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Interview with Robert Straus, October 9, 1985

1985-10-09 Interview with Robert Straus, October 9, 1985 UKMC001:1985OH220 UKMC 001 02:29:53 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries University of Kentucky. College of Medicine -- History University of Kentucky. Medical Center -- History Hospital buildings -- Design and construction University of Kentucky -- Presidents Straus, Robert -- Interviews Community Health Services -- Kentucky Medicine -- Study and teaching (Continuing education) -- Social aspects Social medicine Rural health -- Kentucky Medical Care, Cost of Kentucky. General Assembly Chandler, Happy, 1898-1991 Kentucky. Governor (1959-1963 : Combs) Presidents -- University of Kentucky Robert Straus; interviewee Richard C. Smoot; interviewer 1985OH220_UKMC01_Straus 1:|20(12)|30(2)|44(10)|55(6)|71(12)|82(11)|94(8)|108(6)|120(7)|138(8)|149(2)|165(12)|178(7)|188(11)|200(11)|211(13)|226(13)|239(2)|253(9)|266(15)|278(4)|298(1)|311(6)|323(1)|342(8)|364(8)|375(1)|385(11)|395(12)|404(5)|416(4)|428(13)|440(4)|453(8)|467(4)|478(12)|489(8)|498(10)|510(1)|522(9)|532(11)|544(7)|564(10)|575(4)|586(11)|597(2)|606(7)|620(2)|634(10)|664(2)|678(6)|688(6)|700(3)|711(4)|725(6)|736(3)|750(11)|765(4)|775(4)|786(13)|801(7)|811(11)|820(6)|830(7)|838(10)|848(1)|858(11)|870(6)|887(2)|899(12)|910(8)|925(9)|939(4)|950(11)|959(11)|972(7)|987(3)|994(2)|1002(1)|1013(1)|1023(9)|1035(1)|1049(7)|1063(4)|1074(1)|1084(3)|1093(9)|1104(6)|1115(1)|1125(1)|1144(2)|1151(12)|1178(4)|1197(10)|1208(4)|1220(7)|1235(1)|1247(3)|1259(10)|1272(6)|1285(5)|1297(15)|1309(2)|1321(9)|1333(10)|1350(4)|1363(7)|1386(13)|1406(4)|1419(1)|1433(5)|1453(7)|1465(5)|1475(5)|1487(5)|1505(11)|1531(10)|1552(14)|1566(2)|1582(9)|1597(4)|1612(4)|1630(12)|1639(7)|1649(2)|1672(11)|1682(6)|1690(2)|1698(1)|1705(12)|1716(14)|1727(3)|1742(4)|1753(8)|1764(15)|1777(9)|1792(8)|1812(3)|1832(3)|1841(9)|1863(5)|1877(1)|1886(5)|1895(10)|1907(10)|1919(7)|1935(13)|1952(9)|1970(2) audiotrans UKMCoh interview SMOOT: Dr. Straus, let's begin by getting a little bit of biographical background on you, if we may. STRAUS: All right. SMOOT: Tell me where you're from, when you were born, a little bit about your family life. STRAUS: Okay. I was born in New Haven in 1923, January 9th and, um, my father was from Kentucky, actually grew up in Louisville, went to Yale as an undergraduate and then to law school and met my mother. Uh, they married, came back to Louisville. World War I took him into the Navy and mother went home. My father got out of the Navy without a job and, uh, he had been, uh, a practicing attorney here, but went to New Haven where she was and started teaching high school--was a high school mathematics teacher. SMOOT: Hmm. STRAUS: Had one older brother, was four years older than I. I grew up in New Haven, went to high school, went on to Yale as an undergraduate, actually had two years and two months of undergraduate college with the war acceleration and somehow or other got a degree out of it by working overtime and writing a thesis in the months between, um, the end of my formal third year and, and going into the military and-- with added courses and things like that so that when I came out of the military in 1944, uh, with aggravated knee injury that I had originally incurred playing lacrosse in college, I was, started working for a postwar planning group and then enrolled in graduate school at Yale and, uh, in those days there weren't too many graduate students around and I got a Ph.D. in three years--(Smoot laughs)--so in 1947 uh, I was ready to, uh, start a career. In 1945, I started doing research in alcohol, not as my, not for my, uh, dissertation, but for a job, twenty hours a week for twenty dollars a week--(Smoot laughs)-- interviewing, interviewing essentially skid row alcoholics-- SMOOT: --Huh-- STRAUS: --and that lead to my first publication which was called "Alcohol and the Homeless Man." Uh, my doctoral dissertation; however, was in medical care and, uh, it was a study of an attempt to identify, uh, factors associated with the assumption of responsibility for health care by governments and it had a fancy long title, something like "The Evolution of Public Medical Care in the United States," but after the dissertation was completed, um, because so much of public, early public medical care not only in the United States, but in the world had to do with merchant seamen, uh, the dissertation was published under the title Medical Care for Seamen. That was my first book and, um, I guess as this was obviously an interest in medicine, there was medical history in my family. An uncle, much revered, a great uncle--my older brother had been tagged as the member of the family that's going to be a physician and somehow that never happened. It never even occurred to me that I was supposed to be interested in health and medicine. My mother, uh, was a, on a voluntary basis probably started what you would call diversional therapy for children in hospitals in, in the United States. SMOOT: Hmm. STRAUS: In the New Haven Hospital in New Haven she published the first book on the subject called Keep Busy in which my brother and I were subjects--(Smoot laughs)--so that I, I guess I grew up in a family in which there was interest in health and medicine. I mention this because even though I went into sociology, I drifted very quickly into interest in health care and my first academic appointment was not in sociology, but in applied physiology at Yale where the alcohol group was. Now, as far as Kentucky is concerned, the significance came in 1949, when, uh, I should mention that Yale didn't pay their instructors very much and I had an opportunity to do some moonlighting and, and was introduced to, uh, Dr. William R. Willard, Bill Willard, who was then assistant dean of the Yale Medical School and had been made chairman of a governor's, uh--let's see what was it called--health resources commission and he was looking for some people to do staff work so I started doing some studies for the commission. Ah, did several studies for the commission, including one on the need of a state medical school in Connecticut. (Smoot laughs) Ah, the commission became lame duck because of a change in governor. Uh, Dr. Willard, who is a man never to leave anything unfinished decided the commission could be lame duck, but the was going to file the commission's report and he, he and I by this time were working fairly well together and nights and weekends during the fall of, uh nineteen, uh, '50 I guess it was, it was either '49 or '50, no, '50, he and I wrote a report, fairly substantial report, uh, on health resources for Connecticut and then about that time he was, uh, a year later I guess it was, he was invited by the State University of New York to go to Syracuse where the State University had just taken over from Syracuse University a rather small, struggling, private medical school and was going to create, had the ambition of creating, the Upstate Medical Center and they invited Bill Willard to come and, uh, head that up. He went to Syracuse. In the meantime, uh, I was making a decision. I was very much involved in alcohol research. It was a fantastic opportunity. I think I, I not only got out a couple of books, but maybe twenty-five articles. I don't remember exactly, but, uh, just an incredible opportunity for somebody who was getting into a research career, but I was faced with the question, do I want to commit my life to this area of research, because the early period is rather crucial, or are my interests broader? And I decided my interests were broader and I, among other people I wrote a letter to Bill Willard saying I've decided that when I finish Drinking in College, which was a book I was working on, that--or a six year study actually--uh, I'm going to move out of the alcohol field into the broader health care field and have you any interest? And he wrote back and said, I'm glad you wrote because not only have I interest, but I'd made inquiries at Yale about your availability and essentially been told there was no chance that you'd move. (Smoot laughs) Uh, so we got together and I went to Syracuse and he hired me actually a year before I went there because I was finishing up a six year study that we were doing of drinking among students in twenty-seven colleges in the United States. Sorry. So in the spring of 1953, we moved to Syracuse. Um, expec-, I expected to be doing primarily research and when I arrived Bill Willard said, "Well, I've freed up three hours of curricula, three hours a week of curriculum time in the first year and I want you to develop a course in, uh, the, what we were then calling the social sciences as basic science for medical students." Now he was a pioneer there. Uh, there may have been some dribblings of, of, uh, a few hours here and there in other medical schools, but he was obviously the first person who, uh, was convinced that the social behavioral sciences belonged in medical education and he was so convinced that he created essentially a full-time faculty line, paid out of his own basic budget in order to support it. Um, well, we developed a course, the, uh, chairman of psychiatrics and people in preventative medicine, it wasn't a one person thing, but we developed a, uh, a, a course and I got into quite a bit of research up there. Some of it base--what I'd call basic research. I was doing a study of all the VA patients who had at least ten admissions to a VA Hospital. By this time I was interested in what I called dependency behavior. SMOOT: Um-hm. STRAUS: But about half of my research time was, uh, doing studies for Bill Willard. He was interested in, uh, the, uh, question of, uh, whether medical college faculty should be full-time, paid full-time by the medical school, uh, or have privileges for earning money on the outside. He'd come from Yale which was a full, full-time tradition, he'd gone to Syracuse which was just the opposite and he was reorganizing the school. So he sent me around the country to, oh, at that time eight or ten different places that had different models and I wrote them up for him, um, and I did a study on, um, the costs of going to medical school and how they were being met because we were concerned about the fact that medical students were--primarily because of cost--coming from upper socio-economic areas and how do you broaden the base of people who can go to medical school. Um, and it was a very exciting three or four years, uh, from a personal point of view it seemed like it was moving. He expanded the group. I, I hired three other people so we had a, a section within the preventive medicine department and, uh, things were going very well--so well that my wife and I decided to sell the house that I had bought sight unseen by her and, uh, we had rehabilitated and, uh, move our by then four children into an area where there were more small children and, and we bought a house that she designed. We were in it about nine months when on the evening of June 3rd, 1956, which was my wife's birthday--(Smoot laughs)--and at which time she also was sick with pneumonia-- SMOOT: --Oh-- STRAUS:--Bill Willard dropped in around eleven o'clock at night and this was not uncommon for Bill Willard to drop in at eleven. In fact, he'd drop in at eleven to see if I'd go work with him until--(Smoot laughs)--three or four, but anyway he dropped in one evening and, uh-- and Bill had a way, a very relaxed way about him--and he stuck his long legs out and he started chatting about how things were going and then he mentioned that he'd been down to Kentucky and, uh, finally he got around to the fact that not only he'd been down, but that, uh, people in Kentucky were offering him an opportunity to come in and absolutely carte blanche establish a new medical school and he was really thinking of doing it and kind of my heart was dropping because I was very much identified with him and he said "The one thing that bothered him was that, that he had brought quite a few people like myself to Syracuse and he, uh, really didn't want to leave them in the lurch." And I made a noble speech about how that he shouldn't consider that because after all he had his own career to develop and it sounded like a great opportunity and he said, "Well I'm glad you feel that way because if I go I'd like you to go with me." (both laugh) And, uh, when I looked around this living room and this house that my wife had essentially designed and, uh, by this time her fever was a hundred and whatever, I don't know, she was really sick that night and I think I knew at the moment we were going, but we went through about a couple of months in which I came down to look the situation over and, and they looked me over here and, uh, but in essence, uh, Bill came here in August of 1956, um, and he brought four people, um, with him. Howard Bost, whom you probably will be interviewing. Howard was an economist who'd been at Syracuse for about a year, he'd come from Michigan I believe or maybe Michigan via Texas, he'll tell you. Um, Dick Noback was an internist who was running the outpatient program at Syracuse, uh, and then Alan Ross had been hired as a biostatistician and hadn't even arrived--let's see, I think he was at Hopkins--but he hadn't even gotten to, to Syracuse, but because he had been hired and because of Bill's interest in the kinds of people he was offered the opportunity either to come to Syracuse or come to Kentucky and he decided to come to Kentucky with us so, uh, uh, that was the group. Willard, Noback, two physicians, an economist, a statistician and a sociologist and I would say our first formal beginnings of this school occurred in Bill Willard's living room in Syracuse sometime in August when the five of us got together and started talking philosophy of medical education because we all, we all were interested in, uh, we were all kind of people who were planners, reformers in a way and we saw this as a great opportunity to start from scratch and I remember we talked about, uh, two things, one the need to come in here and, and do a lot of studying of the people and the patterns of health care and the needs of the population, uh, and another we laid out a plan to essentially cover the country and with the questions, if you had the opportunity that we have, what would you do differently? And, uh, various of us took on different tasks, Howard--we also had the problem that an architect had been hired and there was a, a need to move fairly rapidly. Our Governor Chandler who was the stimulus for this had gotten the legislature to appropriate five million dollars, that was it at the time so we were all coming down with the idea that, okay, we've got five million to start with, we've got to convince people that, that it's worth more state money and then we had to get it, prepare to get applications in for federal money so there were some immediate needs to move in terms of, uh, funding. Uh, there were some tight schedules there that were dictated by, uh, architectural planning and, and financing, but at the same time we, we were convinced that in order to take advantage of this opportunity we had to start with program planning. We had to start with program objectives and try to get the, to, to get the architectural planning to meet the program planning rather than hire a bunch of architects to build a building and then try to run a program in it. SMOOT: Um-hm. STRAUS: So, um, we set up a schedule that called for not only visiting people in terms of what would you do differently, but looking at all sorts of physical features and even beginning to do the preliminary screening for the kinds of people we might eventually recruit to bring in here. Okay. This had all come up so suddenly that from my personal point of view I was committed to teach in the fall in Syracuse and I felt that I, I managed things so that I could, uh, cover, feel that I would be covered, uh, by--after about November 1st, but we had to start here in August. I think my official day starting here was September 10th. So for two months, believe it or not in the days when there was no direct air service between here and upstate New York, you had to take the train, I commuted, uh, covering my teaching in Syracuse and, uh, coming down here. Bill Willard got down here in December, Bost, who didn't have teaching commitments moved down, Ross, who didn't have, uh, any--(both laugh)--I mean he was moving anyway, he got here. I've forgotten about Noback, I think, I think he, no, he came about the time I did and then around November, September, October, somewhere-- October, November, Willard and Noback and I got an apartment over here in Cooperstown, a student apartment, and we bached it for a couple of months. Uh, Bost and Ross had their families here. Okay, what we were doing during this period, we were visiting schools, looking at architectural features. One of the considerations at the time was to build a circular wing. SMOOT: Um-hm. STRAUS: That was an idea. Uh, how many single rooms versus, uh, double rooms or wards do you bring, build? Now that, that was a, we made a bad choice there. Uh, we made a very, very bad choice, but we did it for political reasons. I have got to go back and describe this university in nineteen hundred fifty-six. The University of Kentucky in 1956, uh, was, uh, only a few years from a time when there had been a legislative limit of five thousand dollars that any person could be paid and that had been raised to twelve thousand and I guess they broke it for us or in order to give Dr. Willard what was necessary to get him here. I don't know. They broke it obviously for other people because the president had to have more than Dr. Willard, but it was a university where the idea of private offices for faculty didn't exist. Uh, telephones were something that, you know, you had one for a department. Uh, we came in expecting to get a couple of electric typewriters and found that the university somewhere, the board of trustees had a ruling, there shall be one electric typewriter and that's the president's secretary so--(Smoot laughs)--I had to sit down and write a six page justification for buying electric typewriters in terms of, uh, cost savings and that sort of thing. Uh, I re-, I, just kind of setting, it was a poor state with a, uh, a kind of poverty mentality that pervaded the university and, we, we didn't come in to be extravagant but we came in to build a quality medical center and I can remember sitting down with people from Frankfort and having to point out why we were planning private offices for faculty who were going to, you know, be seeing patients and other things like that and why we expected to provide everybody with a telephone, uh. Okay, let me describe what we came to. They, they dug out, I think turned a classroom over in the Fine Arts Building into an office for Dr. Willard and his secretary in one room. They didn't know what to do with the rest of us. Initially, there was a dugout in the basement of the original King Library, a place that literally had been originally not basement and, uh, they'd dug the dirt out of it and made a few rooms, and we sat on some old wooden chairs on cardboard or wooden crates as desks and that's how we started and I remember well, there were some people in the community who wanted to get in on the ground floor of a new medical center with their special interests. There were a couple of lovely ladies who were interested in speech and hearing and wanted to be sure that the medical center would, would put in speech and hearing and somehow or other they got, they got referred to me and I remember sitting there, uh, in this room which was kind of a dugout with a-- with a crate for a desk interviewing these- -(both laugh)--lovely ladies who had come to talk about the medical center. Uh, is this the kind of stuff you want? SMOOT: Absolutely. STRAUS: Okay. SMOOT: Please continue, this is, this is very interesting. STRAUS: Okay. Uh, we started very humbly. (laughs) Uh, somewhere, uh, somewhere along the line, after we'd been in this library dugout for a few, uh, a few months, there was a farm house that stood over here at what would be just beyond the end of the dental wing, uh, that became vacant, called Freeman House. It had been used by the Ag School and they let us have that so that those of us who were on the staff other than Dr. Willard moved in there, uh, and by that time I think we did have some old wooden desks and chairs, but, uh, we moved in there and, uh, Dr. Willard stayed on the campus because it was felt it was important to have him on the campus. Speaking of campus, one of the things I also remember was that we were, we were really, uh, received I would say in two ways. There were lots of people on the campus who were terribly concerned that the coming of a medical school would destroy the university because we would absorb all the funding, uh, and it was a very--obviously with the history this university had had it was a very legitimate kind of concern. There were others who saw it as an opportunity for the university to take off. Uh, I think I had developed friends in both camps. Uh, personally I couldn't have been more graciously received by the sociologists, uh, and there were good reasons why they might not. I'm, I'm sure I came with a higher salary than any of them had, even though I was on a twelve-month basis. Well, I think they were at the time, uh, but, uh, they offered me a joint appointment. I was interested in keeping some hand in academia and I think the second year I was here I started teaching a course in medical sociology and had contact with graduate students and, uh, there was a graciousness that exists to this day and that I would say that among our, my wife's and my, closest friends are our contemporaries who were in the sociology department at that time. People like the, uh, Fords and the Suttons and the Colemans, the Beers and that was very, very warm and not only was it warm personally, but as I'll mention later, it, it established, uh, a base for a program which is unusual in universities--our joint what we call medical behavioral science graduate program which is collaborated with sociology, anthropology and psych here and turned out, I'll come to that later. SMOOT: Well, you were in kind of a new field really or a sub-field of sociology when you came here, were you not? The medical sociology, wasn't that something-- STRAUS: --There wasn't really much of it. There, uh, there were some, there were some people calling themselves soc-, you want the history of medical sociology? (laughs) SMOOT: Just a little bit perhaps, as it relates to you and coming here. STRAUS: The term medical sociology first I saw, am familiar was a book that was published around 1908, called Medical Sociology which was primarily on venereal disease. SMOOT: Um-hm. STRAUS: The pioneer medical sociologists in this country were, um, let's see, I've lost, just lost his first name, really an economist Michael Davison-- SMOOT: --Um-hm-- STRAUS: --who was a sociologist economist and then I call the father of medical sociology a man named Bernhard Stern, who was, uh, a sociologist at Columbia-- SMOOT: --Um-hm-- STRAUS: --who started in the 1920s doing research on technological change and its impact on medical care. He had the misfortune, in terms of a personal life, of being, uh, viewed as a kind of a Marxist and really, uh, experienced a, I would say a tragedy in that he was always on the periphery at Columbia and, uh, I was, had difficulties during the McCarthy era and so on, and, uh, but, uh, he certainly influenced me a great deal and when I was a graduate student at Yale it so happened he was a visiting professor for a year and came up and gave a couple of courses which I, I took with him. Uh, a really, unrecognized, uh, man. The field got some stimulus from the Russell Sage Foundation which, uh, under the leadership of a man named Donald Young, developed residencies in, uh, in a number of medical schools for social scientists with, uh, the idea to see if, if something would take and, oh, uh, quite a number of people who in the, uh, late fifties, early sixties developed an interest in health as a, as a, uh, major institution of society, uh, were supported for two or three years in one medical school or another by Russell Sage, not much of it took. Many of them stayed in the field, but usually elsewhere and this is where Bill Willard was, was the pioneer in that he, he never went to soft money for this. He used, he used hard money from the beginning, showing his convictions really that behavioral sciences belonged as basic to medical education and medical care. We'll develop that theme a little more later. Uh, I'd like to, I'd like to go back to those, those, those early, early days. Uh, there were then about sixty, between sixty and seventy medical schools in the United States. I'm sure I visited thirty or forty of them and the visits were multipurpose. We were looking at physical facilities. We were looking for ideas and we were looking for future people, all in, in one, usually in one, visit, scouting, uh, came back, wrote reports. We used to have breakfast meetings that began often six in the morning. Uh, we were working eighteen-hour days. It was a dreadful thing to do to a wife with four kids, uh, just dreadful in retrospect, but it was, we were just absolutely caught up in this, this thing. Dr. Willard, uh, is a remarkable man. I'd like to talk about him a bit. I'm sure you'll hear about him from Howard Bost, but there are not many of us here who, who can talk about him because Howar-, Howard who retired recently and I are the only two who came with him and many of the people who knew him well in the early days aren't here now. Uh, he was a man, is a man, of, of enormous, of enormous, uh, vision, uh, and he is a man of intense commitment to improving the, the, uh, health of the population. His motives in starting a medical school here were really to provide a means for raising the health care of the people of Kentucky and, uh, he is a man who inspired a lot of confidence. He sold this school. I think, well, Chandler got it started politically, but once Bill came here and there was enormous opposition from the entrenched medical profession, most of whom were, or many of whom were, Louisville graduates and saw this as a, as a competitive, un-, un-, undesirable and some felt unneeded competitive move. I think Bill won them over. He won the Medical Society over, uh, and he did it just because of the kind of human being he was. One of Bill's understandings in coming here, I think one of his conditions in coming here was that he would have direct line to Frankfort. Uh, one of his frustrations in Syracuse was that he had to work through an executive, um, vice-president in the state university system and it took a long time to get things done. He'd gone there to build a new medical school and a new hospital and nothing was happening at the political level and he, he tells the story that Happy Chandler said, "If you come down here, I guarantee you, you'll have your hospital operating before they have a hole in the ground." And that's exactly what happened. I mean we moved here and literally had our hospital open when they were just about digging the first hole in Syracuse that had been promised when he went there in 1950. So, uh, things did move here and they moved partly I think because people developed an enormous respect for this man and for his ideas and they had confidence in his integrity--a man of just impeccable integrity--and following and I think those of us who worked with him got caught up in this and, you know, that's why when Bill came around at eleven o'clock at night and said, "Would you mind, uh, coming down to the office or over to the house, I've got something we need to do." Nobody ever thought of doing anything except going and, uh, he was very effective, uh, for the first eight years, in part because he was in a position to be effective. He was very well supported by Frank Dickey who was the--Frank Dickey became president at the same time Bill came here, I think there--Donovan, Dickey's predecessor, perhaps was responsible for selecting Bill, but, uh, he did it in a lame duck capacity and Dickey was my age. He was a man thirty-six years old at the time, maybe and well, I guess I was only thirty, thirty-three, when I came down, well, a contemporary. I remember the first time I came down. I'll tell you this story. Uh, my, uh, we, one of our children was a peanut butter nut. She wouldn't eat-- not only wouldn't eat anything but peanut butter, but nothing but what was called Big Boy peanut butter--(Smoot laughs)--and that wasn't easy to find in Syracuse, we drove across town to find it. Well, I came down here and for the first visit Frank Dickey met me at the railroad station, took me to the old Lafayette Hotel where the city, uh, offices are now and across Main Street was a great big sign, it said, Big Top peanut butter made in Lexington. I called my wife--(laughs)--that night; I said, "We're coming to Lexington!" (Smoot laughs) It's the home of Big Top peanut butter. Well, right after that Procter and Gamble bought them out and quit making it, but anyway, that's how Young, W. T. Young made his money, he, he was Big Top peanut butter and was bought out by Procter and Gamble. Okay. It was a--I, I want to stress the support of Frank Dickey as president. Um, other members of the administration of the university I think were more suspicious and, uh, there were some struggles, business control, um, but Dickey was extremely supportive. The university was growing at this time and I think Frank Dickey, um, I don't know what made him decide to give up the presidency, which he did voluntarily, I think part of it was the pressure that was on him to get rid of, uh, Blanton Collier as football coach. Collier was a magnificent man and Dickey would not, absolutely would not, tolerate firing him, but I, honestly think that's one of the reasons he gave up the presidency, because has soon as he announced his resignment they fired Blanton Collier who went on to become the winning coach of the Browns, but we had this kind of support in Frankfort. People shouldn't talk about this school without mentioning Combs, because Chandler got the school started. He got the six by five million and then he got another six million and then with federal funding we got it up to about twenty-seven, which is what it cost to build the original medical center, but he was succeeded by Combs and it was Combs, under Combs, that the basic financing of the operating of the medical center was established and it was Combs who put this medical center, medical school initially on a very sound financial footing, better than most medical schools. Uh, he enabled us to go with the full-time concept that all faculty were full-time employees and under our initial arrangement, earnings from the clinical activities of faculty or even in my repetitive consulting for the, uh, what then was the narcotic hospital, I was on a project out there that Al Ross and I, and those monies didn't come to us, they went into the, into the pot and that was as it should be, I mean that, we were fully committed and we were supposed to be paid in accordance essentially had meant we took on things that were professionally relevant, uh, that were meaningful to the school and we said no thank you to things that, uh, weren't. Um, I will at some time talk about what I feel is the tragedy of what has happened in financing of medical education. There are no villains. Uh, it, it was a result of mo, of things far beyond medical education happened in the society, but this was a very, very important factor in the commitment of people who came here and, um, the first chairman of medicine, Ed Pellegrino, who has gone on to all sorts of glory in terms of his career. Ed came, I'm guessing, for about eighteen thousand. Well, if Ed had gone into practice in, in Kentucky in internal medicine, he might have cleared twenty-five, you know, but he never, never occurred to him that, that he wasn't coming because he wanted to be full-time academic physician and teacher and investigator and, uh, I think we all felt that way. We, we were not, uh, it, it just was a time in which we were graced with, uh, having support so that we felt we were, uh, appreciated and we weren't preoccupied with our personal, uh, financial benefits from the job. They, it was, it, the whole, the whole reward was in what we were doing and, uh, the opportunities we had to pioneer ideas. It was a, it was a great time. Okay, Dr. Willard, uh, is a man of enormous, ah, vision in developing things. He had less interest in the day to day operation of, of the medical school once it got going. Um, although I think he did it very conscientiously. As an administrator, it was very interesting to me; Dr. Willard had, uh, meetings of his, of his staff and his--usually working meetings around specifics--but he had a regular faculty chairman meeting and he always consulted people and he went around the table and he listened to ideas, but he always made it very clear that the buck rested with him and, uh, I don't think we voted. Something I learned from Dr. Willard, when I chair committees I try to not vote. You know, when you don't vote you don't have any losers. If you can develop a consensus, if you can give people who don't agree a chance to, to save face, uh, it's very, very valuable lesson. I, I think I learned that from Dr. Willard and I've used that in national committees and I've used it here on campus. In fact, I usually very early when I'm started chairing meetings say let's, I'd like to, I'd like us to agree that, uh, that unless we have to take formal action for some reason we, we avoid voting, will avoid formal, uh, rules of order. Let's just have a chance to listen to each other and see if we can develop consensus. This was what kind of man Dr. Willard was. We didn't have anything like terms for chairman in those days, we served at his pleasure. We didn't have committees that had to, had to, uh, approve every appointment, uh, if I wanted to appoint somebody I put together everything that I thought was relevant and send it to him. If he had questions he asked them, otherwise he approved it. Uh, we weren't encumbered by the committee system. Uh, Dr. Willard attracted an incredible number of fine people. We went through the scouting process, uh, then we started bringing people in, often by twos, for two or three days and we'd be together intensively long evenings, a lot of, lot of the discussion of the philosophical level and the first group of people who came here to chair departments- -really a remarkable group of people and they came partly because they were attracted by the same things that, that attracted those of us who came with Willard originally and probably by him and I, I, I, you know, personally can say that Loren Carlson who came in physiology, George Schwert was our first chairman of, of biochemistry, Bill Knisely our first chairman of anatomy, Ed Pellegrino in medicine, Kurt Deuschle, all these men will tell you--Harold Rosenbaum who, who is still around, who came from the community--and they'll all tell you the reason they took the job was Dr. Willard. Uh, everybody, they all loved that guy, they respected him. Uh, things went beautifully and he, he was a low key person, but you always knew who was in control and he did not hesitate to make a decision, uh, where he didn't have consensus if he felt he was right and he made a few of those decisions too and I won't say he didn't make mistakes. He made, I mean, I could tell you four or five that I think he made, but because they involve human beings, uh, in other words I think he made some mistakes in choice of people, I'm not going to identify. Those, uh, uh, maybe not four or five, there were three. You want to stop for a minute? SMOOT: Yes. [Pause in recording.] SMOOT: Okay. STRAUS: All right. Um, we worked very hard and Howard Bost can tell you more about this and Carl Delabar is another person to talk to because Carl, when we first knew Carl he was working for the state and he was one of the key people who was looking over our shoulders and making sure we were doing things right. (Smoot laughs) I remember ta-, meeting with Carl to explain the blueprints to him and why we were doing certain things and, uh, then Bill hired Carl and he has been a rock of Gibraltar here--a man you must talk to--but, um, just a second, I got off track, oh, yeah, Howard and Carl can tell you more about the financing side of things and how we met our deadlines for Hill-Burton funding and we had a ground breaking out here that, uh, I think was in 1957 actually, yeah, for the Medical Science Building, which is the sort of stub T shaped unit over there, but the thing was designed with the hospital and the medical science building to be an integral unit, but the first contract was for the Medical Science Building, uh, which was started in '57. We occupied in January of '60, just a few months before the students came and we had to get it ready for them. Uh, then the hospital contract was next and we, we were favorable time on the hospital contract because the, um, there was a slump in building and we got the, the bid came in, I think, almost three million dollars below the estimate. We knew we were under building. We knew we were in bad shape in terms of needed space and so we were able to use that money to build what essentially is three modules of space between the medical science wing and the dental wing, uh, or, it's, it isn't really differentiated from the dental wing, but the beginning of the dental wing was created with money that was, uh, essentially appropriated and then not needed for the hospital and that was, that was God sent because we, we weren't six months into this place and we knew we'd under built, but we were using the funds we had and that, you know, things like the hospital, inadequate storage space and so on. I mentioned rooms. One of the big questions in the hospital had to do with rooms and there the, the, the, uh, sort of mindset of Kentucky- -the poverty mindset of Kentucky--I think dominated. We were building a public hospital and we felt it would not be expedient to put in too many single rooms. We didn't put in enough and it's put the hospital in a bad competitive position as, with the other hospitals in the community, although they're now overcoming that with the re-, re-, uh, reconstruction that's been going on floor by floor-- the modification of the hospital. That was one mistake. Uh, it was, it was curious. I remember the meeting in which we finally made our decision and there was a study that had come out of the Public Health Service that had been made in West Virginia that, uh, alleged that large numbers of people in hospital didn't want to be alone. Well, that's true of a lot of our Eastern Kentucky Appalachian patients. They've never been alone in their lives, they've lived in large families in small quarters and the idea of being in a room by themselves was very frightening. So for that, for that aspect of our clientele, uh, we didn't make a mistake, but we didn't anticipate the numbers, numbers, of people whom we would want to serve and who would want to be served by this medical, um, center for whom sharing rooms would be, uh, almost intolerable. Uh, that's one mistake. I think of the first eight years as an era because from '56 to '62 or three, this was the period when Dickey was president, this was the period when Dr. Willard had direct communication with Frankfort where the medical center budget was a separate part of the university's budget. Uh, where our Governor Combs called Dr. Willard, I remember the day he became, took office, and said that he wanted Dr. Willard to understand that he was going to be under a lot of pressure to recommend people for medical school, but that he would put no pressure on Dr. Willard, that Dr. Willard would get letters from him, but there would be no, he respected the criteria whereby we had to select students and politics would not be a part of it and I, that was that one thing Combs did that was, I thought, very important. SMOOT: And the same thing held true for Governor Chandler? STRAUS: Yeah, yeah, I think that's fair. SMOOT: Hmm. STRAUS: I think that's fair. The only point, the only thing with Chandler was that Chandler was out of office by the time we were admitting our students, that's why I mentioned it in terms of service, yeah. No, Chandler, Chandler would pass on, he would pass on information about people, but he never put pressure on. No, no. Chandler, Chandler never took any steps that were not designed to make this a strong medical school. He had great pride in it. Yeah, I don't, I, I, in--let nothing I say, uh, indicate any lessening of the importance of Chandler's role, but I do think that Combs' role has been under-, underappreciated, that's all I'm really saying. Uh, we had an opportunity to design a new curriculum. Uh, part of our--some of our goals, uh, are expressed in some papers that I think I'll give you. Do you mind my sharing these-- SMOOT: --Please-- STRAUS: --I think that would be perhaps a more efficient way to share with you. I've written a paper on "Planning a Medical School for the Student and the Patient" which, uh, was published and I think it expressed a lot of the philosophy. I also think you should have, if you don't, a copy of the 1956 document on "Philosophy of Medical Education in Kentucky." Have you seen that? SMOOT: I read one article that you'd written. I don't recall if it was in the Annals of, uh, the American Academy or if was in the-- STRAUS: --Well, this wasn't one that I wrote-- SMOOT: Oh. Okay. STRAUS: This is one that was a part of planning step. Now-- SMOOT: --Okay-- STRAUS: --I turned over to, to Dr. Powell a number of my early documents-- SMOOT: --Um-hm-- STRAUS: --and, uh, I think maybe, uh, who is it, Nell, no, somebody in his office, has been collecting stuff from him, for him, and I don't know whether this is, whether you, this project that you're on is in any way coordinated with Dr. Powell's attempt to pick up some history for himself. SMOOT: I have some materials that were kept in the chancellor's office and I think that most of that work was done by Pat Tanner. STRAUS: Yeah. Pat would have, of course you need to talk to Pat, which I'm sure you will. Uh, well, I just, when Dr., Dr. Powell indicated an interest in learning as much as he could about it and I kind of went through the files and turned over some things to, uh, to him, but I will, will make some copies for you of some things, some I don't have I just haven't kept. Uh, we began to differentiate roles a little bit: uh, Noback, the internist, uh, more involved in clinical factors, uh, Bost in economic factors, uh, I became, I guess more interested in sort of things like the education and experience of patients, so that I became chairman of the curriculum committee, the first curriculum committee, and the first admissions committee, selecting students, and those were my early roles, my early hats. There were about, by that time in 1959, uh, Schwert, Carlson, Knisely, Pellegrino had joined us to begin developing their departments, so we constituted the admissions committee and selected the first class. We also constituted the curriculum committee and planned the first year of curriculum. Uh, the--we were trying, in selecting students, to afford opportunities for medical education to a broad base of Kentucky people, but at the same time to maintain a level of quality that would, uh, enable Kentuckians to benefit from some ideas and orientations that people brought from the outside, so from the very beginning we tried to select some really outstanding students from elsewhere, um, and we brought in some, some good ones. That first class is very close to my heart. We didn't have any formal student affairs office. I had a simple file folder with each of the forty students' name on it and in, in that desk drawer because-- (Smoot laughs)--that's my original-- when we finally did get furniture-- that's another thing, we got good furniture and, and that bookcase and that desk and that thing are all part of the original furniture. (both laugh) Used chairs--(laughs)--not these. Uh, anyway, uh, we, we chose some unusual students. We, we brought in a paraplegic, uh, a young man who became a pathologist. Uh, we, I remember our decision was heck, we've got a building here, all we need is a little ramp, there's no reason he can't, paraplegics were more or less excluded from medical education because most medical schools couldn't accommodate them in those days. Well, we could. Uh, one woman in the first class, uh, two or three blacks and some very unlikely people. If I, I'll tell you this story, I don't think he'll mind, but we had one applicant who had been playing minor league baseball and, uh, I remember some, somebody brought up the question, you know, minor league baseball and, and, uh, medical school go together and what's this guy's motivation and so on. He's probably, if not the, certainly one of the most highly respected members of our faculty today, Bill Markesbery. (both laugh) Isn't that first class? Just a fine human being. SMOOT: Hmm. STRAUS: Great, great physician, great scientist. (laughs) Um, we built into the curriculum, of course in behavioral science a course in communication interviewing. I think we may have been the first medical school to ever have a course in communication interviewing for medical students. Uh, put an emphasis on human development. We built in a case conference for first year medical students that every week brought them in touch with patients and then discussed these from sort of an integration of clinical and basic science considerations that, uh, it's a course that we're reviving again, uh, this, this next year. And, well, it's part of last year's curriculum committee recommendation. No, this year, in the, in the spring semester. Uh, we put a lot of emphasis on the experience of students and the experience of patients. In the early days, we allotted space so that every student had a studies cubicle. Every, uh, student was given a key to the building, part of a kind of ritual so that they could feel that it was their home. They could come and go. We had a fairly spacious lounge for medical students and a machine snack bar right across from it. Uh, most of this space over time, disappeared as other pressures came, but I remember that first year--(laughs)--we, we had one student--we built a, we built a men's room on the first floor with showers, uh, and I guess a ladies' room with showers, I just never went in it, but I think we--(both laugh)--we had one, I'm sure we did, we had, we put showers in, uh, and, and sure enough we, we found that we had one student who never did, never did get a place to live in Lexington, he lived in the building--(both laugh)--slept in the lounge and, and had his study and could take his shower and had his meals and so on and, you know, wasn't anything all that wrong with it. I guess some people were offended by the idea, but, uh, we tried to do the same thing to the patients in the early days. We knew, we knew from our studies and we had done some sociological studies of human response to illness and we knew from our studies that family and illness went very close together so we, we were very relaxed about letting families come in and be here. We, we, uh, had some cots we could move into rooms and we, lounges, a lot of those things kind of disappeared as we got a little more, more formal, although I still think we do a pretty good job with families. Problem was, a couple of motels across the street where families could stay got taken over by the medical center--(laughs)--through our expansion. SMOOT: Hmm. STRAUS: But anyway, you'll see some of this in this paper that I wrote on the, the, uh, student and patient. Uh, we were emulated. We were kind of at the beginning of a almost mad rush in this country to build more and more medical schools and, uh, we no sooner got through visiting other medical schools and planning this one than we were almost inundated with people who were, uh, visiting us because they were planning new medical schools. Now, one thing that I think, I, I mentioned the, the selection. Uh, the first cadre of people, the people who came as chairman were selected because they believed in the philosophy. They, they all were given things to read, you know, they, we talked for two or three nights and they came, it was a self selection process. They were all very, very competent people and many of them had early opportunities to go elsewhere and some of them went on to be deans, and uh, provosts and chancellors and university presidents and so on. The one thing that happened though, in nineteen, around '61,'62, the pressure of our second class of students and then our third class of students and our pressure of patients was such that we changed the criteria. We just weren't able to do the selection or have the self selection that went into the early, the first three dozen people who came here and it became more and more pressure to get bodies to teach classes and to take care of patients and as that happened, I think, we lost a lot of the flavor of, uh, purpose of this school because people came who really were more interested in doing what they had always done and were more traditional in their orientations and this is not just what's happened to this school. It happened in Florida, it happened at Penn State, it happened at the university of Washington, Seattle. Um, it is almost a phenomenon that is common to most of the new medical schools that were created in the 1950s and sixties and on, on since, although I think some of them created since didn't start with the same kind of, uh, ideology that this one started with. Um, I'm not sure whether, you know, I'm not saying that this is bad, but I'm saying there was a change in, in, uh, flavor and we did become more traditional. SMOOT: Was it something of an inevitability, you think? STRAUS: I'm wondering if it isn't almost inevitable, you know, um, as I look back at it. I'm going to be doing a little kind of writing about this. I'm going to be on sabbatical in, in the next semester and I have a piece of, major piece of writing in the alcohol field and I have also been collecting assorted notes and thought I might do a couple of reflective pieces on my experience in this situation here. Uh, the other thing that happened and, um, happened with the change in university administration with, uh, when Dr. Dickey left and Dr. Oswald became president. Now, I'm going to say some things here that I want to state as matter of fact, without a value orientation although some value orientation may be applied. Uh, Oswald came at a time very ripe for university expansion and he was the right man for the time, uh, but just as Dr. Willard had come here with an agreement that he would have autonomy to develop the medical center, Oswald--one of his conditions was coming with it--he would have total autonomy to develop the university including the medical center and when Oswald became president one of the first edicts was that only the president and the president's office would relate to the state and he, um, because of this I think he, perhaps not intentionally, uh, destroyed a lot of Dr. Willard's effectiveness. Now, um, he was always extremely, uh, respectful of Dr. Willard in public, uh, but I think he made things pretty rough for him in private and administratively. Now, um, that was one thing he did and it was simply a change in the organization and the, uh, and the delegation of, of authority within the university so that Dr. Willard remained with the responsibilities, but no longer had the authority to carry out, fulfill, some of these responsibilities and, um, I was close enough to the situation that I think I saw it very clearly, what was happening. I had, I think it had a very deleterious effect on Dr. Willard personally. The second thing was that Oswald came from California and brought with him a whole different system of university administration and control and essentially what he did was, uh, to kind of dissipate the authority of administrators throughout the university, deans, chairmen and everything else, by setting up committee systems through which all sorts of decisions had to go and this university today is, is just, uh, infiltrated with a system of committees that get larger and larger and more, in my opinion, more and more awkward to deal with. Uh, now I think, it, I personally do not think this is demo-, democratization. Um, I think it's diffusion of authority and, um, I'm not sure that it's helped higher education at all. Um, my own personal position is that, uh, an organization like the university is best run by delegating authority and if people don't do the job you change the people, you don't give the authority to other people and, uh, but that is, that had happened in the university, a large and, um, um, it certainly had its impact, has had its impact on medical center although curiously enough I think the Medical Center in, in many respects, the faculty and Medical Center probably don't exert as much of that authority that they or pseudo power that they might have as, as I think I see in other places in the campus, uh, but it just, very radical change in the way in which things, things got done. I, I'll tell you myself, I think it's an incredible waste of resources. Incredible waste of resources the, the, the, oh, number of levels at things which things have to be approved. Uh, where if you have competent people and confidence in them and an ability to uh, change horses if you're not getting the job done, I think that's a more efficient way to run a university or anything else. That's my position on that. I would say that, uh, Dr. Willard never, he, he continued in many respects to be a very strong person, but I don't think he was ever comfortable under the new regime. One of the things that Dr. Oswald did too, was to look at Dr. Willard's position as vice-president and dean of the College of Medicine and I, I perhaps ought to back up and talk about the medical center concept. Um, the original 1954 action of the board of trustees created a medical college. In 1956 that was modified, creating a medical center to include Colleges of Medicine, dentistry, university hospital, nursing. That's as far as it went at the time. That was, was good. That was certainly good. Dr. Willard came as vice president for the medical center and dean of the college of medicine and until about 1963 or 4, he served in both capacities. Um, to some extent perhaps he could be criticized for not separating the functions of the College of Medicine and the college of and the medical center terribly much. He did it by essentially having, having people handle the College of Medicine jobs for, a number of years, I, in addition to chairing this department, served as what was called coordinator of academic affairs. He had asked me to be an associate dean. I didn't want to go that route. I really wanted to stay in the academic side of things and be a teacher and research and so on. So for a while I did both and, uh, but did it with the title of coordinator, which was my own choice and I remember talking to the faculty colleagues about how they'd feel about my being a colleague chairman and also in this role and Bill Knisely saying to me, says, Bob, he says, as long as you don't enjoy it, he said, it'll be all right (laughs). He said, "If you get to the point where you enjoy doing that job," he said, "then we'll give you a hard time." (Smoot laughs) And it kind of, that stayed with me-- SMOOT: --Oh-- STRAUS: --all these years, but it was too much. I had a kind of health comeuppance around 1960 and, and that was at about -- no '61 -- and that was at a time I think we brought Roy Jarecky in from Syracuse and developed a separate office of academic affairs, uh, which was necessary. About 1964, Oswald set up a committee which he made me chairman of, it was a very awkward and embarrassing position to be in, the committee was charged with recommending, uh, separation of the offices of vice-president and dean and I say charged with the recommendation because he didn't make any, he, he told the committee what he wanted them to recommend. He didn't really set up the committee to advise him whether it should be done--(Smoot laughs)--and, I, I guess he, from his point of view, he was probably very shrewd in making me chairman of that committee, but in any event the committee did--and there were some reasons for it, it-- the job was--was huge, it was humungous--uh, did make recommendation of separation of the function of those two jobs. Dr. Willard became the, the, uh, vice- president. By this time, things were awful crowded down there and this is typical of Dr. Willard: it was obviously needing more space, they had to created space for deans, suite and all that and he was the vice-president and his office was down where Robin's is now, uh, where Robin Powell's is now, and the university had acquired that motel across the street and there were a number of attempts to get one or more department to move over to that motel and nobody wanted to move out of the building and Dr. Willard said, "Okay, hey, you know, I'll move over there." So he moved the vice-president's office over there and he said, "People will come to see me, there won't be any problem." And of course it was there until they just moved into the plaza. Uh, it took about three years to find a dean for this school. The man who was eventually chosen was well, I, I just want to see how personal I want get here, uh, a man named Bill Jordan who, uh was in the, came out of preventative medicine and he was dean I guess from, oh, for about, uh, six or eight years. (pause) It was an undistinguished deanship. I won't, I won't go any further than that. SMOOT: All right. STRAUS: Uh, the, let me, let me just, want to stop that? [Pause in recording.] STRAUS: Dr. Willard, never a man of what you'd call robust health, I remember, uh, his planning staff, even in 1956 when we were, when we were working together, being worried about, about his health because he, I say he'd never been of robust health, because he'd always work twenty hours a day, but, uh, and he was the kind of fellow who you look at him at four in the afternoon and he looked like the kiss of death- -(Smoot laughs)--and somehow if he got an hour's nap he'd be bouncing back. He had enormous resiliency, uh, but I think that, I think, uh, he began to feel a lot of strain in, in the nineteen, mid-1960s and, uh, no, I, I missed when I, I said a minute ago--I don't remember if it's on here--that it was '79, it was about '69-- SMOOT: --Um-hm-- STRAUS: --that Bosomworth became president. I think about 1969, yeah, Singletary became president in '69 and I think either, within a relatively short time they reached a mutual understanding that, uh, Dr. Willard would, uh, become sort of the special assistant to the president for health affairs and, uh, I think Singletary had already spotted Pete Bosomworth as his vice-president. Pete had been a spectacularly effective chairman of anesthesiology, uh, brought in good people, lot of respect. I remember chairing the review committee of anesthesiology that--somewhere, I'd say around '67--and, uh, writing, uh, a, just a very strong support, uh, for the department and Pete had, had, in addition to being chairman of anesthesiology, uh, had taken on the role of associate dean for clinical affairs or coordinator of clinical affairs of the hospital so that he was moving in the right direction and, um, I don't remember much question other than, you know, a few people probably shrugged their shoulders and said, you know, we're being kind of told who it will be, but, um, I don't think there was much question about it. When Pete became vice-president it was more or less, uh, accepted that this was going to happen and, uh, I think Pete is a man of integrity and, uh a, uh, fellow whose heart's in the right place. I think he has often struggled from inadequate staff support which he's perhaps at this time finally overcoming. He's, uh, he's guided this medical center during a period of incredible, there's never a letdown, there's always a crisis of one kind or another and yet, and yet it's expanding and done well. Um, the, Dr. Willard, bless his heart, wasn't too comfortable, you know, in this, in this other position. I think it was kind of a stopgap for him and Governor Wallace in Alabama was looking to expand medical education down there and brought Bill down to start a new medical school in Tuscaloosa in the early seventies and when you, you'd think that he'd done his task at Syracuse and Kentucky, he went down and started a new idea: it was a two year school, but instead of being the first two years with the students then going to clinical elsewhere, it was the second two years. Uh, the students came from, were to come from Birmingham which was a four year school and a selected number of students who were particularly interested in family practice and community health would go to Tuscaloosa and he developed a school very much with some of the objectives and philosophy that he had-- that he, uh, had tried to develop here. Uh, I should mention that Dr. Willard is thought by many to be kind of the father of family practice in the United States because one of the things he did was to chair a committee for the-- the AMA's Council on Medical Education that wrote the so-called Willard Report recommending the creation of a specialty in family practice, recommending that there be, uh, recertifications every seven years, a just incredibly radical, uh, move--(laugh)--and one that now is being emulated by some of the other specialists. SMOOT: Um-hm. STRAUS: And I also should mention that during the years, he held almost every post of honor and responsibility in health education in the United States. He chaired all sorts of committees and so on and, and was really one of the outstanding health educator statesmen, through, through his career and, uh, continued as until fairly recently when his health wouldn't, wouldn't permit it. Um, now, uh, to this school, uh, 1974, I think, oh, we changed deans of medicine and Dr. Clawson was selected, came here. He's, interesting man, uh, very controversial figure. Uh, I get along all right with him. I can argue with him, didn't always agree with him. He wasn't always consistent, uh, but, uh, I think one would have to say that the medical school prospered in many ways under his deanship. It also went through some responses to pressures of the outer society involving the economics of, of medical education. There's almost another subject that I'd like to talk about. Um, I'll mention Dr. Powell, uh, he has brought a, uh, a different flavor to the dean's office. I consider him a man of absolute integrity and a man of, uh, uh, high purpose. He's, he's, he is a man who, uh, puts a lot of emphasis on management. Uh, I, uh, I call him a very decent human being and I think he may be just the kind of dean we need right now. Uh, I'm not sure that we're gonna see, you know, a lot of dramatic movement, but I think he's looking to build some solidity into a situation that, that perhaps needs it and, so much for comments on our deans. (Smoot laughs) Should mention the medical center concept. Um, going back to 1960, the decision was finally made, under Chandler, to have the dental school and there was an enormous pressure then to get the dental school off the ground while Chandler was still governor, which was, uh, which we succeeded and brought in an absolutely, couldn't have been a finer, more able person than Alvin Morris to head the development of the dental school and that dental school, you've heard, you know, ratings of dental schools, forget ratings. I'm going to tell you about that dental school as it, within three or four years anywhere you went in the United States you heard Kentucky has a top rate dental school and, uh, there have been changes, but I think that, and there have been problems, but I think this is still a top rate dental school. They pioneered here technological, scientific developments in dentistry that have been, have, have major impact nationally and it goes back to the fact that Morris brought in himself and some very solid people to get that thing off the ground. Uh, another thing I want to mention, I'll mention the other schools. Um, allied health, uh, there's a creature I think Bill Willard put a lot into getting that started, Joe Hamburg has developed, has been very respected for what he has done. It's a hard field to define because it's kind of a mish-mash of the lesser professions, but I think it, it filled a need and is, and is, and is continuing to fill a need there. Pharmacy, um, the pharmacy was a Louisville school taken over by the university and had just moved to Lexington about the time, or was just moving to Lexington about the time we came down here and was not part of the medical center and it, uh, wasn't much of a pharmacy school. Uh, the decision was made, under Oswald, to turn the pharmacy school over to the University Medical Center and they brought in Joe Swintosky as dean and, uh I know that Joe's been, he's a, he's a tough manager type and, uh, uh, perhaps has antagonized a few people, but boy he has developed a top rate pharmacy school. Now, I served in 1974 and five on a national study commission on pharmacy headed by Jack Mellis and, uh, oh, I don't know, we had fifteen meetings with people in pharmacy around the country. We, it, we, we prepared a book that was eventually called Pharmacists for the Future. It was, it was a commission charged with defining the future role of pharmacy in the United States, but what I want to say about this school is, again I, out of that experience I began to realize that we had a very highly respected pharmacy school here and I would say it's stronger relatively today than it was then. SMOOT: Hmm. STRAUS: Particularly because it is a, it's doing, its research arm has become very significant so, uh, you've heard all the dental controversy and pol-, and there's a lot of politics in that. We have a good dental school and we have probably, I'm going to say, a pharmacy school that, it's one of the best in the country. SMOOT: Yes sir. STRAUS: Top of their field, one went out and developed a College of Nursing, University of California in San Francisco which, uh, has just been spectacular, it's, it's role in nursing education. The other became head of the nursing program teacher's college at Columbia, uh, and she recommended one of her students who was Marcia Dake and became our dean. Um, it was a new experience for Marcia, she, I think had been directing nursing education in a hospital in upstate New York and it was, it was not uncommon of course to bring in people with promise and a chance to develop. Um, my personal view is that one, that, that the nursing college made a initial mistake in that they tended to run away from the university, from the medical center, more toward the university and this reflected something that was going on in nursing at that time nationally--an emphasis that they shouldn't be training nurses to be just nurses, they should be, uh, getting general education. So they didn't want courses of chemistry for nurses or sociology for nurses, they wanted nurses to be taking good general education. They also tended to be running away from nurses doing nursing and, uh, there wasn't a very good set, uh, of relationships developed between our college of nursing and our nursing service at university hospital. In fact, our nursing students were getting some of their, though limited, clinical experience, they were getting elsewhere and it just. Um, very, some good people, well meaning people, but, um, remarkable, they brought in a remarkable number of very fine, very well motivated young ladies. We started teaching nursing students quite early. After they, I think they had a couple of years of getting campus courses and found they weren't getting what they wanted and so they came to us and we started giving two courses a year to nursing students out of this department. When I say we, but they were running away from physicians. In fact, we brought it, we brought Jack Greene, chairman of ophthalmology, in to our course and I remember being told by one of the faculty, they really didn't want their students to be taught by physicians. Well, uh, had an antagonism there, it was unfortunate. Great students, but an awful lot of emphasis on the importance of their becoming administrators, rather than the nursing. There wasn't a lot of, you know, patient care, bedside nursing, type of emphasis. Uh, it was, oh, being academic, education, administration, uh, and the idea then was to develop the two-year programs in the junior col-, in the community colleges for sort of the Indian nurses and keep the four-year program for the chief nurses. Um, I've forgotten how long Marcia was dean or the circumstances that were associated with that. The second dean was Marion McKenna and, oh, Marion is a, became, a strong administrative background, military ma, military background. Uh, they did something that I think, in retrospect, was unfortunate although it was, you know, seemed the id, at the time like a good idea. They decided to do away with the four-year program and become just an upper two year program for, and admit only people who already had the R.N. from a two-year community college. Well, what they did was, they created an opportunity for Eastern Kentucky University, over in Richmond, to develop a big four-year program in nursing because, uh, although this sounded like a good idea on paper, there was still an awful lot of young ladies in Kentucky who wanted to go to a four-year nursing school and, uh, that turned out to be a mistake which has been rectified with the recreation of a four-year nursing school here. Um, Marion retired and was replaced by Carolyn Williams. Carolyn Williams is a professional. She, I have been incredibly impressed with the caliber of people she's recruiting and for the first time, University Hospital Nursing Service and our college of nursing are really, I'm, I'm, I'm not saying they weren't working together, but they are really developing joint programs. They're getting, they're getting, uh, very good, a, communication, some joint appointments, uh, oppor-, increasing opportunities for nursing students to get the clinical training. Uh, they're developing now a doctoral program as well as a master's program. Um, we have, I think, been helpful in, in recruiting. I think we're dealing in joint appointments; a couple of our people from that program are really looking forward to it. Uh, so, what I'd like to say about nursing is that I think we went through some years in which, with the best of intentions, we probably weren't as strong as we might have been and that I see us coming into a period where I expect we will have a much more significant impact on nursing and if I've, if I've said some things there that, that seem unfairly negative maybe you'll just block them out when you listen to it. Will you do that? SMOOT: I think people would understand you're, you're making a variety judgments here that are-- that are understandable. Everybody, everybody does that, but certainly I would-- STRAUS: --I'm trying, what I'm trying, I'm trying not to, to be critical of people, but rather to describe as objective as I can what I think has happened in university education. SMOOT: Certainly. STRAUS: Okay, um, university hospital. SMOOT: What can you tell me there? STRAUS: Let's get, tie it in somewhat with the economic issue that we want to talk about a little later. University hospital, uh, has gone through, uh, its ups and downs and I think it's a fine hospital. Um, I think that from the very beginning university hospital had to deal with a fairly powerful competitive force that it didn't really quite, we didn't really quite appreciate how strong this was, from the entrenched medical profession and that we saw university hospital as providing unique kinds of services and should be available or accessible to anyone in the state who needed them, the practicing medical profession saw university hospital as a place for people who couldn't pay and cases that got so complex that when, uh, you really got in trouble you shuf-, shuffled them off to UK and I think for much of its history, UK Hospital has had to deal primarily with those two elements of the population and only in recent years has been struggling, uh, to become a more balanced kind of institution, serving a broader segment of the population. SMOOT: I seem to recall something along those lines that Dr. Bosomworth had to deal with, with indigents in particular. STRAUS: Yeah. SMOOT: That was a major problem. STRAUS: Yeah. Now the major problem there is the question of financing. SMOOT: Yes. STRAUS: You, you can do it, pay for it. SMOOT: Well, let's-- STRAUS: --We're going to get into the whole financing question later. I mean, because I have some-- some things I'd like to say about what I, you can't talk about the economic aspects of a medical, University Medical Center, without talking about the economic aspects of health care in American society. SMOOT: Yes. STRAUS: And so I'd like to put that off a little bit. We may have to have another session. SMOOT: Fine. STRAUS: Uh, the administration of university hospital, the first administrator, Dick Wittrup, was the sixth person who came here and he joined us in December. Most of us were here in August and September and he came in December. Uh, a great developer, uh, probably again, his greatest strengths were in developing and, more than in day to day administration. When he left here he went to Boston and developed the, the, uh, Peter Brett Brigham merger of several hospitals around Peter Brett Brigham's Teaching Hospital. But, as soon as he got the job done he, by that time he, I think he knew he, he left and he's now with a firm that is developing hospitals all over the world, but he's been primarily in Saudi Arabia and he's a very, very competent person in this, in this area of, of development, uh, fine fellow to work with, fit in beautifully. Another person I should mention that came very early, he was our seventh person, was Alfred Brandon who came and developed our medical library. Al went all over the country in his station wagon and collected books. He had a vision of a, what a medical library should be like that got us off to a very fine start. He too went on to Hopkins, Mount Sinai and other places. Kurt Deuschle, who brought the concept of community medicine here and developed it here, should be mentioned. Kurt, uh, developed a very strong department that was, the educational program, was based around having students go out and study the health needs of communities and he did this very successfully for seven or eight years. Kurt recognized, uh, shortly before he left here, that, uh, this no longer was going to be an acceptable function, that communities were expecting something more than being studied and when he went to Mount Sinai from here, he set up a community medicine program that involved the delivery of health care in Harlem and, uh, he would have done the same thing here. He would have moved his department toward a delivery department, uh, had he stayed because I, he, I remember very well his saying that he, he recognized his idea was passe. Funny, after Kurt left though, there were an awful lot of people who kind of kept talking about this great department under Deuschle and didn't realize, as Deuschle did, that what he had done was passe--(both laugh)--so the next man who came in, uh, Bening, Bennet, Benenson, who Jordan brought here was a military person and was very, pretty traditional public health, developed a lot of, sort of a laboratory, uh, based department and there were an awful lot of people who kept comparing him to Deuschle, in a negative way, which I think was kind of unfair. SMOOT: Um. STRAUS: But essentially what we needed was something different and eventually we were able to bring about a redefining of the function of this, in the area of, uh, what we call in preventive medicine, environmental health and I, I think it's very suited, very appropriate that Arthur Frank was a student of Kurt Deuschle's. (Smoot laughs) He's really working. He's developing a fine, fine department there. The, talk a little bit about this department of behavioral science. I think it was the first department of behavioral science in a medical school. It anticipated the action of the national boards which has created behavioral science as one of the test areas and most medical schools today have either a department or a section or a unit or something where they're teaching behavioral science. Uh, we've become a department that is pretty much dedicated to a bio-behavioral orientation. We, we, we, uh, most of the work we do now is looking at the interface of biological and social and cultural behavior factors. I think my own work in alcohol has evolved in that direction and, and most of the people in the department are working around particular kinds of health problems. A lot of our work is collaborative. Uh, the department has had, had superb backing from Dr. Willard. It has had, uh, good training grant support from the National Institute of Mental Health ever since 1962, we've been supported in some way and in recent years with our move over here and the addition of space which made it possible, we've, we've moved in research, uh, funded research, we've always been doing research, but for a long time we were so crowded over on the sixth floor that we could only do research that we could do ourselves--(Smoot laughs)--and since we came over here we've really been in, moved out and I am, I, I can't tell you how proud I am of the people in this department. We started an initiative, we called it an initiative three years ago that Tom Garrity directed to develop, uh, more broader base of funded research and went from, I guess, bottom of the twenty departments to sixth this last year in terms of the volume of funded researches in our, uh, without sacrificing, uh, uh, a strong commitment to teaching. We have, we teach in the college of medicine a basic course called Health in Society, which involves meeting the students in small groups in topical seminars. We, we try to avoid lecturing as much as possible, engage them, we are responsible also for a course on communication interviewing, the second semester of the first year, and then we do some other odd teaching and we, we have, uh, three or four sessions with third year, uh, students in their medicine clerkship in which we talk about behavioral factors of some diseases and do some things. We have always done some informal, well, I say, not informal, some teaching in, largely in the communication interviewing area for dental students. We have a course called Behavioral Factors in Health and Disease which is required for all pharmacy, all nursing and many of the allied health students. That's our medical center teaching. We've had this collaborative graduate program going back to the sixties with sociology and then anthropology and psych, and there are thirty-eight dissertations here that have been completed in that program and for the last, uh, what, we're in our second five year round of support from NIMH for a postdoctoral program so we now have three post docs in the department and we've become nicely computerized and, uh, I think, I think, I feel that I've only got a couple of years before I expect to retire and I have a very good feeling about this department and where, uh, where it is, its potential. That's about all to say about the department unless you want to talk more about ----------?? (Smoot laughs) I didn't tell you about the areas ----------?? Things we haven't talked about is the role of this department in relation to patient care at the hospital when I did out, went out and did the early scouting many of the things I was asking about were features having to do with experiences of patients in hospitals and how you'd design a hospital to, uh, um, to create not only better medical care, but better patient care, a more satisfactory experience for human beings who had to be patients in hospitals and this is an interest that I maintained for a long time and indeed this department did quite a few studies for the hospital under Wittrup and under Calton, his successor, as hospital administrator, and many of them were done by Carolyn Bacadayan who was then a member of this department and is now the director of planning for the hospital, but we were interested in this area and I had done a paper at a conference on hospital organization from, in which I, which I had called "Hospital Organization from the viewpoint of Patient Centered Goals" that was a chapter in a book and, uh, before Clawson came here as dean he had read that chapter and shortly after he arrived the new house staff quarters opened up over, uh, there, sort of around the front of the hospital and that freed up three north as a, as, uh, a space area and Clawson had the idea to create, on three north, a special sort of model experimental unit to see if we could improve patient care and he had read this chapter and he called me in one day and he said, I'm going to appoint you to chair a committee to, uh, develop a plan for making three north a patient centered area. I used the name patient centered goals. So, uh, the committee consisted of the chairmen of several of the clinical departments, somebody in nursing service, nursing education, uh, myself, maybe one or two others, but Carolyn Bacdayan, who was then a research assistant in this department, was the staff person for it, which is very significant and anyway we developed a plan for three north with a lot of emphasis on experience of the patient. One of the things we did, we had Carolyn follow a whole bunch of patients, just observe their experience in the hospital, and as we saw things go wrong we decided, how can we create on three north, make sure they go right? How, how can, uh, we make this a more satisfactory experience? And we developed a protocol, fairly elaborate protocol, that involved, uh, primary nursing, it involved some commitments on the part of physicians to patients on three north and it involved a, a plan for enormously increasing the communication with patients and their control of their lives. So before a patient came in we wrote them a letter or had a phone call if there was time and explained some things. Uh, we invited them to bring their own clothing, told them that they wouldn't be confined to bed unless it was medically indicated. We created a little lounge area where they could get off the floor. We, uh, trained all the personnel on the floor, or had trained, had them oriented to the various procedures that patients to through so they'd be able to explain to patients, "You're going off today to have this kind of a test and this is what to expect," um, had phone calls before they came in so that they knew who to ask for, somebody from the floor met them, uh, if they had to have laboratory tests, took them to the lab. Um, we put in a finishing er, what is it call, I guess you'd call a finishing kitchen, a little, little kitchen on the floor so that patients could if they wanted to have something to eat other than on regular schedule. In other words, patients were said, here the meals are served at this time, if you are accustomed to having your dinner at eight o'clock at night, it's a limited diet, but you can have something at eight o'clock at night. Um, curious thing, we evaluated this all over the place and one of the things we tried to get patients indicate their satisfactions, dissatisfactions and we found that overwhelmingly patients kept mentioning the fact that there was this flexibility in food schedule as one of the satisfactions. Well over half the patients mentioned this spontaneously. Only 10 percent of the patients ever used it. SMOOT: Hmm. STRAUS: We were giving them control and this was a key. A sense of control, a sense of knowledge and in, in the overall evaluation of three north, the thing that I felt in the final analysis was the most important thing we did was to increase the patients' sense of knowledge about and control about their experience. Now part of this was primary nursing, the nurses were fantastic. The nurses made it work. Uh, they, uh, it was just, just ripe for what a lot of nurses wanted to do anyway. Well, you can read about the plan for it in here. I don't have handy the, the documents about three north, but anyway that's the whole story. SMOOT: Very interesting. So th-, in essence the, the nurses were involved, if you'll, I don't know if this is the right wording, but, uh, there's salesmanship with this too, not just the-- STRAUS: --Oh, yeah-- SMOOT: --fact that it was made available. STRAUS: The nurses, the nurses were the ones who made the, who did the communicating with patients, who made the patients, gave them security. Now, one other thing we did, we cut down on the numbers of people patients had to cope with. SMOOT: Um-hm. STRAUS: We'd done some counting and we found patients were having to cope with forty, fifty, sometimes even more, different people a day and by going to primary nursing and by planning it effectively, we were able to cut down the number of strangers that a patient who was, you know, sick and anxious anyway had to cope with and that was another significant fact. Well, that's a story in itself, but I will say that a lot of three, a lot of our attempt to evaluate three north went out the window because they started emulating what we were doing on three north in other parts of the hospital and we didn't have any good controls. So we never were able to do the, the careful research on three north that we had planned to do because they moved too fast in using the model elsewhere. (laughs) Okay. Since-- SMOOT: --That's-- STRAUS: -- you, you, your, your turn-- SMOOT: --Okay. Well, since we're on the subject of the university hospital, I thought I might ask you about the impact that the hospital has had on local--not only Fayette County, but also statewide--medical practice and standards and competition. We've touched on it a little bit, but thought maybe we could center it a little bit more towards that specific question. STRAUS: Well, uh, there's no question in my mind but that the, the students who have gone out of here and the residents who have gone out of here who practice in Kentucky have enormously raised the access to good medical care throughout the state and you don't, uh, people don't have to come to university hospital these days, they can get good medical care in Morehead and Somerset, Ashland and other places on certain levels. Uh, I think it's had a very profound effect in this regard if it has been a model of medical care. Uh, it's no longer unique in its tertiary functions because most of the other hospitals in the community are providing tertiary care. SMOOT: Um-hm. STRAUS: Account for basically if you have a few things that we are unique in, I guess the neonatal unit and the, and the, well, the program that Ward Griffen had of, on his gross obesity control and the bone marrow transplants and I think our cancer program and obviously we're just on the edge of some really great developments for the new center, the neurologists and work in aging ----------?? I think at different times there have been different highlights. We, I could name lots of strengths, we're extremely strong in neurosurgery, plastic surgery and we've had good surgery here throughout the history of this school. SMOOT: Um-hm. STRAUS: Pediatrics has been very strong. I think the, the gynecology has been strong. Um, psychiatry has had its ups and downs. I think it's, it's in quite good, good shape right now. Um, the, um, I think, I think that in, in, in many respects, if anything, the, the, this hospital and its impact has been unappreciated, underappreciated, by the state. Um, now, one of the things that it has constantly had to, to deal with is the competition of the local practitioners and there is no question that we, we know this from human beings, there are many physicians in this, in this community and this state who tell patients, "You don't want to go to that place, you know, they experiment on you, you don't want students taking care of you" and that's competition. That's been going on from day one. SMOOT: Um-hm. STRAUS: Um, I had a thought as I, but I lost it passing. Oh, you want to talk about K, the Kentucky Medical Foundation. SMOOT: Yes. We could put that off until, uh, we get into economics if you prefer, but I think this is-- STRAUS: --No, that's a different issue, because it was early-- SMOOT: --Yeah-- STRAUS: --its history. Is that okay? The Kentucky Medical Foundation, uh, was in existence when we came here. Uh, it, uh had had Steve Watkins who is an industrialist with a driving force, a number of physicians whose names have been prominently mentioned in the history of the school--Massey, Coley Johnson, others--you, you, you know the names, played an important role and Brick Chambers was, was very much a part of this. Brick had been almost a one-man advocate for a medical school at the University of Kentucky for years, just a really fine, genuine human being. He was head of the university health service and when Dr. Willard came down here in '56, Dickey put the health service under Willard so we had a, we, we're responsible for the clinical programs of the health service from the day any of us got here. Dick Noback more or less over, oversaw that. It wasn't, it was a pretty pitiful operation for a while. Um the Kentucky Medical Foundation people were very sincere in their convictions that the school was needed here and they, uh, certainly did a lot of good lobbying with Chandler to get, get him to essentially get the legislature to create the school. When we came there were a lot of grandiose ideas about the money that would be raised privately, uh, from horse industry and other wealth in this area. For practical purposes that never happened. I can't tell you why. Uh, the only really significant money that came into this place was more, uh, recently that of the, the, well, the first the two million dollars that went to the aging building and then considerable sums of money that were matched, matched Mrs. Markey's contributions to the cancer program, but in those early days we, we were certainly led to believe that this medical foundation was gonna, you know, do a big measure of fund raising, uh, job and it just never came off and I'll tell you, frankly, uh, when I listen to the accolades that are still passed out in relation to these four or five people whose portraits are over in the building and I, I must, must confess I have a kind of a cynical response because we heard an awful lot of promises, but we never saw much come out that--after we got here. I think most of the effectiveness of the Kentucky Medical Foundation as far as the Medical Center was concerned occurred before we got here. SMOOT: Um-hm. Were you, were you familiar with the Will Clayton gift? STRAUS: Was that the house? SMOOT: Yes. Cave Hill. STRAUS: Yeah. I went out to look at Cave Hill after that gift and it was a gift for the house of the dean of the college of medicine. Uh, I've not seen the house since the Brown's redid it. I can't imagine it, having it, I can't imagine it being a gracious southern mansion from what I saw when I went out there. It was in very bad condition. It had wings that were kind of jerry-built. Its, its design was such that it would have been very difficult ----------?? It had a very narrow, one lane entrance. There were no funds for making it a feasible home for-- SMOOT: --Um-hm-- STRAUS: --anybody, much less Dr. Willard and his fairly large family at the time and it, I know, uh, it was a gift that had, carried great intentions and I gather that there were some hard feelings when it wasn't used as it was intended, but it, it wasn't a very practical gift-- SMOOT: --Um-hm-- STRAUS: --and there were other aspects of the Kentucky Medical Foundation activities that weren't very practical. SMOOT: I get the impression, from the things that I've read about the Foundation, that it was not just the fact that they were going after some rather impractical sorts of, um, donations, uh, assistance, but also that there was very little coordination between not only the foundation in the Medical Center, but the foundation in the university and the goals and objectives of both the Medical Center and the university in general. STRAUS: Well, they, two things I want to say. One thing, they did have an executive for a while, a fellow named Russell Wright, Russell, Russell-- SMOOT: --White-- STRAUS: --White, who was over at Transylvania, a very decent guy. Russell did a, Russell was very helpful in getting us introduced to people when he came here. He, he knew a lot of people. SMOOT: Um-hm. STRAUS: I, I remember I went over to Frankfort with Russell one day and, and, uh, we pulled up next to Governor Chandler's car. I hadn't met Governor Chandler and Russell knew him well and took me up and introduced me and Chandler says, "Is he one of ours?" (Smoot laughs) And, you know, that, I was in-- SMOOT: --Um-hm-- STRAUS: --Russell said, "Yes, he came here with Dr. Willard" and so on, but, uh, Russell, Russell is a very well meaning person and he, he knew the grass roots in the state. He knew the grass roots better than he knew the, the money side of the thing, but he did, he was very helpful in introducing Dr. Willard, uh, and to a lesser extent others of us to a lot of people, um, but I think you're right. I think the Foundation was not well coordinated with the university or with the Medical Center and, and I think that another issue that you may or not run across was the issue of whether, of the location of the Medical Center and its relationship to existing hospitals and some of the Foundation people weren't, saw the Medical Center, really what they wanted to do was to have the Medical Center built over on the back of this lot and then build a new St. Joe's Hospital there and have the, have it the major teaching hospital of the Medical Center and I, uh, think, uh, some of the disillusionment or whatever occurred, uh, may, may have resulted from Dr. Willard's conviction that the Medical Center must be a part of the university and this was something again that Dr. Willard gave leadership, he, there was a conviction that he had and, uh, he stuck by his guns, uh, in the face of a lot of pressure. He felt that medical education as an integral part of the university, that the university is strengthened by a medical school and a medical school is weak without a university and he was adamant that we be located in a, in order to facilitate the kinds of relationships that we developed and we really, despite the, the apprehension of a lot of people in university faculty- -I mentioned behavioral science, I should mention physiology, Loren Carlsen, there was a department of anatomy and physiology on campus in arts and science, a few people there. Loren Carlsen came here and, and to develop our physiology department. He, these are perfectly decent human beings and he brought them in, into his department and two or three of them were near retirement. One of them, Lou Boyarsky is still here, a member of that department, must be almost ready to retire, but he gave dignity to those people. SMOOT: Um-hm. STRAUS: He supported them. Now the one area we did not do well with was microbiology. There was an existing department of microbiology headed by a veterinarian named Scherago, who wanted, he wanted to be the microbiology department of the college of medicine. Uh, We felt that the orientation simply wasn't there for that department to be a microbiology department of the university. Uh, they blocked our development of microbiology through the senate and approval of things and for a long time we had to make in-runs and teach microbiology through his unit and infectious disease and the department of medicine and then we created a department of cell biology and the chairman was killed in an airplane accident and, you know, it took us a long time to get it straightened out, it is straightened out now. Alan Kaplan has gotten that situation under control. It took us twenty-five years to get that thing straightened out. That was our big failure in university relationship, our big failure. Uh, sociology, anthropology, the social sciences, even psychology--they were a little suspicious, but they were more concerned about psychiatry than they were about us. (Smoot laughs) Uh, that one went all right. Uh, a lot of us developed warm friendships with people on campus, but, um, microbiology was always an area of stress and strain. SMOOT: Um-hm. STRAUS: Um, I got off of the subject of Kentucky Medical Foundation. My, my reaction to the Kentucky Medical Foundation was, um, I almost use the phrase, full of sound and fury, signifying nothing. (Smoot laughs) I think they let us down terribly in terms of their promise. Now, we really, we, they had no obligation, you know, and I'm sure that they were influential in our ever having a chance to come here. They played a significant role before we got here, after we got here--not much. SMOOT: I don't want to beat the horse, but, uh, was that primarily because of the leadership or was it just the fact that they were promising a little too much than they sh-, could have ever delivered? STRAUS: May I suggest I think it was not naivety on their part. SMOOT: All right. STRAUS: That'd be my opinion. SMOOT: Um. STRAUS: We're at the, let's talk now about, about what the relationship of, of this medical center and what was happening nationally. Um, I think two things need to be emphasized. One, uh, the medical center was started, this medical center, just at the beginning of the major push for federal support for research in health care and second, within a few years we were caught up in some, very massive changes were taking place in terms of the financing of health care nationally. First, on, on the research level, we started with the, with the expectation that we would obviously be a research medical center that, uh, and we built in research facilities for all departments, but they were modest in scope and shortly after the school started, almost about the time we opened our doors, the, uh, amount of research funding that was becoming available and the pressures on medical faculty to engage in research, uh, were increasing so rapidly that we were running out of, we quickly ran out of, of physical resources to handle it, but, um, it changed the, the values of our faculty and whereas we started with an emphasis on the student and the patient and we developed resources for the student and the patient and we developed a philosophy of focusing on student and patient, pretty soon student and patient were seen as almost secondary to research and I think typical of what happened was the student study cubicles, the student lounge, uh, some more spacious corridor areas that you wouldn't even recognize now, they have existed, quickly became research space. Uh, in the hospital, uh, research projects became more important than certain considerations of amenities and there were space conflicts there and I think the whole value of why, how you evaluate and reward a member of the faculty shifted and the primary reward was based on the research and only secondarily was the reward based on being a good teacher or being recognized as a model clinician. SMOOT: Um-hm. STRAUS: And this had happened to medical education all over the United States, it wasn't just this school. It's just that it happened at this school at a critical time and I think it's another factor in shifting some of the emphasis of the school and some of the values in selecting faculty and in rewarding faculty, uh, away from what you'll read about when you read some of those primary documents, so that's the first thing I would say happened. SMOOT: Could we pause a moment? [Pause in recording.] STRAUS: Sure. The second, the second major thing that was happening has to do, and I, I'm going to, this is, may be an over simplification, but I'm going to give you my, my opinion of what, what happened nationally. We have--in the United States--uh, had a movement, um toward trying to provide greater equality of access to health care and, uh, means of paying for health care for a long time and it really, uh, uh, was a very powerful movement in the 1940s under Truman's administration when the, the series of bills identified with Robert Wagoner, James Murray and John Dingell that would have created, uh, national health insurance were proposed and these were opposed by organized medicine and never got off the ground and then there were two or three, uh, versions of a kind of a Medicare, uh, uh, legislation that, uh, finally in the 1960s, mid-1960s, if I recall correctly, uh, uh, coalesced into the, what is currently the Medicare, Medicaid legislation. Ironically, this legislation was created and originally, and written in order to, uh, provide indeed, uh, access to medical care for deprived populations- -populations who either by age or reasons of poverty or disability did not have access to medical care. A compromise--this was opposed by organized medicine--and a compromise that went into the final, uh, either legislation or regulation, I'm not sure which, was them, the, uh, provision for finan-, for paying in accordance with excepted standard charges and that opened the door, in my opinion, for the esclal-, two things--for first the rapid escalation of co, of charges, as long as they were accepted and standard--and second, it created an opportunity that had not existed for the, uh, industrialization of medicine and as a profitable, uh, enterprise and with that, as soon as the profit motive became a major factor the original goals of equality of access kind of got lost and the impact on medical education, one impact on medical education, was this: with rapid escalation in the income levels of physicians generally because of the charges that they could recover through, through Medi, caid -- I always get them confused. Uh, anyway, and of course a rapid escalation of, of hospital potential. Okay, at the physician level this quickly created a income potential for physicians that was just out of reach of academic institutions. Um, some of the institutions that had so-called geographic, so-called geographic full-time -- in other words that paid their physicians only partial salaries and let them earn the rest of their income were better adapted to this change because they already had systems in place that enabled the rest of income to expand more rapidly. Places like ours that were on a full full-time salary had to go through some pretty hard transitions and first we developed the P, PSP [Physician Service Plan], which was a transition and then this KMSF [Kentucky Medical Services Foundation], which sort of opened the door, took the lid off the income potential of physicians. It's had a tragic effect because it has put the, the clinical faculty in a position of perceiving that they not only earn their own income, but really are supporting the whole place. It has changed the whole tenor of, of values. I'll give you an example. For years I used to eat in the, in the cafeteria. We were democratic at first and we just had a cafeteria, then we had a faculty dining room and most of the conversation would be around curriculum, patient care, research questions, clinical cases and so on. I quit going when I realized that I never heard anything except discussions of income. Okay. Uh, it's a tragedy. These are people I like, I respect, but I feel that they got caught up and I know why they've gotten caught up -- it's one thing, it was one thing when Pellegrino came here for eighteen thousand and, and his wife and, uh, uh, his family knew that if he was in practice he could make twenty-five, but he was excited about what he was doing. Uh, it's another thing for, uh, somebody--today's escalated--let's say to have a salary of fifty thousand and his wife and family knew that if he were in practice he would be getting a hundred and fifty thousand or two hundred thousand or whatever. The difference just got too great. The strain became too great and so the, the focus, the economic, uh, focus of economic medicine became, became much, much sharper and we see this in, in terms of what comes first. We see it in terms of students who tell us that clinicians often miss their teaching appointments because they have, you know, other things take precedent, uh, and I, I, I think it's a tragedy. I don't think that they're in, there're no villains in this-- SMOOT: --No-- STRAUS: --it's just a phenomenon that I, that I've seen happening. Now, at the level of hospitals, at the level of, of patient care we've seen the same thing happening. We saw in Lexington, Kentucky a H, the first HMO was the Hunter Foundation, which was created to provide health care for a segment of the population in north Lexington, black and white, who simply weren't, didn't have good access. That is now part of Health Care America, which is a, um, not a non-profit, but a profit making organization. We've seen the development of, uh, well, let me say, say this, thirty years ago a private hospital was a proprietary hospital and it was like a dirty word. Protiretary -- proprietary hospitals you avoided at all cost because you knew they were being run by second rate physicians for profit. You went to non-profit community hospitals where you had good medical care. This thing's turned around now and the, I think, this is an over simplification, but ironically the same Medicare, Medicaid provisions that opened up the lid, took the lid off of the potential profit, made, they attracted private industry. They made it profitable enough for these big organizations--the Hospital Corporation of America and the Humana and so on to come in the thing. Now, I'm an optimist. I've written a position paper for the Kentucky Tomorrow Health, uh, Committee that I'm on, which suggests that we may be at the beginning of a swing in the pendulum and yesterday's New York Times that had a long article about the trouble that Hospital Corporation of America is getting into, I think, is a sign of the beginning of the swing of the pendulum. I'm a real optimist on this score. Uh, I think we've gone so far and it's got to get back, but it will come back, not without cost, human cost, and ---------?? cost. Let me tell you another reason I'm an optimist. I'm looking at medical students. Students have an uncanny way of anticipating the future and, uh, we saw a change in the sixties in the kinds of people coming into medicine. Uh, they were coming into medicine for the profit in the sixties and the seventies. I remember a time when my wife and I used to have medical students out to the house and, uh, it's like the little luncheon thing, but I remember one night after we had had about a half a dozen students and their wives out at the house and listened to them talk about why they were coming into medicine and when these gals talk about why they married the physicians, we said, "Never again." Uh, I mean it, it just. Okay. We've got a, we've got a bunch of great young people coming into medicine again and they are anticipating what I think is a swing in the pendulum. The sch-, our department, other, other faculty--we're excited about these students right now. We have, we've seen it, you know, it's not a sudden change. This particular class is good. The last two or three years we've seen more and more young people coming into medicine who seem to have some of the, the service ideals again. So I, I'm an optimist. I think we're gonna, somehow or other we're gonna get through this, this morass of, of, uh, profit domination in medicine and get back to a, a more fundamental, service oriented institution in our society. SMOOT: Um-hm. STRAUS: Uh, I've wondered if, at times, it might not come through some kind of a change in which health care would be more like a public utility with, you know, the acceptance of profit, but with some kind of public, and I, maybe that's what we're seeing in, in DRG. Maybe this is the health version of a public utility formula--(Smoot laughs)--but whatever, whatever it is, I've very quickly and, and in a simplistic way given you a kind of my own overview of what I think has, has happened and, and I hope it will change back. SMOOT: Hmm. STRAUS: And, uh, talking about success for our medical students here? SMOOT: Yes, the graduates of the medical center, ----------?? STRAUS: Oh yeah. I don't have that systematic information. I think Major Reincke probably has that-- SMOOT: --Um-hm-- STRAUS: --information better systematized than anyone I would know of. Uh, you may--impression in Lexington, I think, you know, I think we've turned out some, just fine physicians. Lexington, Kentucky is a healthier, better community partly because a good segment of the people who are practicing medicine here came out of this school, I think. SMOOT: Um. STRAUS: And certainly other parts of the state, one of the things that's happening that you may have referred to a little earlier is that we're really, uh, getting some of the subspecialists distributed better throughout the state so that, uh, more and more people can get good medical care nearer their homes. SMOOT: Um-hm. STRAUS: Uh, maybe for critical issues they have tertiary places, but, uh, no, uh, question, much better distribution, not only of physicians, but other health, health personnel as well. SMOOT: Um-hm. STRAUS: Uh, the, we get feedback after the first year from the people with whom our students have done their first year residencies and internships and they're generally quite good. Uh, they often reflect a, I'm glad to say they often reflect a level of interest in human beings that we like to think we--(both laugh)--sometimes they reflect this in the wrong way. In other words, some, some physicians who do the evaluation say they're too interested--(both laugh)--uh, but it's gone up and down. Uh, I've sat on the platform at graduation and watched some of the people go by, I'd say, "Good lord, what are we doing?"--(both laugh)-- and I, you know, sat and felt very, very proud. SMOOT: Right. STRAUS: Uh, but I think it's just a very, generally very respectful medical school. SMOOT: Um-hm. STRAUS: Probably the medical school, in relation to medical education, generally has not achieved the distinction and stature that our, pharmacy and dental, uh, have achieved, uh, I think that is in part because there were vacuums there. Uh, it didn't take as much, uh to be an outstanding dental school and even less to be an outstanding pharmacy school. SMOOT: You've been involved with, uh, a lot of organizations, uh,-- STRAUS: --Nationally-- SMOOT: --nationally, yes. STRAUS: Yeah, that's a good part of my life (laughs). SMOOT: Why don't you tell me a little bit about some of your activities with these various national organizations? STRAUS: Okay. Now, that's a fair story. I guess, ah, oh, aside from holding office in some of the professional organizations which I started doing in, in the, well, while I was still at Syracuse, I helped organize a committee that, on medical sociology that became a section of the American Sociological Association and I held office in the American Public Health Association, things like that and that really, as I think about it, I was president of the Association of Behavioral Science in Medical Education, that, that was an earlier phase of my life--some overlap--but I started on the national scene in ''8 and, uh, started with an invitation to serve, uh, on a review panel for the National Institute of Mental Health and I was on two, one right after the other, and then in 1958, also the NIMH decided to fund a major national study of alcohol research that, and what they did is that they gave a grant to an organization that was called the Cooperative Commission on the Study of Alcohol that was cooperative because there were some Canadian as well as American folks involved, or US folks involved, and I was on the four person group that was designated to get this thing going, get it off the ground and then became its first chairman, which I chaired for '60 to '63, I think. That was at the same time that I was coordinator of academic affairs here and I was commuting once a month to Stanford where we had a research group and that's when I had my little coronary episode, but anyway, from fatigue. Um, so I was in on the national scene in the alcohol field in a group that issued a report in 1966, uh, that called for more significant role of federal government in supporting research of service in this area. Uh, the result of that report was that President Johnson directed that a national advisory committee on alcohol would be created within HEW. Kevin Gardner appointed that committee and I was asked to chair that so for three years I chaired that national advisory committee on alcohol. In the meantime, I was also serving on study sections, reviewing grants, peer review for grants continually and in 1963, when the Kennedy when Kennedy, uh, uh initiated the community mental health/mental retardation program, uh, which was going through NIMH, I got a call one day from Robert Felix, who is director of NIMH's mental health, asking me to come to Washington the next Tuesday. He said, "I've just got to ask you to drop anything and everything and come" so I went and he had seven people, plus he was there. He said to us essentially, I want you each to give me six months of your lives. (Smoot laughs) Well, you know, nobody was ready to do that, but what it involved was, he created a group called Special Consultants to the Director of NIMH and we met nineteen weekends in thirteen months, some of 'em four day weekends and drew up guidelines for the national community mental health movement. Many of our guidelines weren't followed because we turned this into Felix in August of 1964 and he said, "By the way fellows, I've resigned." (both laugh) He became dean of a medical school and his successor used some of them, didn't use others, but that was a national experience of some, although, let's see that one would've prec-, coincided with the Cooperative Commission on Alcohol and preceded the National Advisory Committee. Then the, uh, National Advisory Committee, I was reappointed by Mr. Finch, under Nixon, and then the reappointment was rescinded by Nixon, who appointed another gentleman who told me that later, became a good friend because we spent some time on the transition, told me he'd given three hundred thousand to Nixon's campaign--(Smoot laughs)--but the interesting thing was he wanted me on his committee and, um, I said, "Sure I'll serve as a member." I liked the guy, his name was Tom White and he said, "I'll take care of it" and he wrote a letter to Finch, it was a two liner saying, I need this man to serve on my committee. He was the former chairman and he knows a lot about it and so on, please appoint him. Nothing happened and Finch got fired and Weinberger became secretary so he wrote another letter, sent me a copy. Nothing happened. So finally he wrote a letter to Nixon, a little longer letter -- I have copies of all of them and he called me one day. He says, "Bob, I can't get you appointed." He said, "They've got something on you, I don't know what it is, but" he said, "you're on the blacklist." Well, a few months later he called me and he said, "I know why you're on their blacklist." He said, "You were a delegate to the Democratic state convention in Kentucky in 1968" and I started to say, "Don't be ridiculous, I'm not, you know, politically active" and then I remembered I had been. (Smoot laughs) Uh, another frightening experience: our son, that summer, was between college and the marines and became interested in politics and he and some friends decided to see if they could get control of one of these local, neighborhood precincts so they got their parents and their friends to come out and the local political hacks weren't prepared and got outvoted--(Smoot laughs)--and so my wife--(both laugh)-- and I were elected delegates to the state convention. We went, were there for three hours, came home, forgot all about it and the Nixon administration had that on the record and blacklisted me from being on this, a member of this committee. It's probably why I got, after Finch reappointed me, got put out anyway. (Smoot laughs) Then I chaired, uh, a study section on Health Services and Research in '70, '71-- SMOOT: --Um-hm-- STRAUS: --and decided that no more of that, uh, until I was asked to be on a new study section on behavioral sciences which I served on for four years--Behavioral Medicine Study Section. Then in 1975, uh, I had the, I would say, good fortune of being elected to the Institute of Medicine which has been a really exciting experience. You, your condition of election is that you will give service to serve on various consulting committees. I'm about to chair a national study of alcohol research for the Institute of Medicine which just got signed off on last week. SMOOT: Hmm. STRAUS: Originally it was supposed to start a year ago and I was going to be on sabbatical and doing it on that basis, but it got delayed and so I'll be doing it on a commuting basis because I've changed my sabbatical, I should be in Berkeley. SMOOT: Hmm. STRAUS: But I've had, I've managed to have two or three things going in Washington most of the time. In Kentucky, I've served for many years on the Health Service Advisory Committee, have served or chaired various alcohol groups, am on that Task Force on Alcohol now and Kentucky Tomorrow and Convention and Promotion Committee. I think I'm on four different things in Frankfort--(Smoot laughs)--so that's, that kind of keeps life interesting. SMOOT: Right. STRAUS: It's good balance for what we do here, good perspective. SMOOT: Um-hm. STRAUS: Is that what you wanted? SMOOT: Yes, yes. STRAUS: Okay. SMOOT: Let's, uh, stop there and can we talk again? STRAUS: Yeah, I'd like to. SMOOT: Very good. STRAUS: I, I think it may be kind of filling in pieces, but I have a feeling I haven't quite finished. SMOOT: Oh, I, I agree and thank you very much for your time this morning. [End of interview.] Dr. Robert Straus (Chair of the Department of Behavioral Science 1959-1987) discusses attending Yale, developing medical school at Syracuse University, and being a member of the group that founded the University of Kentucky Medical Center and Medical School. Dr. Straus provides significant detail on the role of Dr. William Willard in creating the Medical Center and the Medical School and the obstacles in accomplishing those tasks. He also speaks about how supportive various UK presidents, the Kentucky Medical Foundation, and the governors of Kentucky were toward the UKMC. insert here

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