, you're in trouble. For instance, my father's salary had been cut in half during the very first part of the Depression. He had some stock holdings and they had become worthless. Even at that time, though, there was a great deal of wealth around Dartmouth, although I had very little contact with people who had much wealth until I reached medical school.

I applied and was accepted into the medical school at Dartmouth, probably because they wanted to encourage medicine among the residents of New Hampshire. I did have the idea then that I would be a general practitioner, but I didn't really know where. I do remember that I didn't want to be subservient to anyone if I could help it, except my patients maybe.

Medical school was very, very enjoyable. We had a class of 20, and there were only two classes since it was just a 2-year school. Dartmouth did a deluxe job of teaching. We had some of the best teachers I ever had. In anatomy, there was a corpse for every two students. Spent all year working on it. It was a great time. I believe I am the only general practitioner from that class.

We all had to go on to another school for our clinical training after the 2 years at Dartmouth. I went to Rush Medical College in Chicago. At that time it was a part of the University of Chicago. It was quite an experience to go from Hanover to the west side of Chicago. I was in a class of 105 at Rush. There were eight or ten women in our class. I'm sure that out of our class of 105, probably 25% or 30% became general practitioners.

We were in the most impoverished part of Chicago. I'd never seen poverty such as that, not in New England, even at the worst of the Depression. I lived in the YMCA right across the park from Cook County Hospital. I used to walk in town every now and then, and I'd see 15 or 20 drunks lying on the sidewalk near the entrance. There were gangsters too. The Mafia was taking over restaurants, bombing and so forth. We were told when we were in obstetrics making home visits that we should never have more than a dollar in our pockets, and a dollar watch, because we might be robbed.

At that time, obstetrics for the poor in Chicago was practiced by the method of Dr De Lee, I think it was, who established clinics for charitable delivery of obstetric services. The women came to the dispensary for their prenatal care, but when they delivered they were delivered at home by teams of medical students. We went to tenements and apartment houses and followed the routine of trying to establish a somewhat sterile field with rolled-up newspapers, some hot water, and a pair of gloves. That was about it. The first time you went out, you went out with a student who had been out before, and he taught you what he knew. You could call an assistant resident from Presbyterian Hospital, who would come out and try to help you, but sometimes there were disasters. I had one, actually. A girl was pregnant with her first baby, which was in a posterior occiput position, and she couldn't deliver. Finally, we got the assistant resident out and he tried to put on forceps and rotate the head. I was giving her ether, which I had never done before, and I was scared to death. We were using the dining room table. Friends of the patient came in to hold her legs. One guy crawled under the table and vomited. I was running around the table trying to give ether, or holding up a leg. It was an awful mess. We got the baby out, but I'm not sure how well.

Most of the poor we dealt with were from all over Europe. At that time Chicago had the largest Czech population outside Czechoslovakia, the largest Polish population outside Poland, and so forth. And that was one of the reasons I didn't stay in Chicago, because I had to deal with people with a foreign language. We had to use an interpreter to get a history or a physical from them.

In general, Rush was excellent. We had some very good teachers but the classes were big. The dispensary was excellent. Rush treated largely low-income patients for free. We worked on the wards at Cook County Hospital, where we really learned. We saw patients at Presbyterian Hospital too, but they were mostly private and we did less with them. I think the tuition was $400 a year. The school helped me a little and my parents chipped in. I borrowed some money, about $2000 I think, while I was going to Rush.

When it came time to apply for internship, I wanted to come back to the Northeast. I went to Maine General Hospital in Portland partly because I wanted to get away from the foreign languages in Chicago. It was an 18-month rotating internship with no pay. Interns got room, board, and laundry, and that was all.

There were ten of us interns and we were all as poor as church mice. We were on call every other night, every other weekend. I was only at Maine General for a year because the war came along. I had joined the Reserves and got called up in June 1941. I was married in May of that year, so it was kind of a busy time. I spent time in Panama toward the end of the war at Gorgas Hospital, a 1000-bed hospital run by the army. I was assigned to the contagious disease section where I saw people with leprosy and typhoid fever. I did rotations on several other services and came home in December 1945.

When I was discharged from the service, I decided I needed more training, particularly in obstetrics, if I was going to be a general practitioner. So I returned to Maine General Hospital and started a surgical residency. I stayed for 2 years before deciding it was time to start my practice and to take the offer from the lady in Lisbon.

Getting the practice going in Lisbon turned out pretty well. I guess the fact that I probably had more training than almost any of the local doctors helped. Then, some people apparently didn't much like Dr Pickwick and they came to me right away. There was a woman doctor up the road who was getting along. I didn't know it at the time but she was also becoming an alcoholic. As a result, I acquired practically all of her patients. I hired Miss Isabella Smith to do my book work, my laboratory work, and so forth. She was a graduate of Lisbon High School 2 years ahead of me and trained as a bacteriologist at Simmons College.

My wife, Phyllis, was a tremendous help to me in the practice right from the start. She was a nurse, and I would say that any general practice physician who doesn't have a nurse for a wife is crazy as hell. When we first began, she was the housekeeper—took care of the office, the floors, everything—and helped with the patients. She'd listen to my gripes and answer the phone for me at night when I was away or otherwise busy.

I used the Littleton and Woodsville hospitals, both a bit of a distance and in different directions. It could be nerve-wracking, keeping everything covered. My wife used to have to come out and flag down my car at times to try to stop me, or she would leave messages. I used to call up the operator and tell her, "I'm going to Lyman today, and I'm going to stop and see so-and-so." If she needed me she would call me. She'd track me down. It was great—far better than most answering services these days.

I made house calls all my life. I think that's the way medicine should be practiced. A doctor should be able to see people in their homes, to see what their hygiene is like, to look in the refrigerator. I probably made three or four house calls every day.

I used to try to get to the hospital by about 9 o'clock so I didn't interfere with breakfast and the cleaning up of patients. Then I'd go to the other hospital, maybe make a house call or two. Then office hours in the afternoon. At first I had open office hours from about 1 until 4, and then in the evening usually from 7 until 8. In certain seasons, flu season, for example, the waiting room was packed, and other times I had nothing to do. Eventually I went from open office hours to scheduled appointments, sometime in the 1960s.

Lisbon has always been a pretty poor town. We had a woodworking mill and later a shoe factory, and during the last 20 years we have been making wire, at Lisbon Wire Works up the road. The mill did not offer any coverage so people had to pay as best they could. Blue Cross came along in the 1950s and I think probably 15% or 20% of my patients had it. By 1985, when I retired, maybe 75% of my patients had insurance, including Medicare and Medicaid. A lot were still not covered, though. Health insurance made a great improvement in many ways, but the whole thing became so complex, it drove me nuts. First of all, go back to the '50s. I can remember when I first began practice, I realized after a while that some of these patients owed me a fair amount of money, which they didn't bother to pay. I looked at their homes, and they would have TV at a time when I couldn't afford TV. So I remember I got pretty angry at one time, and I told Miss Smith to send the bills to a collector. It didn't work worth a damn. I told her in 1960, "I'll be damned if I'm going to bother with that kind of stuff anymore," and I didn't. She used to admonish me, "You must do something about these bills!" I'd reply, "The hell with it." That's the way we worked, and it worked well enough. She stayed with me until she retired in 1982.

As time went on, I was seeing a cross-cut of patients from Lisbon and the surrounding towns too. Around 1956 a very well-trained surgeon named Harry McDade came to Littleton and I realized immediately that it really was foolish of me to do surgery since he was here. I kept on with obstetrics, delivering babies until the middle '70s. At that time fetal monitoring came in and caused quite a commotion. It irked the hell out of me, and quite frankly I despised it. I gave up obstetrics about 1976.

When I retired on July 31, 1985, I tried to get someone to take over my practice. I even advertised. But no one was interested so I simply closed it up. Eventually Littleton Hospital took over my old office and arranged for two Littleton physicians to use it on a part-time basis. Someone must be there about every day of the week. The office is being renovated and will be a satellite of Littleton Hospital. But I tell you, I don't like it. I think it's producing a nation of gypsy physicians. They go where the best money is, and they stay a short time. Then they're off and away.

I have seen general practice become family practice and that's been for the good. When the American Academy of General Practice [now the American Academy of Family Physicians] was founded in 1947, I joined immediately and kept up. I thought it was an excellent thing. When I started practice, there wasn't this whole array of specialists. So as a result, you were forced to take everything on and try to do the best you could with it. The old-timers, if they had had a year's internship they were lucky. They had to learn on the job for the most part. I'm sure I did. These physicians had to learn a lot of things very quickly. Most of us were aimed at small towns and rural areas and were going to take care of everything. When I began I was probably taking care of 95% of everything that came along. A general practitioner today ought to be able to manage 85% of everyone he or she sees; the other 15% he probably ought not to be managing. The real question is to know who are the 15% you should refer.

As a general practitioner, you could experience some real problems, even when you were careful. A girl had a baby. After the baby was born, she came back to see me several times with minor complaints. I didn't think too much of it. Then she showed me some personal journals—just stream of consciousness stuff. I tried to encourage her; her husband was a minister. The next thing I knew she had taken the car and disappeared with the baby. Everyone was looking for her. She was eventually found and brought home, but in a rambling, florid state. At that point, I sent her down to Hitchcock [the Mary Hitchcock Clinic at Dartmouth Medical School]. She continued into a psychotic state and eventually died. It was a sad case. Oh, you get some awful messes at times.

Over the years, of course, I dealt with a lot of family problems and the like. Drugs were practically a nonproblem when I first began practice. I don't think there were so many sexual problems either. I remember one patient telling me a problem she had of a sexual nature and how shocked I had been that she came out with it! At that time, I'm darn sure I didn't offer her any advice whatsoever. I occasionally saw women who had been beaten up by their husbands, and I would try to get them to prosecute, but they never would, even those who said they might.

There were a lot of other things in a small town that militated against this sort of thing. The Masons, for instance, the Boy Scouts, youth groups, religious groups, and so on, exerted quite a bit of power in getting kids not to do things that they ought not to be doing. In addition, the police were not inhibited by some of the things that have gone on in the courts. They had no compunction about beating somebody up if they felt he or she was doing wrong. They did. I think people knew it. If someone was to beat a child, for instance, the father or whoever did it could get one hell of a beating from the police.

Alcohol certainly was a problem. Even when drugs for the treatment of alcoholism came along, they didn't help much. As a matter of fact, years ago, in the '50s, one of my patients—a very wealthy woman—was a terrible alcoholic. She had married a guy who was a drunk himself. One night I was called to her house and found her standing in the middle of the room, not moving. "He's down there," she said. "Who's down there?" "Louis is down there." Turned out that her husband hid his liquor in the cellar. He had gone down to get some and she put the trapdoor down and was standing on it and wouldn't let him up. Well, now she wanted a drink. She tried to get me to get her riding boots, which were in a corner of the room: one boot had a bottle in it. Well, I was pretty irked and I wouldn't do it. I think I just said, "You've got to let him out of there!" She eventually let him come up and they were calm and peaceful and then had more drinks together and I just left. I took care of her for many years after that. She caused a lot of commotion and kept on drinking.

I enjoyed my years in practice but I wasn't sorry to get out when I did. The number one reason was the litigiousness of patients, physicians, everyone. It had gotten much worse over the years. The second reason goes back to the late '60s, when Medicare came along. Medicare—and by association Medicaid—got us into a bookkeeping system that I think is probably the most monstrous thing I've ever seen in my life. These people make you continually sign documents that say everything is true, and if it turns out not to be true, I'm likely to be sent to jail for 10 years or fined $2000 or whatever. Signing that used to irk the hell out of me every time.

I'm glad I don't have to practice today because of the choices involved, the idea of joining an HMO or a PPO, particularly for a physician in a small town. Some of them want you to sign exclusive contracts. That would really pose a problem in a small town. How can a physician possibly function that way? I can see how an HMO can save money, but the only way to save money is if the physicians who are the gatekeepers are the most honest characters that have ever been created, and I don't believe they are.

I've been asked from time to time, "Isn't general practice boring, seeing the same thing all the time?" Actually I think it's the reverse. When I was a resident, I thought about going into urology. But the problem with urology was that I just couldn't believe that I would spend the rest of my life looking at penises and bladders and kidneys. In general practice, you're looking at a tremendous range of medical conditions. It's true that you can't have every bit of knowledge at the end of your fingertips, but you can find it relatively quickly. No, I thought that general practice gave far greater diversity and much more enjoyment. I saw eyes, I saw hearts, I did rectal examinations, I did feet. I pared corns and I delivered babies. Everything. The whole works.

Work as a general practitioner is not necessarily easy for your own family. Phyllis was a great help to me and we had three wonderful children: Eugene, Jr, born in 1942, who is now a professor of political science at Indiana University; James G., born in 1947, who is a nuclear technician for a radiologist in St Johnsbury, Vermont; and Kathryn, born in 1950, who is a Methodist minister in Colebrook, New Hampshire. I think my wife felt at times that it was all too much, because we were up all hours of the day and night, with deliveries particularly, and it was a very hectic schedule.

I probably didn't see my children as much as I might have. But I think my family would agree it's been a good life. I think about it a lot. I remember it well. But I am glad I retired.

Dr Mullan is clinical professor of pediatrics and health care sciences at the George Washington University School of Medicine and Health Sciences, Washington, DC, and a contributing editor of the journal Health Affairs, which is published by Project HOPE, Bethesda, Md.

Support for the Primary Care Oral History Project has been provided by the Robert Wood Johnson Foundation, the Pew Charitable Trusts, and The Milbank Memorial Fund. The full transcript of all of the interviews, including this one, can be found in the Primary Care Oral History Collection, National Library of Medicine, History of Medicine Division, Bethesda, MD 20894.