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1985-10-10 Interview with Robert Straus, October 10, 1985 UKMC001:1985OH224 UKMC 002 01:08:36 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 Chandler, Happy, 1898-1991 Kentucky. Governor (1959-1963 : Combs) Breathitt, Edward T., 1924- Nunn, Louie B. 1924-2004 Presidents -- University of Kentucky Robert Straus; interviewee Richard C. Smoot; interviewer 1985OH224_UKMC02_Straus 1:|13(8)|21(14)|35(11)|43(3)|52(9)|61(8)|72(4)|84(1)|97(12)|108(10)|124(6)|160(2)|173(11)|184(7)|197(2)|205(4)|222(7)|244(3)|257(4)|267(10)|276(8)|288(3)|301(7)|331(12)|340(3)|351(2)|360(9)|370(12)|385(5)|395(7)|404(12)|416(1)|438(5)|451(10)|474(2)|500(10)|517(2)|528(8)|544(3)|557(7)|576(3)|593(11)|621(1)|631(7)|642(1)|652(13)|662(7)|677(7)|689(5)|703(5)|712(3)|743(11)|756(6)|774(7)|786(2)|797(14)|809(10)|825(10)|840(8)|853(1)|866(4)|887(2)|906(2)|929(2)|938(6)|951(9)|960(7) audiotrans UKMCoh interview SMOOT: Okay? STRAUS: Okay, we were starting with the question of why Dr. Willard was interested in social science and I mentioned that he had had a brother who is deceased who had been a sociologist, but I think that, uh, more than anything else this probably came from his own intellectual background and interest and his, uh, his background in public health. Um, he had been a, went to Yale Medical School. He interned in pediatrics at Rochester for a year and then went to, I think it was Hopkins where he got his doctorate in public health. Um, he was the army's chief public health officer in Korea at one time. He was a health officer in the, in Baltimore, in one of the rural counties. Uh, he had a lot of exposure to the relationship between health and lifestyle and the broader aspects of, of human existence and human pathology and, uh, this was just a conviction that I think, uh, uh, in which he was somewhat ahead of his time and in somewhat, to some extent, it was a, I think based on Dr. Willard's also historical perspective because as we mentioned yesterday--no, maybe we didn't- -when I talked about my early study of public health, um, provisions, really, um, when you look at the medical literature in the United States in the period of, oh, I'd say 1840 to 1870, look at medical journals, very heavily weighted with articles relating the specific health problems of the day-- SMOOT: --Um-hm-- STRAUS: --to, um, to lifestyle--condition of cities, um, problems of sanitation, problems of work, occupation--an awful lot of medical literature in that period with what we would call occupational, environmental, um, literature. They didn't know much about, anything really, about infection and so on and this was, this was a period when lots of what physicians did was really, uh, since they couldn't do much about severe illness, they provided the TLC, they kind of ministered to families, uh, where they were, and, and they did make observations about gross factors in peoples' lives that were affecting their health. Um, this changed abruptly in around the 1870s when we began to have a breakthrough in terms of, uh, modern, what's called modern, scientific medicine. The develop-, the, uh, discoveries of, uh, uh, cause of infection and the sepsis, the, uh, breakthroughs in analgesia that made modern surgery possible, followed by a whole series of developments in chemotherapy and, and modern X-ray technology, uh, mushrooming of invention that changed the role of physicians. It changed the locus of health care to the hospital where a more sterile environment could be provided, uh, and it changed essentially the concept of what was basic knowledge for a physician from more general knowledge that included what weren't formal sciences--social sciences--but included a lot of the content that have become social and psychological knowledge to an almost exclusive focus on the biological sciences. That's where the dramatic breakthrough, and we really went through a period that I, uh, would say of increasing exclusion of everything but biological sciences until about World War II and, uh, I think in World War II the, there was a rekindling of, uh, interest in sort of psychosomatic things because of the dramatic, uh, effectiveness of, uh, psychological intervention in getting people back in the, the firing line who had one, during World War I would have been considered, uh, hopelessly crippled psychologically and, um, also during World War II the behavioral sciences, the social and behavioral sciences, went through an enormous development -- part of the studies the American soldier, the introduction of much more sophisticated techniques for handling quantitative data and began to develop at least a modest amount of respect as sciences, self sciences, but sciences, and I think this sort of provided a background for what, uh, was developing. I mentioned the work of Bernhard Stern in the 1930s and in the 1940s there were others who I could mention, a whole history of the emergence of medical sociology background and ---------(??). Well, Dr. Willard, uh, he wasn't even familiar with this movement. He, to him this was almost an intuitive, uh, conviction that the social and psychological sciences were, were really basically important and, uh, the kinds of questions that he had were logical questions to take to sociologists and that's how he happened to be interested in my working with him in New Haven on this health resources thing and, and then brought me to Syracuse and I say, actually opened more doors than I ever anticipated in terms of teaching and research and, uh, involved me in studies that were, germaned his own policy, planning of, he developed the institution and, and the same thing down here. Now, uh, when I came down here, we didn't have an idea of the Department of Behavioral Science. That emerged as we began to look at the structure of the Medical School and it was Dr. Willard more than, more than my conviction that if the behavioral sciences were to play a significant role, they needed to have a place in the structure of the school that was analogous to the structure of everything else and therefore a Department of Behavioral Science along with a Department of Anatomy and a Department of Microbiology. I really think that that was a, I mean that was a decision that was extremely important because comparing our development here with places where behavioral science has been a section in psychiatry, pediatrics or so on, we, we certainly have played a much more central role. We've represented ourselves. We've been part of the committee structure, part of the decision making process, part of the power structure of the school because we've been a department and I think that's been very important and it goes right back to his, his conviction. Now, curiously enough he was in conflict because he wanted me to essentially take on the academic role of the College of Medicine because I think I, I mentioned to you yesterday and, uh, many times as we've talked in the past and the last time I talked I, I went, met with him when we visited in Tuscaloosa, he, he, he always brings this up, "Hey, I wonder how things would have been different in Kentucky if you had taken on that academic role instead of the department" and then he'll say, "But I know what, you, you did the right thing"--(both laugh)-- and, uh, he just, uh, had these kinds of convictions. It wasn't just sociology, I mean Howard Bost, an economist, uh, played an extremely important role in Bill's, reg-, regime, was a close advisor to Bill. Howard and I have very different styles in that Howard is a project person and he'll take a project or maybe two or three and work on them pretty much alone, uh, whereas I tended to work, uh, more through groups of people. SMOOT: Um-hm. STRAUS: Um, the, the, uh, when Bill asked me to take on the role of academic, what we called coordinator of academic affairs, curiously enough one of my conditions was that I do it from the Department of Behavioral Science and not from his administrative suite downstairs and I guess that was indicative of my feelings about wanting to be more identified as an academic person than as an academic administrator-- SMOOT: --Um-- STRAUS: --and he agreed to that, but the, that first year when we just had forty students and there were, little file folder on each student and they had to relate to me as the sort of academic person in the dean's office they related to me up on the sixth floor in my behavioral science office. I didn't have a place downstairs, uh, and I didn't want it. SMOOT: You've worked under both, um, Dr. Willard and Dr. Bosomworth. STRAUS: Um-hm. SMOOT: How would you compare the two? STRAUS: Act-, actually, you say I worked under Dr. Willard and Dr. Bosomworth and I have, but really I worked under Doc-, my direct responsibility has been to the dean so-- SMOOT: --I see-- STRAUS: --I worked under Dr. Willard as dean and vice-president-- SMOOT: --yes-- STRAUS: --but then Dr. Jordan, Dr. Clawson, Dr-- SMOOT: --Powell-- STRAUS: --Powell-- SMOOT: --um-hm-- STRAUS: --uh, I've gotten along reasonably well with all of them. I've had different levels of respect for each of them-- SMOOT: --um-hm. STRAUS: --and I think I've made some comments about that yesterday. And their styles were very different. SMOOT: um-hm. STRAUS: Their sense of security was very different. SMOOT: Um-hm. STRAUS: I don't particularly s-, want to be negative. I think that, uh, well, we'll say Jordan had a hard act to follow, uh, and I never thought he followed it very effectively. Uh, Clawson accomplished a lot. He had a very controversial style, uh, controversial personality, very flamboyant, enormous, enormous, lot, number of sort of needs for his own ego-- SMOOT: --Um-hm-- STRAUS: --involvement in things, but I had, I felt a sense of loyalty to his position and I felt that I could work with him very, very well. Uh, Powell, as I've mentioned I think, is a man of, uh, he's much more meticulous, he's much more, uh, gives much more attention to a tight organizational management which I think the school needed and I think will be in the long run effective in the Medical Center, uh, and when talk to, you know, people are forever asking the things that, that come to mind. And the two words that come to mind most when I think of Powell are integrity and decency. Uh, so I compare those men in that respect. Uh, I'd say, you know, I think Pete Bosomworth also is an extremely decent human being and I mentioned yesterday that he was enormously effective as chairman of anesthesiology. Curious thing happened when, when Dr. Bosomworth gave up the, the chair in anesthesiology. He developed a very strong department and there were maybe a half a dozen people in that department, each of whom, uh, I guess thought they were ready to be chair and none of them particularly wanting to serve under one of the others and the department kind of collapsed. What, what had been described and I think was a, one of the strongest departments in the school kind of collapsed when he left. Now he'd done a lot of good delegation within the department and I guess this was one reason that a lot of them felt that they were ready to run things because he, having his other hat as coordinator or director or whatever of clinical services, had, had delegated quite a bit within the department, but it's very curious that, uh, I'd don't know whether any of that group are left, there may be one or two, but, uh, that, that, department has gone through a lot of turmoil and turnover, uh, since, since he left it. Uh, he is a man of, uh, I think, intense loyalty to those for whom he works, namely the president of the university, uh, enormous, uh, I think, desire to do the right things. Uh, I think he has over the years not had the quality of staffing that his job required, the quality of staff support--uh, Cauldell Barr being the major exception, Howard Bost being an exception who, but a man who worked primarily on projects. Um, he had very effective person in Pat Tanner for years, who worked with him, but considering the enormity of the task, I know many of us over here compared the staffing that Clawson had and the staffing that Bosomworth had and we used to comment that Clawson actually had much more effective staffing than Bosomworth. SMOOT: Has that been primarily because of economic considerations or has it been for other reasons? STRAUS: I don't, I don't know. Uh, I think Pete has perhaps made some adjustments in that in recent years, although he, he still, I think, has people who, uh, are terribly hard working, terribly loyal, but often stuck with doing jobs for which they don't have necessarily the ideal background. SMOOT: I see. STRAUS: ----------?? (laughs) SMOOT: Um, we touched on economic issues, just points, uh, several times, just never really got into the meat of the subject, I think, and, uh, you said you would be willing to talk about the economics of the Medical Center, the development of the, uh, Medical Center. STRAUS: I think we talked yesterday about that to some extent toward the end when-- SMOOT: --yes-- STRAUS: --when I, I related, tried to relate what I think has happened economically-- SMOOT: --um-hm-- STRAUS: --in the Medical Center to the larger picture-- SMOOT: --um-hm-- STRAUS: --of health and medicine and the larger society. Uh, we started out with a level of state funding that if it wasn't the highest of any public medical school in the country it was close to it and, uh, in terms of level of state funding for the medical school on a relative base, I guess it's been downhill ever since. SMOOT: Um-hm. STRAUS: Uh, now, some of this is simply the natural course of the increasing costs of running an academic medical institution, the, the inflation in salaries of, of, uh, particularly clinical personnel has exceeded that of salaries in other sectors of the society, uh, and the eventual, I think, economic necessity, even though I, I grieve about it, the economic necessity of moving to a different system of, of support. Um, at the same time, uh, I think there was historically a lot of waste in, in, uh, health care institutional management and to some extent I think this, we've seen an enormous reduction in that waste, uh, forced by the pressures of society against the escalating cost of health care so I, I would guess we're getting a heck of a lot more for our bucks in the running of the University Hospital today than we were, were ten years ago. In that respect I think the administration has done a good job. I'd like to feel that they'd done a good job without, uh, sacrificing the importance of focusing on patients and to a degree I think economic forces have helped in this regard too because the more we become competitive with the private sector in health care or even with the other community hospitals, the more this competition becomes a factor of survival, uh, the more patient satisfaction becomes an important consideration and the, what, what was essentially started on three north, which was to take steps to increase the satisfaction of patients and staff and the, uh, feelings of people about the experience of being a patient. I think there have been major steps in the hospital, uh to try to make this a more, these kinds of experiences, more generally available in the other areas. Now, a lot of that has been directed by Carolyn Bacdayan and, who has kind of, uh, had a major role in overseeing the, the, uh, renovation of all the hospital, at least those aspects of renovation that pertain to, uh, the patient care as contrasted to medical care. When I talk about patient care I'm talking about experience of the patient as a human being in contrast to the procedures that, the medical procedures, that the patient may be experiencing. Carolyn is an important person for you to talk to. Uh, very quiet, unassuming, absolutely great dedicated person who, whose contributions to this place are not always appreciated. Now, Pete Bosomworth discovered her and he, uh, he relies heavily on her. SMOOT: Um-hm. STRAUS: Um, the task of a person in the position of a chancellor of a university medical center today is, is, uh, so overwhelming you wonder why anybody wants that kind of a job and it's very easy, if you're not faced with the daily crises and multiplicity of problems, to be critical, but the demands are almost inhuman and I don't choose to be critical. I choose to be appreciative--(laughs)--of what anybody in that kind of a job is up against. SMOOT: Do you, we talked a little bit yesterday also about the support rendered to the medical center in its development, by not only Governor-- STRAUS: --um-hm-- SMOOT: --Chandler, but also particularly Governor Combs and the importance-- STRAUS: --um-hm-- SMOOT: --that he had. He had chosen to-- STRAUS: --could I interrupt you for a second? SMOOT: Why certainly. STRAUS: I'd like to go back to the other deal, the point-- SMOOT: --certainly, certainly-- STRAUS: --that, you're going to hear a lot of criticism, depending on who you talk to, of administration. SMOOT: Oh, well . STRAUS: That's the easiest thing in the world to be critical of and I can be critical too, uh, but I've got to express something in my own philosophy. Uh, I came here in 1956, uh, after the first, oh, very few years I was in the prime of my career in a way and doing a lot of things nationally, had a lot of visibility and had many, many opportunities to, uh, do other things, become-- SMOOT: --um-hm, um-hm-- STRAUS: --deans, um, provost, other things. I had to do a lot of self examination and I'm a believer in the Peter principle and, uh, chose first, uh, to try not to be enticed into a position in which I felt that, uh, I wouldn't be effective in terms of, uh, what, the things that I can do comfortably and well, uh, and second, awful lot of attraction to Lexington and to this institution and a sense of loyalty to this institution and I chose very deliberately to try to maintain a positive -- if, if not constructively--a positive view toward the institution and the people I work with, um, and that's why, uh, I'm not going to be terribly critical of, of individuals , because I appreciate the task they're up against. Uh, I could be, but I'm not going to, uh, because I take the point of view that it's, uh, kind of, you either decide you're going to be positive and supportive or, uh, you get out and do something else and I chose to be positive and supportive of all the people. I think I have been very supportive of all the deans that I've worked with. Uh, I've had different levels of respect for them, but I've been supportive of all of them and I would say the same for the other administration, uh, administrative people, and I'd be, I could be very critical of Pete and the times in terms of things that I, you know, mistakes I thought he made, uh, but I respect the fact that he's in there willing to do it and, uh, so that's, this is part of my own basic kind of, uh, philosophy that is one of the reasons that I'm here after twenty-nine years and not off doing something else. Uh, I also feel that it's very important in, in terms of my role as department chairman, uh, with about forty people who, uh, I have a responsibility for, to maintain a very positive posture and I don't mean that we don't discuss problems, of course we do and I share administrative problems with them and they hear me complain about the ever increasing bureaucratic red tape that we have to go through for everything which I think is really a very serious problem in, in the University's (??) Medical Center, uh, but in general, in general, primarily, if I can't be positive I don't belong in this job. Um, so, now I will tell you, and we'll come back to the other thing, that I do think one thing that has happened, uh, to this university, to many universities and, uh, in a way to the larger society, is that I, I really think we have become burdened with and over bureaucr-, bureaucratiz-, bureaucratization and one of the things that some of the basic science dep-, chairmen and faculty right now are complaining about, I'm sure clinicians are, too, is, uh, we're right in the middle of evaluating faculty. Now, this is evaluating performance. Okay, in order to do that, if you do it conscientiously, I mean gather a lot of data, all right, we'll turn these things in, in January and the next thing we have to do is forms on distribution of time and effort. In order to do that you have to gather a lot of data, in order to come to an agreement with people on what their distribution time and effort. Actually evaluation should be made with the distribution of time and effort in front of you because there's no point in evaluating a person as a lousy teacher if they only spent 5 percent of their time teaching. Well, you may evaluate it as poor, but that may be one of the reasons they're only spending 5 percent of their time as teaching. Uh, we no sooner get that done and we have to do an annual report and the annual report, if it's well done, again, is based on the cumulative productivity of the faculty in the department. It means that three times a year we have to go to the faculty to provide us with this basic information so that we can do the this, utterly ridiculous that this isn't all done in one, in, uh, one operation. Uh, the numbers of times we have to sign our names, uh, when, if we have good competent businessmen and as, as we do, they should be able to sign them for us. Things like that, they haven't got anything to do, I mean, these don't come from Bosomworth--I don't know- -I suppose they come from the Council on Higher Education or whatever, uh, but they do, they, they increase the job at every level and, uh, I think that there is an incredible amount of waste of the talent of people like Pete Bosomworth and people like Robin Powell and the department chairmen and the faculty in this kind of checks and balance process. Whereas, I am personally convinced that these institutions, uh, like, the institutions like this could make a far more effective and economic contribution to the society if we went on the principle that we give people responsibilities, we give them the authority with the, that goes with those responsibilities and we retain the, uh, uh, ability to change horses if they aren't doing the job. Instead, we seem to have a system, which protects the lowest common denominator in which we waste the resources of effective people in order to literally, uh, protect within the system the ineffective people. Uh, that's my biggest complaint. It hasn't got to do with, and I think we're all of us victims of this and all of us less effective because of this kind of thing and I know that somebody like Pete Bosomworth's, he plans his day and then he gets all sorts of things dumped on him from Frankfort or the president's office that aren't part of that plan. I know Robin Powell does the same thing and I know I do the same thing. It's at every level, uh, and I also am convinced that if I were to have left here fifteen years ago and gone to a different institution, and I've spent sabbaticals at two of them and made these observations, it wouldn't have been any different (both laugh). I spent, I was at Berkeley once before--I'm going again--but one of the things that really struck Ruth and, and me when we were in Berkeley--we have a lot of friends out there--is how unhappy a lot of these people who have national reputations are. In fact, that was the worst part of being there. It's a very exciting place to be in terms of, uh, intellectual climate and stimulation, all sorts of things, but a lot of our, we really were saddened by the fact that a lot of our close friends whom, as soon as you get away you think they're just riding high, they're at Berkeley and, you know, well-known, well-thought of and so on, but they're not happy. I think we've got more happy people at Kentucky than at Berkeley--(both laugh)--or at Yale. SMOOT: Pretty important thing to say, too. STRAUS: Um-hm. So, I'm sorry I interrupted you-- SMOOT: --not at all-- STRAUS: --but I really didn't feel I'd, I'd done-- SMOOT: --um-hm-- STRAUS: --I wanted to give you a little personal philosophy to, to go with the, this whole question of, of evaluating people. I think you've got to evaluate people in terms, not of just what they're doing, but in terms of, of the, the, uh, medium which they're trying to operate in, the actual, uh, uh, barriers that are placed in their way and I said, I said yesterday, if Dr. Willard, for eight years Dr. Willard here was the most effective person you could have imagined. SMOOT: Um-hm STRAUS: And when the system changed. He knew it. Those of us who were close to him knew it. His effectiveness was enormously compromised, just enormously compromised, and one of the real tragedies was the extent to which it affected (??), now there I blame Oswald and I think Oswald's ego and his own needs to be, uh, the key person was such that he could not tolerate having a person of Dr. Willard's stature and ability in a position where he would continue to be effective and to be, uh, to have the authority that he had. SMOOT: Rather than, rather than being someone who would, uh, just simply want to make sure that everything was being centralized and, and coming through the president's office, you see it more as something where he, he just felt that nobody else could. STRAUS: He dissipated, he dissipated, uh, the ability of his good people to be effective. SMOOT: I see. STRAUS: And, uh, he did it under the guise of creating a system that would get rid of dead wood and things like that. SMOOT: Um-hm. STRAUS: But what he really did, uh, there was an awful waste and it wasn't just Dr. Willard. I could name other people in this University that I think were very effective whose effectiveness was destroyed under the new system and, uh, it's interesting because for, for, uh, years I, I served as chairman of this department on, at Dr. Willard's pleasure. He could have dismissed me at any time. Uh, I kind of think that was a better system that my having a six year term and being evaluated every six years. SMOOT: Um-hm. STRAUS: Uh, six years is a heck of a long time. So be it. Uh, now, you had another question. SMOOT: Well, I was, I thought perhaps related along the same lines and sorts--I was interested, yesterday you were, you were really putting more emphasis on, on Governor Combs. STRAUS: Yeah. SMOOT: And his, uh, help in developing the Medical Center. I was wondering if we could go beyond Governor Combs now and ask about Ned Breathitt, Louie Nunn-- STRAUS: --okay-- SMOOT: --other governors, their influence, their participation or lack thereof-- STRAUS: --all right-- SMOOT: --with the Medical Center? STRAUS: I'll give you my own perceptions of, of the political scene and more in terms of the University than perhaps the Medical Center per se. SMOOT: Um-hm. STRAUS: Uh, Breathitt, I don't have strong impressions one-way or the other. Uh, I think Breathitt was governor at a time when, uh, there weren't serious economic pressures. There was a sustaining of what had started under Combs, which was an increase in support for higher education. Now, one thing that did happen during that period as far as this University is concerned was that the, it was a period when the, the political power of the regional schools was increasing and, uh, they were smart enough to get together and work very closely together. The presidents of the then four regional schools, um, developed a very powerful, political base in Frankfort and I think the University of Kentucky was, uh, off guard-- SMOOT: --um-hm-- STRAUS: --caught off guard a little bit politically. Now, when Louie Nunn came in, um, as governor, uh, it's my opinion that he really was an anti-intellectual and that one of his goals was to cut down the demands of the state of higher education and certainly of the University of Kentucky and it is my opinion that, uh, well, I don't think it's even my opinion, I think you'll hear this from other people, that the time that, uh, there was a vacancy in the presidency of the University, um, there was a search committee that included some faculty members, some trustees, I don't remember the constituents of it, but the search committee actually made a recommendation and the individual- -it was an individual who had been approached the year earlier and declined the job, but then felt that his situation was such that he could be considered a year later, 'cause you know we had a interim president, Kirwan, for a year. SMOOT: Um-hm. STRAUS: They had a recommendation, um, and my understanding is that this thing went so far as a press conference had been scheduled in which this man was to appear and be introduced as the new university president and a couple of days before this was scheduled, he was called and told that everything was called off, that the governor had intervened and that he was not acceptable to the governor as president and the governor essentially, uh, engineered the appointment of President Singletary and this is not a criticism of Singletary at all, but simply a matter that I think the governor's intervention in part was to find a president whom he felt would be responsive to him in his effort to cut down the escalation of the University of Kentucky and I think Mr. Singletary, in his first presentation to the faculty, made it very clear that he saw the, the rapid expansion of the University coming to an end and he saw more difficult times ahead. It was kind of a voice of doom speech. SMOOT: Hmm. STRAUS: Um, Mr.--the fact that the person who would have been the president happened to be a physician may or may not have anything to do with Mr. Nunn's attitudes toward this place, but I'm not aware of any, any great support of the University Medical Center during, during this period and I think during the, certainly during the first several years of President Singletary's administration it's my impression that, uh, Medical Center expansion was kept under pretty close wraps, that, that, uh, that the Medical Center's, um, budget going through the University, that, that most of, many of the things that the Medical Center wanted to present to the legislature as, as needs just never really got, got there. SMOOT: Well, let me ask you, uh, since, uh, you mentioned your view of Governor Nunn, and that of many others, is one of anti-intellectual, there's lots of people in Northern Kentucky that would probably disagree with that. Uh, Northern Kentucky University and they have the Louie Nunn Center and all this sort of thing, uh -- STRAUS: --yeah, yeah-- SMOOT: --was it so much that he was an anti-intellectual or was it so much he was anti-University of Kentucky? STRAUS: Well, I guess that depends on what you consider that, uh, Northern development. Was that a, was that a development in the interests of intellectual excellence or was that a development in the interests of political expediency? SMOOT: Um-hm. STRAUS: And if I felt that that was a, that the emphasis in developing that institution was on quality education, I would say one thing. If I felt that it was, uh, the emphasis was on, uh, visibility of, uh, of investment in, in, in a politically significant area because of the population concentration, I'd say another. I think, I won't, I won't mince any words, I think the law school at that institution has been a travesty from the word go. SMOOT: Um-hm. STRAUS: And I don't think you need to look any more than, than at the, at the, uh, record of their graduates on our own state bar exams. Uh, so that I saw that simply as a, as a move to, uh, dilute the state's investment in education, uh, and weaken quality in the, uh, in the interest of political expediency. That's a pretty strong response. SMOOT: Well, um. STRAUS: I don't know, were you from northern Kentucky? SMOOT: No, I'm from northeastern Kentucky (both laugh). I'm from Ashland, so. STRAUS: Okay. SMOOT: That doesn't affect me directly by any stretch. STRAUS: No. SMOOT: Let's stop there for a moment. STRAUS: Sure. STRAUS: We're talking about the committee system. SMOOT: Right. STRAUS: And faculty objection, sure you'll always, I mean, I guess it's the, it's the vogue today for faculty to want to be involved in everything. I think if you've got really, real confidence in your, uh, leadership and you sense, uh, that they're trying to facilitate you're doing what your real task is that, uh, faculty are not all that interested in committee. Now, um, I believe, and you'd have to test this, I believe that you would find in this department that there is relatively little concern that, I probably make a hell of a lot of decisions that in, might be submitted to a faculty. Uh, I make a lot of decisions actually by, um, walking around the corridors and finding who I can find and trying out ideas and we have, we have meetings. We don't vote unless there's something that comes through that says we have to and then we, you know, we do, but again, I've talked to you about this matter of consensus, but, uh, uh, I'll make another observation that I, uh, oh, served on the senate for years, at the university--uh, in the early days because it was important for Medical Center, there weren't many of us--(both laugh)--from the Medical Center, you know- -and I served, served on a lot of the University committees in the senate and some, I've made wonderful friendships, a lot of respect for people I worked with on committees, uh, but let's say about the senate, that's an institution in which there is incredible waste because, uh, an awful lot of people who, I do believe, relish their role on the senate because they are not achieving the kinds of satisfactions that they might be achieving through their teaching and their research and I think this is a problem in the University in that certain kinds of committees tend to get in the hands of the folks who, uh, enjoy it too much. It's, like the str-, had mention, administratively, if a, if a, administrative person is enjoying the power of the administration too much they're not, probably, a good administrator and I see this danger in, in the committee system, in putting power in the hands of committees when the time that they take and the effort is such that some of the folks who would be your most responsible committee, uh, members don't have the patience to do it. Now, I'm not proud of the fact that I deliberately scheduled my graduate seminar on Monday afternoons so that I would have a polite and respect-, respectab-, respectful way of declining to run on the senate, run for the senate, but after years of, of what I considered a terrible waste of time in which, uh, people were meeting their own needs with speeches and making mountains out of mole hills I just came to the conclusion that my personal time was not well-invested there, so in a, in, in doing so, I was deliberately, uh, essentially giving somebody whose judgment I might not respect as much as my own the opportunity--(both laugh)-- to do it, but, uh, I, I, just keep coming back to the fact that I think we, I think we deceive ourselves when we think that a committee system is necessarily a democratic system versus a monocratic system and that one can have very effective democracy with an appropriate delegation of responsibilities and authority, the safeguard being that if a person doesn't handle the job effectively and responsibly you give it to somebody else and that's the way I'd like to see us run the University and I think I'm repeating myself there. SMOOT: Um, that's all right. Serves by way clarification a lot of times. STRAUS: Okay. I think this is more some of your notes about-- SMOOT: --okay-- STRAUS: --U.K. administration, UKMC relationships support, okay, let me go back. SMOOT: All right. STRAUS: My decision to come to U.K., uh--(Smoot laughs)--the opportunity to continue working with Dr. Willard and to, and the opportunity that all of us had to, to start with a fresh slate, see, we'd been working in Syracuse for three and a half, I'd been there three and a half years, he'd been there a little longer, trying to remold a very traditional school and I think we were making a lot of success and I will tell you that till the night that Dr. Willard came and talked about Kentucky, I had no idea whatsoever that I wouldn't be in Syracuse for a long time and that things weren't going well. It was just, uh, a greater opportunity. Uh, developing, construction, implementation, I think we've talked about that. I've identified the original team. I don't know whether you'll, you'll, you'll get a chance, but, uh, Alan Ross, who went from here in '62 to Hopkins and became chairman of their Department of Biostatistics and is still there although I think he gave the chair up just a couple of years ago, good friend--you might want to touch--he was one of the original team, along with, with Bost. Uh, why were they chosen? I think I told you that yesterday. SMOOT: Yes. STRAUS: Uh, U.K. Medical Center as a functioning institution. Evaluation of programs--I went through the colleges and gave you some thoughts, uh, even within this college. Incidentally, I think right now the College of Medicine, department by department, the majority of departments are pretty good departments. Uh, surgery has got some problems because they're kind of in limbo in terms of, of leadership and they've had some divisiveness within the department but they've gotten a lot of strength. Surgery is really a collection of divisions and some of their divisions are very, very strong. Uh, medicine is a collection of divisions. John Thompson certainly has brought in an impressive group of people. Um, I think our basic science departments, biochemistry and medical microbiology particularly, very, very strong departments, pathology under, under--(Smoot laughs)--Gordon--no--Abner Golden, good friend. University Hospital--we've talked about that. Medical practice, standards, competition. SMOOT: Could I stop you for a while? STRAUS: Yeah. SMOOT: You touched on the point that there had been various ideas kicked around for the architectural design of the-- STRAUS: --um-hm-- SMOOT: --hospital and there was a compromise that had to be struck. STRAUS: --yeah-- SMOOT: --uh, in the design-- STRAUS: --the original design-- SMOOT: --okay, with whom and why? STRAUS: Okay. Uh, one had to do with number of beds-- SMOOT: --um-hm-- STRAUS: --that we could get for our dollar-- SMOOT: --um-hm-- STRAUS: --and when we considered the circular wing, it would have, uh, provided more sort of private cubicles that would have been open to a central, nur-, nursing center. It was a brand new idea. It had been tried in one or two places, uh, but for the bucks we would have ended up with quite a number of fewer beds, I've forgotten, maybe fifty or sixty fewer beds-- SMOOT: --um-hm-- STRAUS: --that was one of the major considerations in, in not having the courage to go with that at that time. The, I, I mentioned the poverty- -both reality and, and sort of way of thinking of the state--and I, I think we felt a responsibility to, in making certain architectural decisions, to bear in mind that Kentucky wanted quality, but not extravagance. SMOOT: Um-hm. STRAUS: And that was one of the questions, one of the considerations that went into the number of, you know, single rooms ---------(??). Basically it was a very satisfying architectural experience in this regard. Many architects whom I've had exposure to, uh, want to start with their architectural concepts, you know, the outside of what a building should like and then fit your function into their monument-- that's what happened at Stanford. Uh, that's what happened in a number of medical centers that we visited. SMOOT: Um-hm STRAUS: And we, we were able to benefit from this. Uh, I could tell you some, I, I went through the Stanford, the new Stanford Medical Center, we'll say, was being built and looked at things from a functional point of view that, that are actual-, absolutely horrendous and came back with all these things we ought to avoid. For example, they had designed their hospital as a double corridor hospital with patient rooms on the outside and functional rooms on the inside, which meant that right across from the doors to the patients rooms were all sorts of, of noisy, uh activity, uh, dirty linen, clean linen, sterilization, uh, examining rooms, all sorts of things, uh, and you--I like the idea of patient rooms being able to have the doors open and quiet and so on and I said, "My gosh, we must not go to the double corridor system," which we had in the medical science building in the hospital. Uh, they did it at Stanford and it's awful. Because of some demands of exterior architectural shapes, many of their offices, at Stanford, could only be, uh, approached by going through other offices. Well, when you're thinking of clinicians who may want to see their patients or talk with their patients in their offices, not just in examining rooms, or other kinds of activity even activities as such in this department, you don't wan, uh, people to have to go through each others offices and get to their own. And essentially the planning of this medical center--there was a consultant architect, a firm called Ellerbe and they had a resident architect with us and he traveled with us and so he shared our thinking as we were looking at program and essentially the building was planned from the inside out. It was planned in terms of what you want to do with program and then you make the building fit the program. We, we decided to adopt, uh, laboratories, teaching laboratories, that would be multifunctional instead of having each department have its own laboratories--anatomy have theirs, yeah, anatomy had to have theirs because it was special function, but physiology, micro, and biochemistry we found could use the same laboratories--give them better laboratories, uh, better equipped laboratories, uh, for teaching this is, uh, with the idea that they, their, their scheduling time, their curriculum time would be different anyway so we could avoid those conflicts. So we started out with these multifunctional laboratories. They didn't work exactly as well as we thought they would, but the i-, the idea was based on objectives, educational objective, we also wanted to do more sequential teaching so that students would be studying the same kinds of principles in anatomy, physiology and other subjects at the same time and multipurpose labs facilitated that kind of, of educational idea. What we didn't count on was that when we got a faculty they wouldn't want to teach that way (Smoot laughs). They were more secure in their own disciplines. SMOOT: Hmm. STRAUS: But we wanted, wanted to create a building that would facilitate more multidiscipline work. That interviewing room that you saw in the film, uh, we put that in. We put quite a bit of one-way glass in at the time. Well, we don't need it now because we use television, but point was we wanted to preserve the dignity and the privacy of patients, uh, while we were teaching exemplary patient care and, uh, a lot of these things came from our visits. Uh, a lot of things in the design of the nursing stations in the hospital and so on came, and the architects went with us and then, you know, we'd come back and we'd have meetings about ma-, major decisions about program objectives and then the building got planned that way. Now, that is not the way, then or now, that a lot of buildings are planned. A lot of buildings are planned by architects and then you try to fit into them, uh, but that-- I thought it was a very ideal arrangement. SMOOT: And reflected the philosophy. STRAUS: And it tried to reflect the philosophy, yeah and the thing, things like the design of waiting areas, well, we, we had an idea that we were going to run clinics with adequate scheduling so people wouldn't to spend all that time waiting around, um, but we, we tried to design waiting areas that would be accommodating, not just patients, but patients' families. We didn't go as far as, as it turned out we might have to meet needs, but we recognized that the people of eastern Kentucky, when they seek health care, they go in family units. We looked at the hospitals over in Paintsville and Pineville and so on and we saw what was going on there. Somebody, a member of the family is in the hospital and the family was camping out. We tried to at least make some accommodations for that sort of thing. Uh, now, it turned out we made some accommodations there and we didn't put enough storage room in. We put little interviewing rooms on each floor, uh, so that when physicians wanted to talk with patients and families they could do it with privacy. We tried to put rooms where teaching could take place outside of the hearing of, of patients so that patients were constantly aware of their being talked about. This didn't mean you don't do teaching in the patients' room, but you don't talk about people in the corridors and the elevators and we tried to get this built into the education of the students--a sense of recognition of the dignity of patients and things like that and some of this worked and some of it didn't, but it was incorporated in the original plan. Values changed though. I mentioned we had, we, we built in studies and f-, and lounges for students and then eventually most of that space got turned into research space. Well, in the hospital we didn't put in enough storage space and we didn't put in enough offices for the various people so some of the things that we'd put in that were designed to, to be supportive of good patient care got turned in, into other uses and one of the things Carolyn Bacdayan has achieved in, in the renovations is she's getting some of that stuff back, so. You got a time bind, do I notice you? Okay. SMOOT: Um, when this was all being developed, uh, of course it's so difficult to foresee some of these things, but could you have foreseen what we have now as far as the expansion of the Medical-- STRAUS: --no-- SMOOT: --center? STRAUS: I don't think any of us very well did. We, we planned the school for eighty students. The, uh, push to 110, uh, came from federal incentives to increase class with capitation grants that, uh, you know, when--we've gone through this cycle of not enough doctors, too many doctors. We, um, we saw expansion and we saw the need for the land. Um, our assumption was the expansion would be this side of Rose Street. SMOOT: Um-hm. STRAUS: It turned out to go the other way. I mentioned the story about that, but, um, I don't think we envisioned, I don't think you can envision those things. SMOOT: Hmm. Do you think that the, the newer structures, uh, have attempted to reflect the philosophy of the original, uh, medical center development? STRAUS: Well, certainly the cancer building-- SMOOT: --is that-- STRAUS: --has. I think the, the Nursing Health Science building to an extent did. I think there were some serious mistakes in that building. SMOOT: Um-hm. STRAUS: But I don't think they were philosophical mistakes, I think they were, they were other kinds of compromises. Uh, the, you know, I think gen-, I think generally, to, uh, a degree, to a degree the, the original philosophy, um, we missed a lot of things. If you read the article that, that I wrote on "Creating a School for the Student and Patient," you know I like to feel it's all still there. Uh, I like to feel we're re-achieving some of those things. SMOOT: Um-hm. STRAUS: And I really think in, in the last, uh, few years, maybe even the last five years, we're beginning to change our values. As I told you, I think we're in a pendulum and I brought that article from the New York Times that I referred to-- SMOOT: --okay-- STRAUS: --on the problems -- oops -- well, here it is. I really, I want it back but-- SMOOT: --sure-- STRAUS: --the problems of, uh, of, uh Hospital Corporation of America, because to me that's the best illustration of what I've been talking about when I, when I mention a pendulum. Okay. SMOOT: Um. STRAUS: Let's see what you've got here. In 1958, um, we had a good relationship going with U of L and, uh, one illustration of that was that we developed a joint conference for advisors of medical students from the state and adjoining states. I think we had several of them as a matter of fact. The first one was here in Lexington in 1958 and, uh, uh, we invited from the colleges of this state and the adjoining states the medical advisors to come in and talked about our admission philosophy and, uh, how we hoped students would be prepared and how we planned to go about selecting them and, and we invited Louisville to join us and talk about it from both school's point of view and again, I can remember, um, in those early days having many meetings with the person in Louisville who was the counterpart of my unofficial role as coordinator of academic--(laughs)--affairs. Of course, it was an expansion time, it wa-, the, they were not a state school. They did have state subsidy, but we weren't in competition in that respect. We were in comp-, competition for good students. They were taking a large number of students from out-of-state and so we, it wasn't even that, that great, so that in those early days, there was a, a, oh, relative warmth. Murray Kinsman, the dean, and Bill Willard, our dean, got along well and I never heard Kinsman say anything that didn't appear to be reasonably supportive of us and there, uh, were lots of things that have never really, I think, been made any great issue of that did involve a reasonable amount of cooperation. I think at one time their chairman of anatomy dropped dead and our anatomy department immediately helped them out with, with some teaching and, uh, some other needs that they had--uh, quite a bit of informal moving back-and-forth, lecturing here and there on a guest basis. It's not been a, it's not been a, uh, high at least at the firing line level there, hasn't been a high competitiveness, at least until recent years. Now, I, I think the competitiveness has been forced by the Council on Higher Education-- (laughs)--and some of them, some of the their maneuvers right now, more than anything else. I think there is there is a concern right now that, uh, maybe you can flip that off for a minute. SMOOT: Dr. Straus, is there anything you'd like to add, uh, to what we've been discussing? We've discussed quite a bit. STRAUS: We've discussed quite a bit and I think we've covered most of the bases. What I'd like to suggest is after you get a chance to look at this and if you're going to make a transcription, let me look at it and also I would guess that some things are going to come up in your discussions with other people that you might want to come back and say, um, what do you think about that? SMOOT: Is that-- STRAUS: --and I'll be glad to. SMOOT: Well, I appreciate that. STRAUS: Shall we do it on that basis? SMOOT: I think that would be nice. STRAUS: All right. SMOOT: I appreciate it and thank you so much for your time. STRAUS: My pleasure. SMOOT: Yes, sir. [End of interview.] Dr. Robert Straus (Chair of the Department of Behavioral Science 1959-1987) discusses the role of behavior science in medical education, the construction of the medical center and the other key individuals recruited to build the University of Kentucky Medical Center and Medical School. He also criticizes the bureaucratization of universities and particularly the current system of faculty evaluation. He also speaks about how supportive the governors of Kentucky were toward the UKMC. insert here