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1985-11-30 Interview with Ward Griffen, Jr., November 30, 1985 UKMC001:1985OH248 UKMC 020 02:01:12 University of Kentucky Medical Center Oral History Project Louie B. Nunn Center for Oral History, University of Kentucky Libraries Griffen, Ward O. -- Interviews University of Kentucky. College of Medicine -- History University of Kentucky. Medical Center -- History Surgery Medical education Hospitals Administration Eiseman, Ben, 1917- Willard, William R., 1908- Bosomworth, Peter P., 1930- Ward Griffen, Jr.; interviewee Richard C. Smoot; interviewer 1985OH248_UKMC20_Griffen 1:|13(6)|28(2)|39(2)|50(7)|78(3)|93(13)|121(9)|137(3)|159(4)|174(6)|192(3)|210(4)|241(11)|258(9)|275(2)|290(12)|306(12)|321(7)|340(1)|363(8)|387(7)|403(10)|416(2)|441(12)|452(5)|465(10)|480(11)|501(10)|515(9)|530(2)|543(8)|555(3)|568(8)|583(2)|597(1)|612(4)|633(11)|655(3)|671(3)|684(6)|698(1)|711(3)|723(5)|735(6)|748(3)|762(5)|775(11)|789(6)|805(6)|819(7)|832(5)|852(11)|875(13)|891(5)|913(1)|923(9)|936(7)|949(5)|964(9)|988(11)|1013(7)|1026(4)|1037(3)|1055(5)|1071(1)|1089(1)|1100(14)|1115(4)|1128(9)|1145(5)|1155(9)|1167(10)|1180(10)|1194(6)|1207(2)|1225(4)|1238(14)|1251(11)|1266(8)|1287(4)|1304(11)|1320(1)|1343(1)|1354(6)|1368(10)|1384(6)|1398(4)|1414(8)|1428(11)|1441(13)|1462(6)|1476(12)|1492(10)|1506(7)|1522(5)|1534(6)|1561(1)|1576(1)|1598(6)|1622(9)|1637(10)|1650(7)|1670(12)|1692(12)|1711(10)|1728(1)|1745(5)|1764(12)|1780(2)|1792(11)|1806(6)|1818(12)|1844(10)|1860(6)|1876(12)|1895(3)|1913(4)|1926(11)|1946(7)|1962(8)|1991(3) audiotrans UKMCoh interview SMOOT: Dr. Griffen, to begin would you give me a brief autobiographical sketch of yourself? Tell me a little bit about your family background, where you are from, where you were raised, your education and so forth. GRIFFEN: Okay. I was born in New Orleans, Louisiana, but at the age of eight moved to Baltimore, Maryland, uh, basically outside of Baltimore, uh, went to junior high school in, uh, Baltimore and then went to high school at a, actually a prep school in Hagerstown, by the name of Saint James, uh, School, then went to Princeton, uh, in the class of 1949, although I graduated in '48 and, uh, at the age of nineteen, which is important only in that I didn't get into medical school the first year I tried. Uh, there were a lot of service men coming back from the war. This was, uh, 1948 and they--in fact, I remember our dean telling me one time, uh, a very famous dean by the name of Sevringhouse (??) who was at Columbia, telling me that if he got a, a veteran coming through who had maybe even not as good a scholastic record as mine, he would take the veteran over me because I was too young. And he gave me a good piece of advice, he said, "You know, you've been working all your--you've been studying all your life, what you need to do is go out and work for a year." So rather than go get another degree, a master's degree or whatever, he convinced me I should go out and work, so I did. I went out and worked for Bloomingdale's for a year and sold, uh, boy's clothing. I--a lot of people don't realize that, but that was sort of fun actually. It was a, it was a yea-, it was sort of like a sabbatical, I took a year out, uh, then matriculated at Cornell University Medical College in '49 and graduated in '53. Did an internship in internal medicine at Bellevue, uh, before going to the University of Minnesota, where I did my surgical training under Dr. Wangensteen and, um, that was basically a, a nine year residency which included training in general surgery and thoracic surgery and also, uh, spending a great deal of time in both the surgical laboratory and, uh, the physiology department and I did obtain a PhD, uh, in surgery, which is what, the way the program was set up there. So that, uh, at the present time I'm board certified in both general surgery and in thoracic surgery and, but I also have a PhD which helped when I came down here, which I'll get to I suppose at some point. At any rate, I was on the faculty at the University of Minnesota from '63 when I got my degree until '65 when I came down here. Then I came down here, uh, began work with the university on the first of September 1965, as an associate professor of surgery. And then on the first of July '67, I was named the professor of surgery and kept that position until I went to the American Board of Surgery as the executive director. I also had an appointment in the department of physiology and biophysics, uh, which is why my PhD part of it is important. And I was a member of the graduate school faculty as well as of the medical school faculty, uh, and taught gastrointestinal physiology to the freshmen medical students for the entire time I was here. Uh, when--I really enjoyed that, I enjoyed it for two reasons. One is because it forced me to keep up with the field of GI physiology, but secondly, uh, it gave me a unique opportunity in the medical school of, uh, getting to know the medical students from the time they were freshmen right up until the time they're seniors. And most of the time clinicians in medical schools only, really only, get to see the medical students when they come in the third year and start their various clinical clerkships. So that was sort of fun, I, I enjoyed that, I really did, I had a good time. And I sort of miss that part of what I'm doing now, but that's the way it is. SMOOT: Let me go back and, and follow up-- GRIFFEN: Okay. SMOOT: --on a few of the things that you said. Had anybody in your family been involved in medicine? GRIFFEN: No. SMOOT: Why did you decide-- GRIFFEN: None at all. SMOOT: Why did you decide to go into medicine? GRIFFEN: (laughs) Well, from the time I can remember, my mother always said that, uh, when I was two years old I said I wanted to be a doctor and I never changed my mind. I'm not so sure that's true. Uh, I think she wanted me to be a doctor and she convinced me that I had been saying that for a long while. Uh, and as a matter of fact, because she did have, uh, a fair influence on my life, she, uh, also convinced me as I was going through college and, uh, getting into medical school that mental illness was the scourge of the earth and so I actually went to medical school thinking I wanted to be a psychiatrist. In fact, I was a psychology major at Princeton, um, much to the chagrin of my pre-med advisor who was the chemistry professor and felt I should take nothing but chemistry and biology and what not, very bad advice, by the way. But we, we might get into that at some point. But any rate, uh, I did, I went to medical school truly, uh, thinking I wanted to be a psychiatrist and then I met one, that was the end of that. (Smoot laughs) I became a surgeon. No, that's not true, some of my best friends are psychiatrists, but. SMOOT: What about your father? What had he done? GRIFFEN: My father was a chemical engineer and actually he was a farmer from western New York state and went to the University of Rochester, uh, to learn modern farming technique and he got into the chemistry part of it and the chemical business and decided he didn't want to be a farmer, he wanted to be a chemical engineer, so he transferred into the engineering school, graduated from the University of Rochester in 1915 and then got a job with U.S. Industrial Chemical Company, which is now a subsidiary of National Distillers. At that time it was a, a freestanding company and his first job was in New Orleans which is where he met my mother and they were married. My older sister and I were born in New Orleans and then we all moved up to Baltimore. SMOOT: Um-hm. GRIFFEN: Then eventually we moved to New York actually, that's--my father got promoted. SMOOT: Your sister the only sibling? GRIFFEN: No, I have a younger sister that was born in Baltimore. SMOOT: Um-hm. Uh, did either one of them decide to go into medicine or--? GRIFFEN: Nope, they're both-- SMOOT: --something else? GRIFFEN: --they both are living in New Orleans. Uh, my older sister, uh, was married to the first sixty-four thousand dollar winner, uh, which I'm sure you don't remember, but he was a marine captain who, uh, gave answers on cooking. They subsequently became divorced and my sist-, my older sister has three girls, uh, and she teaches school down in New Orleans. My younger sister is married to a lawyer in New Orleans and, uh, they moved to New O-, they both-- well, my fath-, when my father retired they moved back to New Orleans. When my older sister got divorced she moved to New Orleans to be closer to mom and dad and my younger sister had gone to New Orleans with, uh, my mother and father and went to school down there and just stayed down there. SMOOT: Hmm. What made you decide on Princeton, aside from being a beautiful campus and a great reputation? GRIFFEN: Uh, actually, I got a scholarship at Princeton--(laughs)--uh, and I graduated first in my class in high school which isn't any great shakes because we had ninety students total in the school. My class was a class of seventeen, but I did have a good record in high school and I got a very good education. It was a typical small prep school where you did nothing but study basically, although I also played football and soccer and a few things like that. But, um, it was, uh, there were, at, it was in--during the war years so they had, had plenty, the schools had plenty of money and I just, I got a scholarship there and I just went there. Of course, I, I was aiming at some Ivy League school, there wasn't any question about that. Princeton does have a beautiful campus. My youngest daughter wants to go to Princeton. SMOOT: Fairly expensive proposition these days. GRIFFEN: Yeah, they tell us it's seventeen thousand dollars a year for tuition. SMOOT: Um-hm. (laughs) GRIFFEN: I can hardly wait. SMOOT: While there you had obviously decided on your major, as you mentioned earlier, in psychology. I wanted to follow up on that. You, you said that you had been advised that chemistry was-- GRIFFEN: Well, my, my professor, Gregg, Hal Gregg (??) was my, uh, pre-med advisor and he was a professor in the chemistry department and, uh, he, like so many pre-med advisors, uh, said, "Well, science is your forte and you like science and therefore that's what you should take because you'll do well in it. And you'll get good grades and then you can get into medical school." As I say, unfortunately that advice is still being given to pre-med students. At one point when I was here, uh, we tried to convince the powers that be at the University of Kentucky, that is, that they should allow the clinical faculty of the medical school to be the pre-med advisors, rather than the professors of zoology and biology and chemistry and all the ones that do the advising. Uh, and were basically turned down. Uh, I would love to advise pre-med students because I would tell them to take am-, only what was necessary to get into medical school as far as science is concerned and to concentrate on some of the, uh, more important things that they're going to have to deal with in medicine, uh, including some humanities and things like that because I personally, I'm very concerned about medical education at the present time. I think we're taking the wrong kinds of students into medical school. We're taking students who can pass multiple guess examinations, uh, who have a lot of science in their background and not much else. And, uh, as far as I'm concerned a multiple choice examinations do not measure problem solving ability, which is what a physician really needs to do. Um, and I can say that because I am in the edu-, I'm in the evaluation arm of education now, being with the American Board of Surgery, because that's our job, is to-- SMOOT: Um-hm. GRIFFEN: --is to administer, actually develop and administer and evaluate and analyze examinations, and I just know that multiple choice examinations do not measure problem solving. And so we're getting, uh, students who are very narrow in their outlook, who have 4.0 average in multiple choice examinations, which means they can memorize well. And I think those are the wrong kind of people that are going into medicine and we, we're going to suffer from it--we the medical profession--if we aren't already suffering from it, because the, I still will see--run into patients, and I have a whole group of lay people in my office and all I hear about is the fact that the doctors don't take any time to talk to them. SMOOT: Hmm. And that is a problem. GRIFFEN: That is a problem. I, I mean I hear it constantly. To me medicine is being able to take a good history from a patient and then do a thorough physical examination and 90 percent of the time you can make your diagnosis if you do those two things well. And all I hear about is that the doctors spend a minimum of time with the patient talking to them, uh, spend a minimum of time doing a physical examination and then they, um, order fifty tests which cost them a thousand dollars and put them on five drugs which costs them another five hundred dollars and they've seen the doc for about eight to ten minutes and that's the complaint I hear and that's because that's the way we're educating them as far as I'm concerned. SMOOT: Hmm. GRIFFEN: But, you know. SMOOT: We could come back to that because obviously Dr. Willard and the members of his original team had a different concept of the way physicians should be educated. GRIFFEN: Well, this isn't true only of Kentucky though. SMOOT: Um-hm. GRIFFEN: I mean this is true of medical schools throughout the country. SMOOT: Um-hm. GRIFFEN: And I can tell you my own bias as to why that's happening, but, uh, which I will at some point. SMOOT: Okay. Perhaps this would be a good time to go ahead and, and follow up with this. GRIFFEN: Well, I think the, uh, there, uh, a fair number of academic, uh, physicians who go into academic medicine to get away from patient care. They don't want to take care of patients; they don't want to spend the time; they want to work in the laboratory; they want--which is important, I'm not denying that it's important--but, uh, as the medical students are being exposed to a role model who really aren't interested in taking care of patients, so they get the idea that the way to take care of patients is to do it over the telephone or whatever, but it certainly is to avoid it and alth-, and I'll admit my bias because I am biased about it. I think that the non-surgical specialties are much more guilty of that than the surgical specialties. SMOOT: Hmm. GRIFFEN: And if you want to read an interesting treatise sometime, uh, I don't know whether Dr. Straus mentioned this to you, but one the PhD's in his department is a gal named Cecilia Roberts, who wrote her PhD thesis. She spent six months, three months on the medical service and three months on the surgical service, going around with the residents, and then wrote her thesis on that experience. And you might, if you want to, contact him, I'm sure he's got a copy. I have a copy of it at home, I'd be more than happy to send it to you if you promise to send it back. But it's a, it's an interest-, it's--eventually was written up, she wrote it as a book. She's an associate dean or dean at this point out at, I think the medical school at South Dakota. But, uh, Cecilia had a--I thought it was a great idea and she, she had some very interesting, uh, uh, reports to make on the whole situation. And it clearly showed what I, what I think is wrong with medical education. SMOOT: Hmm. GRIFFEN: At this point in time. And we've got to get back to teaching medical students how to do histories and physicals. You know, I go to medical schools now, I still do a fair amount of visiting professorship work, and I get to talk to medical students and residents and I, I, everywhere I go I ask them, did any professor in your medical school ever watch you do a history? And the answer almost invariably is no. Or did they ever watch you do a physical exam? And the answer is invariably no. SMOOT: Something that related, and we, you've mentioned Bob Straus several times, uh, the original team of the medical center wanted to instill in the medical students at the University of Kentucky a more, uh, a greater social consciousness. And the department of behavioral sciences was established, Dr. Straus was of course involved with that and I suppose others. Uh, is this something that is needed, something more necessary than has been recognized and, uh, beneficial? GRIFFEN: Well, it, uh, I think that it's being recognized. There, in fact, uh, Harvard and a couple of other medical schools have actually put a humanities course into their, uh, curriculum, in the medical school curriculum, and you know, my feeling is that it's a tragedy that it has to be put into the education of a physician so late, because quite frankly, I think it should be done earlier, uh, because those are skills that, that they need to learn early on, not, uh, when they get to medical school. I think medical school's a little late to s-, change some people's ways of doing things. You know, that's one of the, I'm, I think the computer is a great thing and I am all for it and I think it's going to help in medicine, but it could also hurt it very badly because it could even make the distance between doctor and patient further apart, uh, rather than being, bringing them closer together. Uh, because I can just envision the patient coming in and getting a computer sheet and a computer CRT thrown at them and they fill out this questionnaire and then they pump the questionnaire in through the computer and the computer comes out with the sixteen diagnoses that it could be. I mean that's just, to me is just terrible, because that's terrible medi-, but any rate, um, no, I think that they came with a very good idea and it was an idea whose time had come, more or less a la Chardin and, uh, they, they parlayed it into a very good thing because they got a lot of federal support on the basis of it. I was often asked, when I was here, when I first became chairman, as was Dr. Eiseman asked the same question, why do you need a high-powered surgery department and a department that's doing surgical research and all the rest of it in a medical school whose principal is to turn out the undifferentiated physician? That was what their idea was, they wanted to turn out a well-rounded physician that had the, had the social consciousness, but also who was going to go out there and do primary care. What, what--I hate that term, but that's the term that they use nowadays--because I personally think that surgeons provide primary care. I think all physicians provide primary care actually, when you get down to it. Um, and my, my answer, as was Dr. Eiseman's answer was very simple, if you're going to turn out a good undifferentiated physician, they'd better know as much as possible about the disciplines of internal medicine, OB-GYN, surgery, psychiatry, et cetera, because they've got to know, if they're going to go out there and really provide primary care and see lots of patients and try and, uh, deal with their problems, but recognizing the fact that they aren't going to be able to deal with a given problem in depth, then they'd better know how to recognize the problem so they can know when to refer the patient at an appropriate time. SMOOT: Hmm. GRIFFEN: And I used to teach it all the time because lots of tragedies that occur in surgery occur because the diagnosis wasn't made at the time the patient was seen by the family physician. Probably the best example of that is ruptured abdominal aortic aneurysms, because the first person to recognize that is the first physician that does a good physical examination. A patient comes in complaining of back pain, if he doesn't feel that pulsatile mass in his abdomen and make the diagnosis of abdominal aneurysm and, uh, says this--decides this is osteoarthritis and gives them some aspirin or whatever, I can guarantee you that thing is going to rupture and the mortality rate from a ruptured aneurysm is like about 75 percent as compared to 5 percent if it's done electively. SMOOT: Hmm. GRIFFEN: So those are the kinds of things that I think are well worth while teaching all physicians and particularly the physician that's going to go out and be a family practitioner. That's part of my philosophy, I guess. SMOOT: Let me just step back and, uh, ask you a little bit about your education after Princeton. Um, you went on to Cornell. GRIFFEN: Yes. SMOOT: Uh, what was your experience like there? GRIFFEN: Well, it's a great medical school, uh, New York Hospital. It had--and of course at the time there was a division down at Bellevue, the, uh, second medical, second medical and second surgical division. And it was really a great, uh, a great, uh, place. Um, and I had a good time. I had a good record in medical school. I did make AOA, which is the honorary, uh, medical fraternity. Um, and I really enjoyed, uh, myself tremendously, uh, there. We were exposed to, it, you know, that was back in the late forties and fifties. We were exposed to physicians who really enjoyed practicing medicine. At that time of course, they didn't have all of the fancy, uh, CT scans and ultrasound and all that sort of stuff, so you had to make diagnoses by listening to the patient and doing a modicum of laboratory tests. Uh, part of why I went down to Bellevue in medicine actually was that our class, the class of 1953, was the first class that was on the national matching program for interns and residents. And I don't know if anybody's talked to you about that, but-- SMOOT: No. GRIFFEN: --you know about-- SMOOT: Yeah. Yes. GRIFFEN: --you know about the match. SMOOT: Yes. GRIFFEN: You have to get matched. Our class was the first and we had to have our, uh, choices in by October of our senior year. Now, Cornell had a peculiar, at that time, a somewhat peculiar curriculum, in that the outpatient year was the third year and the inpatient year was your fourth year, unlike nowadays it's the inpatient year is the third year, you do your clinical clerkships, they're all inpatient and the outpatient then is the fourth year. Well, the fourth year in medical school now is what I call Montessori medicine 401, you go play in your sandboxes, uh, during the year and don't get a whole lot of education. SMOOT: Hmm. GRIFFEN: But that's, again, neither here nor there. But the, um, any rate, we had, I had had no exposure to inpatient surgery at that point and October is a year, I had had outpatient surgery which was basically looking a people with varicose veins and putting, wrapping them up and taking, uh, sutures out of stitch abscesses and things like that and it didn't really excite me too much. Um, however, by the time I graduated, I knew I wanted to be a surgeon so I went down to Cornell. I went down to Bellevue on the Cornell division in medicine because when I talked to some of my advisors at Cornell they said, well, regardless of what you're going to do, you ought to go somewhere where you're going to see lots of patients and lots of interesting diseases, uh, and where you will recognize that the most common disease entity is not leukemia or thyrotoxicosis or something, it's good old-fashioned, uh, myocardial infarctions and pneumonias as stuff like that. And that's what I saw down at Bellevue. We still, that, those years we still rode the ambulance so I saw a lot of other interesting aspects of man's inhumanity to man, but it was a great year and I enjoyed myself immensely. Apropos of that, in about 1973 or four, the senior class, uh, had as their commencement, the senior class in medical school at UK, had as their commencement speaker, uh, Bill Nolen, the surgeon author from Minnesota who wrote The Making of a Surgeon and a few things like that, and the first thing he, uh, said when he got up to speak was, he said, "I want to tell you something, you all probably don't realize this, but I taught your professor of surgery how to do his first cut down." Which is absolutely true. I was a medical intern and Bill was a surgical intern at Bellevue, he was on the Cornell division, I was on the Cornell division and I had, as I said, I went down there knowing I wanted to be a surgeon, so I sort of hung around with the surgeons, uh, a great deal and he did in fact teach me how, how to do a cut down. SMOOT: Hmm. From Bellevue you went on to the University of Minnesota, is that right? GRIFFEN: That's correct. SMOOT: And worked with Dr. Wangenstein? GRIFFEN: Wangensteen. SMOOT: Wangensteen, okay. GRIFFEN: W - a - n - g - e - n - s - t - e - e - n. He was Norwegian. SMOOT: E - e - n rather than e - i -n. Tell me a little bit about, uh, that experience because I, I've heard of him and-- GRIFFEN: (laughs) Everybody's heard of him. Well, Dr. Wangensteen was one of the all time great surgeons in this country. He was, uh, very innovative. Uh, it was his idea to marry, um, surgery and the basic sciences to get a PhD and in fact, uh, at the time that I was going through I spent, um, a little over two years in physiology and if I had spent six more months in physiology and instead of, uh, when I took my exam for physiology as the, as the second course it, for my PhD. Uh, I had to answer, uh, two out of five of the major questions, the long essay type questions, and seven out of ten of the short answer type questions. Uh, and if I'd spent six more months in physiology and then, uh, done, uh, answered three out of five of the big questions and all ten of the little questions, I could have gotten a Ph-, and passed them of course, I could have gotten a PhD in physiology. When I went home and spoke to my wife about the possibility of spending six more months in residency she said, having already spent about seven and a half years, she said, "Over my dead body," more or less. Well, we had a, at that point we had five children under six, so, uh, we had a, a house full of children and a, I needed to get out and make some money. She was right. So I got my PhD in, in surgery. But that was, those were fun years. Uh, those--that was back in the days when we got paid very little. Uh, we did get our meals at the hospital, uh, but we didn't, uh, we didn't get paid very much. We, I have many, many friends from that time that, uh, who, we've kept up our friendship. As a matter of fact, just two, uh, weekends ago I saw one of the persons with when--with whom I had been resident in Minnesota. He happens to be the--he was the chief of cardiac surgery at Hopkins for a long while and they live in Baltimore so we got together sort of half way between Baltimore and Philadelphia and had Sunday brunch together. So we've kept those friendships for a long time and that was a fun--we worked very hard. Um, you know, the residents today complain when you're-- when they're on a rotation and it's every other night. Uh, we were on every other night for the entire time of my residency and of course when you're the senior resident, you're on every night, basically. I mean, you're, you've got to be available every night; you're not on call every night, but, so that, uh, times do change. SMOOT: Yes. (laughs) You stayed on at, uh, Minnesota for awhile. GRIFFEN: Yeah, I was-- SMOOT: This was '65. GRIFFEN: Sixty, I finished, actually got my degree at the March commencement, March of '63, and I was there until the fall of '65. SMOOT: What were your impressions of, of being on the other side now, uh, at the University of Minnesota teaching and so forth. What were your impressions? GRIFFEN: Well, of course one of the reasons Dr. Wangensteen was so well known is because he insisted on teaching and research as part of your bag as well as doing clinical, uh, work and so we were teachers all during our residency. I mean, we really were expected to do the teaching, a lot of the teaching, and did. So that that part of it didn't really change very much. I mean I gave a few more formal lectures perhaps, once I got to be a professor rather than, uh, a resident, [knocking] but, uh, and of course I, but I was expected to do research and that was where, I mean I had by the time I graduated I had, I don't know, maybe sixty publications and, uh, in fact, that's why you should interview Tom Brower, because at my roast when I left here Tom Brower gave a fabulous story of meeting me for the first time and he said, "Here came this bright-eyed, bushy-tailed guy with a crew cut much as he has today, but a lot less gray hair, and he already had ninety-seven publications." He said, "Now, how in the hell could a young guy like that have ninety-seven publications?" (Smoot laughs) That's what he, that's basically, that's one of his stories. Any rate, we were expec-, so we were expected to do research. Only now we were expected to get our own money for it. Up until then, well, I had done resear-, I had spent two years in Dr. Wangensteen's laboratory and, uh, um, he, uh, came up with the ideas and he was the one that got the money to finance the research. Now that I was on the faculty, I was expected to get my own money, so, uh, that was a change. But, uh, basically it was just the same old thing, doing--except of course, I was now, uh, the ultimate response-, person responsible for patients. Uh, I wasn't the senior resident who could always ask the professor what do I do now, kind of thing. Uh, but I, uh, what Dr. Wangensteen was to imbue in you a desire to be an academic surgeon and that's why he was so great. And there's, uh, so many of his trainees all over the, uh, country at this point, at medical schools and many of them, you know, very well known. I was there of course, during the golden age of the Minnesota, what some people call the Minnesota mafia. I mean, I was there when Christiaan Barnard was there and Norm Shumway and-- SMOOT: Hmm. GRIFFEN: --uh, a whole host of people who were well known in the academic surgery world, uh, and it, it was a good time. SMOOT: What brought you to Kentucky? GRIFFEN: Ben Eisema-, there is a, a, Ben, well, Ben Eiseman brought me to Kentucky. There is a, uh, surgical postgraduate given at the University of Minnesota that has been going on for years, uh, always given in late May or early June, the middle of June, in that period of time, and I'll never forget it. Ben Eiseman was one of the speakers at the program in late May of 1965 and Dr. Rene Menguy, who would--was down here with Ben, uh, had just announced he was leaving and going to, uh, University of Chicago as the professor and Ben actually was looking at two people at Minnesota. One was myself and the other was a guy named Demitri Nickleoff, Jim Nickleoff, uh, and so Ben invited me to come down to look at Kentucky, which I did in June of 1965. I had always been an admirer of Ben; I am still an admirer of Ben. I think he's just a super, uh, academic surgeon and a, and a, and a really good force in the country. Uh, and I liked what I saw. And as a matter of fact, my wife, uh, has often said that she knew when I got back from Lexington that we were going to be moving to Kentucky because, uh, uh, she just knew I was all en-, caught up in the enthusiasm. But I did, I liked what I saw. I th-, I liked the physical plant, the way in which they had the various departments, uh, arranged, although I must admit I would have put surgery with physiology rather than anatomy, but I think to the non-surgeons who sat up the school, and let's face it, they were no surgeons really, in that first group. Uh, they thought that anatomy and surgery made a much better, uh, combination than, uh, physiology and surgery. Uh, be that as it may, I thought the concept of putting the clinical disciplines with the basic science disciplines and the whole geographic set-up, with the surgery department and everything being on the second floor you go, your office, your, the clinic, your, um, the operating rooms, et cetera, I just thought it was really, uh, forward looking and a, and a great place. In addition to which, I did meet some of the non-surgical people on my first interview and, uh, they all had great words to say about the surgery department, which they should, because it was a great surgery department. Uh, and, uh, I liked the surgeons I met, too. So I, yes, I, I guess I came home with a great deal of enthusiasm and my wife, uh, detected that. She's very good at that. And I must say, Minneapolis is an exciting town--I don't know if you've ever been there--but the weather is terrible. We used to say we had two seasons, winter and the fourth of July, which was about right. That year, uh, fall of '64, winter of '64, winter, s-, beginning of '65, we had a hundred and forty inches of snow during that winter, uh, so that we were getting a little tired of winter by the time that the first of May rolled around, when we finally saw the earth again. And, uh, I think that may have influenced us to some extent, but at any rate, when we first got down here we moved into a section of town which we were the last house on the block because it was brand new, it was out in Lansdowne, and, uh, uh, I didn't know it, but my wife was rather unhappy for the first six or eight weeks, uh, that we were down here. I was having a ball. I was going over to the hospital every day, it took me two minutes to get there by car and I could park right behind the hospital and just walk in and that was really neat. No, there were a, great deals, great advantages to it. But she, uh, hid her disappointment greatly. Very interesting, one of the biggest, uh, problems with my taking my current position, well, there were two problems, one was, was I going to leave the operating room, that was a big decision; the other one was whether we wanted to leave Lexington because we really grew to like this town very much. And we sort of look upon Lexington as our home. I realize this is where all our kids grew up and where our last child was born and a few things like that, but the fact is, is that, uh, uh, it's just, it's a good town and we've grown to love it. And of course it's, it's grown too. I remember when we first got down here there was Turfland Mall, it was, wasn't even completed yet. The New Circ-, the Circle road hadn't been completed and there were about two restaurants, Levas' and one other, in town and that was about it. And of course the town, as you well know, has just burgeoned since then. SMOOT: Hmm. Why didn't, uh, Mrs. Griffen like Lexington at first, uh? GRIFFEN: Well, as, that's, I guess that's what I started to say. Minneapolis had enormous, uh, many things to do. I mean, it had the Minnesota Symphony, which at that time was still called the Minneapolis Symphony, an excellent orchestra, uh, certainly a lot better than the Philharmonic when we got down here. The Philharmonic now is much better than it was, believe me. It was awful before. I mean, you don't even have to take that off the record. When Le-, uh, Leo Shear (??) was the, uh, director, it was just--in fact, Pug and I were on the search committee that got Dr. Zack to come down here, so we sort of feel partial to him. But any rate, um, and it had the, uh, Walker Art Museum, Tyrone Guthrie Theater, I mean, you're talking about some very professional and very good organizations, and this town had nothing. I mean, it literally, I used to say, we came down here and it was, uh, a little tiny town that had an agricultural college that happened to have a basketball team. And we weren't even basketball fans at that point because hockey was the big sport in the winter up in Minneapolis. So that, no, it was, it was just a sort of a culture shock for awhile. SMOOT: Hmm. But you were adjusting very rapidly and, in fact, uh, at the University itself. GRIFFEN: Oh, yeah. SMOOT: No problems there, uh. GRIFFEN: Well, I, I had a good time. For example, one of the first things that Ben did was to put me, Ben Eiseman. First of all, he made me in charge of pediatric surgery. I having not done any, I didn't do any advanced training in pediatric surgery. At that point in time, actually there wasn't such a thing. Uh, now, they have these two year pediatric surgical residencies, now, then, they didn't have any. But I was in charge of pediatric surgery and I, so I got to know Warren Wheeler very well, even though he and I disagreed on occasions. Um, and I, I'll tell you a little bit about that, that was sort of a fun time. But he also put me on the curriculum committee. They were, they were starting already, in '65, to think about revamping, the curriculum. And so I was the department of surgery representative. Uh, Story Musgrave was the department of physiology representative. Story th-, having done a year of surgical internship and then gone into physiology. So I got to know Story very well because of that. The representative from medicine was a gal named Barbara Bates, uh, who was a classmate of mine at Cornell, uh, with whom I violently disagreed about most things that she ever did. And she's in history, by the way, now. SMOOT: All right. GRIFFEN: I didn't know whether you knew that. SMOOT: No. GRIFFEN: She went out to Kansas, where they have a, a very big effort in the history of medicine, as you know, I mean that's Ralph Majors' old place and Seegress (??) and that group. And, uh, Barbara has, as I understand it, she, I don't think she even practices medicine now and she's in the history of medicine endeavor. But any rate-- SMOOT: Hmm. GRIFFEN: It was a good, it, I thought it was a great, uh, uh, committee. We had, we had great times together. We would meet for hours on end at night and talk about all kinds of things and how we wanted to restructure the curriculum. I thought we came up with some neat ideas, but, none of which got implemented, but that was all right. At least it, it allowed us to think out some things. Uh, one of the areas that Barbara and I disagreed violently on was this whole business of elective fourth year. I used, I said then, and I continue to say now, the elective i-, the idea of electives in the fourth year, particularly almost the total year being elective, is great for the good student because a good student will look at where the gaps in his or her knowledge is and will structure his, the elective year to fill in those gaps. The poor student, recognizing that he's got to get through medical school, and that means, does mean passing the fourth year, although at this point in time I think you can, if you get through the first year of medical school they rarely flunk you out, but that's neither here nor there. Uh, but the poor student, because he's got to get through that fourth year, rather than picking up on his weaknesses will go for his strengths so he's sure to pass, and therefore he comes out of the medical school with enormous gaps in his medical knowledge base, which I think is very bad. I mean that's--I'm just speaking as an educator at this point, but it does bother me that that does tend to take place. And of course the argument against that is, they say, well, every student has a faculty advisor, so that the faculty advisor should pick up on those things and do that. But you know what the faculty advising system is, the student comes in and says I want to take this, this, this and this, and you say, okay and sign off on it, you know. I'm, even, I as a faculty advisor, I must admit, did that. Although if students came to me and said they wanted to be a surgeon, I always told them to take everything nonsurgical they could. I used to tell you that reg-, I'd say, okay, what are you good at? And they'd say, well, this, this, this in surgery. I'd say, what are you good at in non-surgical things? Well, I know cardiology pretty well; I'm not too strong on pulmonary medicine. Take it. Uh, I'm not too strong on, I'm strong on gastroenterology; I'm not too strong on renal. I'd say, take it. Because, uh, a surgeon is an internist who happens to have some motor skills in his hands, quite frankly. That's my viewpoint of a surgeon and I think you need to have those medical background. Uh, so that's, but that's my own philosophy of how students ought to learn medicine. [Pause in recording.] SMOOT: What were your impressions of the administration at the medical center when you came here, Dr. Willard and, and his team? GRIFFEN: Well, I think, I think Dr. Willard was a very strong administrator. I knew that Dr. Eiseman had had his battles with him. Uh, and I--those were basically more philosophic than they were, and basically more philosophic about how to finance the institution. Uh, Dr. Willard felt that, uh, you could finance all of the institution by, uh, grants from research and things like that, and there's nothing wrong with that, I think that's fine, although I think that Ben, being a surgeon, and recognizing that already surgical, uh, research had not been funded as adequately has he, Ben, would like to have seen it, uh, felt that if any time came when there wasn't enough research money coming out of the federal government, and he felt that that time was coming, then they were going to be deep in trouble. In addition to which, he felt, and I felt with him, that, uh, the whole, uh, business of, uh, not really caring about whether you collected for patient care. I think that's a noble idea, but the fact is that it's not terribly realistic and, uh, I think there's--well, I think there's two problems with it. One is, that, uh, it doesn't allow, it, it doesn't, uh, make the hospital responsive to the patients' needs because they really are looking upon the patients more as teaching, uh, material than they are as a human being that's seeking some kind of help. In addition to which, quite frankly I think that it really in a way, uh, is detrimental to the doctor patient relationship and, uh, that, uh, disturbed me. In fact, I think that's part of this whole syndrome that I've talked about before, about the academic physician not being interested in patient care. If they can get away from that and not worry about whether they charge for it or not, um, then, uh, it doesn't give them a sense, as much of a sense of responsibility. And, uh, I was appalled when I came down here, because, uh, we were on--at that time we were on a full-time salary, which the department chairmen negotiated with the, uh, administration every year. Um, and, uh, actually as my wife is, is, uh, always pointing out to me, I took a 40 percent cut in pay to come down here, which is true. Uh, when I finally got all the bills that patients owed me from up in Minnesota. Well, there basically, there are several ways you can run a medical school in terms of its financing from the clinical side of it. You can do full-time, true full-time, where you, uh, get paid whatever the administration and your department chairman, uh, decide. The problem with that, I th-, I think is that that discourages patient care. Because if you, if you are an assistant professor of whatever and you're going to get paid the same whether you take of five patients, fifty patients or five hundred patients, since patient care is often delivered at odd hours, over weekends and night-time and stuff like that, uh, then what you do is, you don't take care of patients. And I, I saw that after I'd been here for two or three months; it was obvious that that's what was happening. Surgeons are crazy, they like to operate, so they will continue to see patients, but internists, uh, don't get a lot of thrill out of taking care of, just changing drug orders and stuff, so they stopped seeing patients and that's what was happening. Uh, as, as a faculty member in surgery, you often were talking to the residents, in pediatrics or medicine or whatever rather than talking to the attendings because the attendings hadn't become involved in the patient's care to any great extent. And I thought that was a--that was wrong, that was what's, was detrimental about a full-time system. Uh, but there are problems with the geograph-, so-called geographic full-time system, where the clinician earns money, uh, by his clinical activities. Uh, if, in that, if you don't have a tight rein on it at the level of the department chairman, uh, then the clinician who's very good at doing clinical things will do nothing but clinical things and he stops doing research; he stops doing teaching even, except as whatever teaching he does as part of his clinical activities. Uh, so you have to have a tight rein on that. When I got down here, I looked at both Cincinnati, that had a geographic system, and Louisville, that had a geographic system, but they had very, uh, they had--first of all, they had no university hospital. It was a municipal, city municipal hospital and the chairman of the departments didn't really hold a tight rein and several of the, uh, faculty members here were, had been at the University of Cincinnati and they said it wa-, the surgery department was a joke as far as a, a teaching, any kind of teaching went on. The residents ran, the surgical residents, ran the Cincinnati General Hospital with very little supervision. The might get a, have rounds once or twice a week, for example, uh, because the professors were all over at Christ Hospital or Jewish Hospital or Episcopal or wherever, uh, Holmes Hospital, doing their private cases because the university didn't pay them very much and they made their income on taking care of private patients, but they did it outside of the educational system. Of course here we could do the private patient care right here at the University Hospital, which is what I had at, when I was at Minnesota, and of course I had a very strong head at Minnesota that also insisted upon us doing research and teaching, so, uh, the geographic system at Minnesota worked very well. I think it worked very poorly at Louisville and Cincinnati and that's part of why I'm sure that the administration here, when it began, began on the full-time system. Um, and I fought a long time to get a practice plan in here that was, would be sort of in between those two extremes, the full, full-time and the geographic full-time that just went off into the wild blue yonder. And I don't know whether I succeeded or not, but at least we got a practice plan that, when I had been chairman for about five years, I was getting a little tired of bringing in young academic surgeons, having them, uh, work hard here, make a national reputation and then go off to some other place and get a 50, 60, a 100 percent increase in salary, uh, because our salaries were just not competitive. And whether you believe the double AMC figures or not, in terms of salaries in medical schools, we were at about the twenty-third percentile-- SMOOT: Hmm. GRIFFEN: --uh, at that time and then in '78 the practice plan finally went into effect and by 1980, actually '79, we were at the eighty-ninth percentile of the double AMC as far as faculty salaries were concerned, so, and we had a stable, relatively stable faculty, too, at that point. So I thought, think that was terribly important. But any rate, to get back to your question about the administration, I think it was a good administration. Dick Wittrup, who was the, one of the originals too, that was the head of the, or was the hospital administrator, uh, I used to, I was just, I used to be appalled at the fact that he really didn't have as much interest in collecting money from patients as I thought he should have as a hospital administrator. As a matter of fact, I can remember Dr. Norrell and Dr. Wilson, both of whom we'd been through the Oxnard Clinic for their neurosurgical training, uh, kept encouraging, uh, Mr. Wittrup to go down to the Oxnard Clinic to see how a hospital should be run. And as a matter of fact, one of his, uh, administrators, oh, what was his name, Cap--any rate, he did go down to the Oxnard Clinic and saw how to really run a first rate, uh, collection agency. And I don't know if you've ever been in the Oxnard Clinic, but they have, uh, they set up a f-, Oxnard Foundation to which monies go and they have a, they have a restaurant and a gift shop and a motel and et cetera, all associated with the Oxnard Clinic. All the income from those endeavors go into the Oxnard Foundation, which then supports research and travel and all kinds of things. Any rate, it was, I mean, in those days, ''65, '68, uh, it was--that was a new kind of thing. Nowadays, of course, it's the way to do it. Uh, but any rate, the reason I mention this guy, Cap, I think that was his name, is because he eventually became the hospital administrator at the University of Arizona at Tuscon and has done very well as a hospital administrator; has a very viable, financially viable thing going out there. SMOOT: Hmm. GRIFFEN: So I think educationally, it was a great administration. I think financially, it was not completely realistic, although I don't fault them because at that time there was plenty of federal money and it was pouring into this school like crazy because of the, uh, innovative ideas that the group had about educating physicians. SMOOT: Let me ask you just a little bit more about the money situation. Uh, because you, you came when, when salaries were kept at a fairly low level and eventually that changed, uh, to become more competitive. Uh, and when they started the medical center there was a great deal of fear on the main campus that all the money that they should be receiving, this is of course part of the-- GRIFFEN: Oh, I understand. SMOOT: --campus, not all, but they were fearful that part of the large portion of the money that they should be receiving was going to be going into the medical center, this new elite that was being set up over here on the other side of campus. GRIFFEN: They're still fearful of it. SMOOT: Yes. GRIFFEN: Even now. SMOOT: Uh, and within medical schools, I suppose one could say that the surgeons are seen as an elite within the medical school itself, so, uh, did you note, first of all, any resentment within the medical school, from other departments for example, when salaries were brought up, the changes were suggested and so forth? GRIFFEN: Oh yeah, yeah, the surg-, --every time, I know every time Ben started to raise, uh, questions about the way in which, uh, the fac-, clinical faculty was being paid, he always got thrown into his face, well, aren't you interested in the total medical school? Why are you only interested in the surgeons? And he kept saying, I'm not interested only in the surgeons; I am interested in the total medical school. I used to say the same thing because I had the same things thrown at me. I'll never forget one day when we had our meeting of our PSP group and, uh, the head of neurology, Dr. Clark, saying to me, he said, "I'm getting tired of you surgeons walking around like king of the roost." He said, "I've spent three or four weeks working up a patient in neurology and I get paid thirty-five dollars for it, I turn him over to the neurosurgeon, he does a two-hour operation and he gets a thousand dollars for it." He said, "It just isn't fair." Uh, and unfortunately, there are a lot of non-surgeons who look upon surgery as just that. It's still going on now. The surg-, the medical community is talking about cognitive skills versus technological skills as if the surgeons don't think any time when they're taking care of patients, all they do is put their little hands down and do their little thing. I mean it's just nonsense, but, uh, no, I heard it a lot and this was when was young in my chairmanship as a matter of fact, and I wasn't prepared for it. I probably should have been. I went back and I asked every one of the division heads to tell me how many patients they got from their counterparts in medicine. You know, the urologists, how many patients do you get from renal medicine, uh, neurosurgeons, how many patients do you get from neurology, et cetera. There was only one general surgeon, how many do you get from gastroenterology. There was only one group that really was dependent upon the non-surgeons and that was the cardiac surgeons, because the cardiologists did the cardiac caths and came up with the lesions and all that sort of business. Uh, neurosurgeons got only 10 percent of their business from our own neurologists. Uh, GI medicine gave us about 8 percent. SMOOT: Hmm. GRIFFEN: We got all the rest of them from referrals from outside of the medical center. And that was still going on when I left the place. SMOOT: Hmm. GRIFFEN: So that it hadn't changed one whit as far as I was concerned so that--this business about them spending all this time working up patients and then, and not getting paid for it and then, and it just wasn't true, but that, at that time I didn't realize, any rate, um, the one thing that did happen when I was asked to, uh, be Dr. Eiseman's successor, and I could tell you a little story about that if you want to hear it, but, uh, uh, because it does show you about search committees versus search committees versus search committees. Um, the, um, one thing I did ask Dr. Willard, I said, "You know, I, I think that the clinicians must be making more money than you all are letting on, uh, and I suspect that if we were under budget you would be on our case to make enough money at least to meet budget." And I doubt very seriously if we hit budget just right on target, so my only conclusion has to be that we're making more money than you have budgeted and I think that the departments ought to be given some of that overage in order to support some of their, uh, educational activities, uh, travel for residents or research or whatever. And they did agree, beginning in 1967, that, uh, the departments would get an overage. They still weren't to the business of giving it to the individuals based on what they made, but they were willing to give it, so we had, uh, a budget that came from the dean's office back to the departments to help finance some things and the clinical departments gave some of their monies and we also, uh, asked that the clinical department overage, some of the overage from clinical departments, be given to the basic scientists, so that they got something from us too. Uh, that's the one concession they would give to--that we still stayed on the full-time salary basis. Um, but any rate, to make, to tell you about my becoming a professor, in November of '66, Dr. Eiseman called Ben Rush, Les Bryant and me to his office and he said, "I want to tell you that, uh, before you hear it from the grapevine or read it in the newspapers, I want to tell you that I was, uh, uh, I have put in my resignation effective, uh, 30 June 1967, and the reason I'm telling the three of you is because one of you is going to be my successor." And we hadn't heard anything about it, we had no idea that was going on. So after that little bombshell and we had a brief conversation, then he left and the three of us were talking and finally Les Bryant and I, uh, were left because Ben Rush had to go off and so something and Les and I decided that Ben Rush should be Dr., uh, Eiseman's successor because he'd been here longer, uh, he been here the longest, he was the oldest, et cetera. And so then Les and I flipped a coin to see who was--go in and tell Dr. Eiseman and I got the honor of going in to tell Dr. Eiseman. Well, I didn't get to see him for a couple of days. I made an appointment to go in and see him and I walked into his office and I said, uh, "Dr. Eiseman, I, Les Bryant and I have discussed it and we think Ben Rush should be your successor." And I'll never forget it because he said, "Sit down, sonny." (Smoot laughs) I said, "Yes, sir." And he said, "I just have come back from Dr. Oswald's office and Jack and I have agreed that you should be my successor. Now, we're going to set up a search committee and Dr. Greene is going to be the chairman of the search committee, Jack Greene, uh, but we've already made the decision." And I was absolutely flabbergasted. I went home, of course that was the ultimate, I mean, that's what I had been looking for, uh, all this time and I had--when we originally came down to Lexington our idea was we were going to be here a few years and I was going to make my mark as an associate professor and then somebody was going to call me to come looking at a chair at some other place, not even, not ever thinking we were going to stay here. Uh, but that's how it came about actually. We did have a search committee and I went around and interviewed people and, as I say, one of the people I interviewed was Dr. Willard and I told him that I thought that, that's when I said I thought the departments ought to get some more finances from their clinical endeavors. So that's-- SMOOT: Hmm. GRIFFEN: --any rate, that's how it happened. SMOOT: Hmm. GRIFFEN: Unlike the current situation, where they're still looking for my successor. As I have said several times at national meetings, uh, that I am impressed with the University of Kentucky because they have their, obviously have their priorities, uh, correct. The basketball coach quit and within a week they had a new basketball coach and they're still looking for my successor. SMOOT: That was a great department that you were in, lots of big names in surgery-- GRIFFEN: Oh, yes. SMOOT: --were there. Uh, I'd like to ask you a little bit about some of those people, uh, the department in general. Uh, I suppose the first question I would ask is, what makes a great department of surgery? GRIFFEN: Well, there, actually there are two ways of, of developing a department of surgery, I believe. Uh, and I think Dr., actually Dr. Eiseman and I had two different ways of doing it. Dr. Eiseman believed in getting stars to join and that's what he did. He got Frank Spencer, who is still the professor and chairman at NYU, got Rene Menguy, who went up to Chicago as the professor at Chicago, but was a disaster, and that's another problem, uh, he had Ben Rush, who is now the professor at, uh, University of New Jersey School of Medicine and Dentistry, uh, had Les Bryant, who is now the dean at Huntington, but was, went, left here and went down to be the chief of cardiac surgery at LSU and then became the chairman at, uh-- SMOOT: Marshall. GRIFFEN: East Tennessee. SMOOT: No, East Tennessee, then went-- GRIFFEN: East Tennessee--was chairman of surgery at East Tennessee. SMOOT: Um-hm. GRIFFEN: Quillen-Dishner School of Medicine and then went to, uh, Marshall as the dean of the medical school. Um, Paul Weeks was here as the professor of, uh, plastic surgery and is, he took the James Barrett Brown chair of surg-, of plastic surgery which was the chair in plastic surgery at Washington University in Saint Louis. And you know, when people do that, uh, you-- they leave, uh, you have, an, sort of an ambivalence about it because they, uh, you, you want, you wish them well, you want them to go forward to this big, new job, uh, and it's sort of a feather in your cap, but on the other hand, you hate to lose them because you're losing such a good person and that's the way I felt about Paul Weeks leaving. Uh, Loren Humphrey was here, having joined the faculty just a year before Ben left and Loren eventually became, went down to Emory and then eventually became the professor at the University of Kansas. Uh, Myron Kaufman was here as a transplant surgeon and then went back to Milwaukee, which is his home town and, uh, uh, is doing transplant surgeon at--surgery, at the University of Wisconsin. No, it was a, it was a good department. And of course, Tom Brower was here and, uh, still is. Ken Walton was the, uh, became the chief of urology when, uh, Dr. Ray finally, uh, decided to retire and Ken was--then went down to Emory as the professor of uro-, professor and chairman of urology down there. Uh, so it was, there were plenty of big names and, uh, uh, and that was Ben's style, was to get stars. My style was to, uh, not get stars there were, well, I guess it was in a way forced on me because I couldn't get, I--the salaries were such that I couldn't, uh, coax the stars to come join, uh, I didn't have the charisma that Ben had to get these people to come in. The, uh, but the other thing is, is I wanted to get a department that was relatively stable, get people in here who would stay here and who would continue to work here and do their thing here because I th-, I always felt that you had to have some people who, you had to have indians, you couldn't have just all chiefs and, uh, so that was the philosophy that I worked on and as I say, I, between the salary situation and my own philosophy of how to get a department, I got in individuals who I knew were solid educators and would do a good job as far as the local scene of the department of surgery and if they got notoriety that was fine; they could get notoriety and, uh, then move on to bigger and better things, and some of them did. SMOOT: Um-hm. GRIFFEN: Some of them did. SMOOT: What about your impressions of the local surgeons when you came here? GRIFFEN: Well, the local surgeon, first of all, the medical community in Lexington is very good. I know that when the school was first, uh, started, uh, there was some concern on the part of the practicing physicians, particularly practicing surgeons, that they were going to lose their income and all that sort of business. Uh, I think that, again, I think that Dr. Willard, uh, did a good job of, uh, allaying that fear in pointing out that practically every place where a new medical school had started, if anything the income of the town physicians had increased. But there were some very strong people in town who were, were quite instrumental in helping the school. Brick Chambers was one, he was the health service doctor here, uh, at the university, but he also was in practice in town, or had a practice in town, and he helped enormously, as, as did Dr. Ray, uh, as did Dr. Coley Johnston, who was a surgeon in town. Coley was very, he was the president of the Fayette County Medical Society at the time that the vote, a vote was taken. I don't think the vote would have changed what Happy Chandler was going to do anyway because Happy was going to have this medical school come hell or high water. Um, and I think that Lexington deserved it. I don't think there was any question about that, uh, but I do know that there were some people in town who were not terribly happy about it. Another, another person in town who was very instrumental in helping was Francis Massie. Then when Ben came, one of the first things he did was, he did two things that had to do with the town physicians, town surgeons, which I think was very important. One, he established an advisory committee of some of the leading town physicians. I forgot to mention Dr. Ralph Angelucci, too. SMOOT: Um-hm. GRIFFEN: And that that advisory committee was made up of Francis Massie, Coley Johnston, uh, Ed Ray, uh, Ralph Angelucci, seems to me there was one other. And I don't think it was Jim Holloway or Dave Hall, but, uh, uh, they were sort of later. Any rate, uh, he, uh, had them as an advisory committee to give him advice. And I remember him telling me one time, uh, that, uh, that advisory committee they, they had, had one meeting and they were discussing something and somebody said, let's take a vote. And he said, "Wait a minute, you are an advisory committee, the advisory committees don't vote. You just give me your advice and I either take it or I don't take it, but we don't ever have votes about things." I remember that very well. But that was very important because that got the, the kingpins of the surgical community on his side. Then the other thing he did was, he started up a seminar and, uh, had invited all of the town physicians to come and held a quarterly seminar in the, in the evening and really got the guys talking to each other. Well, uh, by the time I came there was a very good feeling between the academic surgeons and the practicing surgeons and I never did anything but continue to support that, uh, constantly and do to this day. I mean, many of my good friends in town here are the surgeons in practice in town. Of course, I've contributed a lot of the surgeons in practicing in town too, through the residency program. But the fact is, is that, uh, I think that sur-, academic surgeons are more likely to speak sort of the same language as practicing surgeons as compared to academic internists and practicing internists. SMOOT: Hmm. GRIFFEN: You know, we set up the, Jim Holloway, Dave Hall, um--who was the fourth guy, somebody from Good Samaritan, but I can't remember who it was--and I, uh, got together and started the Lexington Surgical Society, which was an, which was an attempt to have a quality assurance, where we brought every, uh, all of the morbidity and mortality numbers from all the hospitals and discussed them in an open forum and it really worked that way for the first, uh, two or three years. Unfortunately, it's gotten like all surgical societies get, the Cleveland Surgical or you name it, uh, they get where they have somebody come in and give a talk, uh, and present some interesting cases, but they don't really look at the mortality and morbidity from every, uh, hospital, the way that we used to do. Part of that is because they, it's just gotten, you just don't do it, but the other thing I think is the legal climate is such that no one wants to hang out any kind of, uh, untoward happening at, at that level because, uh, of the legal implications that could ensue because of it. SMOOT: Hmm. You became chairman, this is 1967, is that-- GRIFFEN: That's correct. SMOOT: Um-hm. Uh, had to start working a little bit more on, on different levels and so forth, uh, what, what problems did you encounter? What, uh, opportunities did you encounter, in your chairman? GRIFFEN: Okay. Well, I'll tell you. The biggest problem that I had I think, and why I would advise, I, I saw why the military, whenever they promoted somebody to a command position always transferred them. Because suddenly one day I was friends with my colleagues on the faculty and the next day I was their boss. Uh, and that unfortunately, I think contributed to my making some decisions that were not good. Uh, for example, uh, when, uh, oh, another name I forgot to mention was Gordon Danielson. When I took over, Gordon Danielson and Les Bryant were in the department of, of, uh, uh, cardio-, or division of cardiothoracic surgery. Uh, and, uh, when--(pause)--oh, and Gordon was the chief. Gordon Danielson was the chief, he's now up at the Mayo Clinic. And Les Bryant came to me and complained one day that, uh, he wasn't being able to get as much of his thoracic work on as he'd like to, in addition to which Gordon Danielson was taking all of the consults from cardiology and he couldn't get any cardiac surgery done. Um, I, I spoke to Gordon Danielson about it, knowing that the Mayo Clinic had already started looking at him, and Gordon, the way Gordon took it was, well, obviously you don't want me around anymore, so I'm going to leave, uh, and did so and went to the Mayo Clinic. And I then talked to both Ben Eiseman and Frank, uh, Spencer and asked them if they thought that Les Bryant could, uh, do a good job as the head of cardiothoracic surgery. Uh, knowing, or having some concern actually, uh, about Les as, Les' ability as a cardiac surgeon, I wasn't concerned about his ability as a thoracic surgeon. This probably should go off, at any rate, I, I did eventually, I made, uh, after Gordon Danielson left, I made Les Bryant the chief of cardiothoracic surgery, then, uh, Joe Utley became chief and then Joe left and went out to San Diego and Ed Todd became the chief and Ed is still the chief there, as you know. Um, the urology situation has been stable for a long while, but that's because I was very lucky in being able to convince Bill McRoberts to come here, who I think has been excellent. Um, after Horace--after Charlie Wilson left and Charlie is the Naphsiger (??) professor of neurosurgery out in San Francisco and has a national and international reputation and Horace Norrell became the chairman. And, uh, Horace eventually went into private practice, he just got fed up with the academic scene basically, an excellent, excellent academic surgeon, but he just got fed up with it. He didn't have the patience that say, Tom Brower did for example. Uh, and I named Marty Blacker the chief then Marty was the, the, it, it had been Wilson, Norrell and Blacker and I named Marty Blacker. And Marty was super until he had his coronary artery bypass himself at the age of thirty-nine and I don't know whether that took something out of his sails or what, but he became sort of a non-operating neurosurgeon and the residents were complaining and all that, so that I called Marty into the office one day and said that I was concerned, that he just didn't seem to be interested in surgery anymore. And basically he said, "Well, it sounds to me like you don't have any confidence in me as the chief." And I said, "Maybe that is what I'm saying, but I think you've gotta." And so, uh, he decided to step down and I put Byron Young in as the chief and Byron has been the chief there ever since. And that's been, I don't know what it is now, twelve years or so, maybe longer. In the meantime, I had, uh, well, Bob Belin (??) had come down with me, not with me, but he came down, uh, from Minnesota; he was in his residency at Minnesota. He came down and he completed his residency here, uh, then completed thoracic surgery here also and then went into the service and decided he wanted to be a pediatric surgeon and although he never took a pediatric surgical residency as such, he, uh, did eventually get his tickets and he did head up the pediatric surgery division. Um, and then when Dick Segnitz, who was the only pediatric surgeon in town, had his massive coronary, uh, the pediatricians started contacting Bob to do work for him, uh, for them. And this is another interesting thing about, uh, the way in which, uh, this place runs administratively, the--Bob came to me and asked if I thought he could set up an office out in town and I said, "Well, they've let the ophthalmologists set up an office over in Versailles and do some work out there and I don't know the exact arrangements, although I'm told that they are able to make some money on it." And I said, "In addition to that, the renal medicine people are out there in Dialysis Inc., uh, as consultants and they are making money off of it. I don't see any difference between that and your setting up an office, so I said, "Sure, go ahead." And then about six months later I get called down by Dr. Clawson and said that Bob had to make up his mind and I said, "Well, I can tell you what he's going to do, he's going to go out into practice because he's not about to give up that office." Uh, which is exactly what he did do and we lost our pediatric surgeon, full-time pediatric surgery division. That wasn't only, that wasn't only because of the financial arrangements though. That's because Bob had some real difficulties with the pediatric department itself. I talked to Jackie Noonan about it umpteen times and got nowhere, so it just, uh, stopped there. Every time, most of the complaints were the fact that, uh, the nurse, many of the nurses on pediatrics, and particularly the neonatologists doctors on pediatrics wouldn't pay any attention to the orders that, uh, the residents wrote, even wouldn't pay any attention if Bob Belin wrote them. SMOOT: Hmm. GRIFFEN: And Bob said, "You know, that's just intolerable." And I agreed with him and I would talk to Jackie about it and Jackie would defend her nurses and say, "Well, her nurses were right." And I said, "Okay Jackie." I said, "You keep it up and you're not going to have a pediatric surgery division here before long." And that's exactly what happened. But that was just one of the unfortunate things. Uh, then as far as general surgery is concerned, uh, I think that it, it, it was fairly stable actually. Some of the people came out of our own program, Brack Bivins and Rick Bell, um, I did recruit Bill Meeker in here, who, who was a guy I knew from Minnesota from, and who was at Roswell Park at the time, subsequently recruited Charlie Sachatello from Roswell Park also, um, and got, uh, uh, Pat Hagihara, who just finished a colon and rectal, uh, residency and he, uh, came, um, down, then Mike Rom (??) came as the chief of the VA after we had Truman Mays at the VA for awhile and then Truman went into practice, uh, then Sally and Bill Mattingly both came on the faculty simultaneously. Bill in cardiothoracic surgery and Sally in general surgery, and Bill subsequently went out into practice and Sally stayed at the university. Um, and then, I think, uh, part of, uh, people's leaving when they left, uh, was dissatisfaction with the administration, whether it was my administration or whether it was the administration of the medical school, they always said it was the medical school administration. I don't know whether it was, probably a combination of the two, because they probably thought I should be able to do more than I was able to do. As an example, Brack Bivins and I tried for about ten years to start up a nutritional support service at our hospital. Every other university hospital in the country was getting them and it, and I got nowhere. Every time we'd take it to the administra-, hospital administration they would take it to their systems analyst people and their systems analyst people would come up and say that, uh, uh, it would lose money and we can't do it and so then it would get put back on the back burner and I couldn't get any support from any of the other people, uh, like the chairman of medicine and that sort of thing, so it just never, it never got off the ground. But that was one of the problems perhaps in the whole administration of the medical school. Um, we always took votes and, uh, wherever the majority went, that's what happened. For example, the emergency medicine department, um, there were two individuals who were very much opposed to it, myself and the head of OB-GYN. Uh, myself because I didn't want any--these ER docs doing things that they shouldn't be doing surgically, which I knew was happening all over the country and still is and Jack Greene didn't want it because he didn't want them getting these high-risk pregnant gals in there in driving labor and then having them try to deliver a child down there in the emergency room when they didn't know what the hell they were doing. But the vote was nine to two to establish an emergency medicine department because medicine and pediatrics and everybody thought it would be great to have people down there and then they wouldn't have to have their own residents down there, at least on a full-time basis. Uh, and that's the way it went. There was always, uh, votes being taken and in general I was always on the sort end of the stick and I would go back to the faculty and say, hey, you know, um, and, uh, I, as I say, I'm sure that they thought I wasn't being articulate enough in presenting the case for surgery, uh, but I was. At least I thought I was. SMOOT: Hmm. GRIFFEN: I just was in the minority most of the time on some of those kinds of decisions, uh. SMOOT: You would suggest then, it would have been far better had somebody with, with the right vision and leadership been in a position to make the decision rather than voting on those decisions. GRIFFEN: Well, I think so and I, but I also think, I can tell you that I had some great difficulty with the, uh, certainly two of the chairmen of medicine that I had to deal with. Uh, and I interviewed both of them along, as they were coming in and asked them both the same questions, are you gonna be interested in patient care? And they absolutely insisted that they were gonna be interested in patient care. Uh, and both of them turned out to really not be interested in patient care whatsoever. SMOOT: Hmm. GRIFFEN: And so they weren't pushing their, uh, faculty to see patients. But it, again, that's not just UK, that's true in the majority of medical schools today. I talk to my colleagues in surgery and they tell me the same thing. They can't get the professors in their medical school to see patients and I can't either. I mean, uh, example, I see a patient, uh, gall-bladder disease or whatever, they have high blood pressure. Okay, I'd call up Ted Kotchen, because he's the big high blood pressure person and say, would you please see this patient; I'd like you to see this patient and see the patient longitudinally. It's not Mrs. Gotrocks, but it's somebody that's, can pay their bills, et cetera. Oh, don't worry. So they--he would see the patient the first time, he might even see it the second time and then about three months later Mrs. Whoever would call me up and say, well, I'm going to see Dr. Perrine out in town or Dr. Hench or Dr., uh, Whoever. Um, and I'd say, why are you doing that and she said, well, I saw Dr. Kotchen a couple of times, he's very nice and he's very knowledgeable, but he said, sh-, then I, then I'd come in and I'd see a different doctor every time I would come in, who would be one of the residents, uh, and they would change the medication and ju-. And she said, I just, I don't feel as if I'm being seen in a, in a longitudinal fashion in any way. And that went on, and st-, is still going on, I can guarantee you. SMOOT: Hmm. GRIFFEN: And so that our department got to the point where the only people we'd call for a medical consultation were the people in general medicine, Sam Scott, Ralph Caldroney, uh, Sandy Riegler, because we knew, one, they would come and see the patient, two, they would continue to see the patient. Uh, and that's a shame, because that isn't, to me that's not the way medicine ought to be practiced, but that's the way it is practiced and that's the way it's practiced in many, many medical schools in this country. [Pause in recording.] SMOOT: We've talked about the outstanding individuals that were a part of the department of surgery here at the University of Kentucky. What about the student body? What about the students that were being brought in? GRIFFEN: Well, of course it, Kentucky is doing what it is supposed to do and that is educating its own population. Uh, there are several difficulties, number one, you know, we were mandated, uh, a number of years ago to have x number of black students in our, in our school, as well as black faculty, for that matter. Uh, it is very difficult for any state university and Kentucky is among those, to get the good black Kentucky students to come to Kentucky because they are going to Vanderbilt and Harvard and, uh, you name it, the high, the, the well- known medical schools, as they should. If they have that kind of talent there's no reason why they shouldn't go to those medical schools. But that does make it very difficult then for, uh, Kentucky to attract good Kentucky black students. Uh, and I don't know how to answer that, I really don't. I think it's, it's a problem, it's a difficulty, and I, I wish I had a, some kind of an answer, but I, again, it's, UK isn't alone in that particular aspect. Uh, and I think the same is true actually with getting black residents. Uh, we have difficulty getting black residents if they're going to be able to go and train at some high-power place, even though I know personally the training that they would get at our institution is superb and I'm very proud of the residents that we've turned out, they're good doctors, they're good surgeons, they're competent, they're safe, uh, they pass their boards, et cetera, et cetera. Uh, so that I know that the educational system, the graduate educational system, in surgery is good, uh, but it has been, it was, was and has been very difficult to attract good, black, uh, residents into our program. One of the, uh, graduates of our place, Robert Hatfield, I tried my best to get him to stay at, at, uh, Kentucky even knowing, knowing he was going into orthopedic surgery. He was a star football player at Eastern Kentucky University, was a AOA student at the medical school here, but he went to Georgia and, uh, is doing his orthopedics over there. Which is all right, I mean that's a good, good school too, but I tried my best to get him to stay and I tried to get a couple of others. Um, one thing about the student body though that, and I've made this point, and I made this point at, often at meetings. I think that the University of Kentucky Medical School ought to be given credit for, uh, taking some students who were deprived in their education, not because they were black, not because they were female, but because they were educated in Eastern Kentucky, where there are some very poor school systems. Everybody recognizes that. I mean, when I first came here, they used to tell me, they'd say, at Kentucky we always say, thank God for Mississippi, otherwise we'd be at the bottom of the heap educationally, you know. I mean, that's the kind of, kind of thing, and we took some students who really did not have the best of, uh, undergraduate education, elementary school on up, and taught them to be darn good doctors. And, uh, I think we should be commended for that. I often said I thought we ought to get some credit for that kind of, uh, arrangement, even though the person's skin was white, but, uh, of course with--it fell on deaf ears as far as any of the feds were concerned or whatever. But the fact is, they were deprived, had been deprived and, uh, so that they needed some education in a whole host of things other than just in their medical education. And I think that the student body is a, is a good student body. I never had any problems with them really. I used to say I would put the top five in any class in our medical school up against any medical student in the country. I might want hide the bottom five, but that's neither here nor there. SMOOT: Everybody wants to hide their bottom five. GRIFFEN: I suspect that's true. SMOOT: How do you think that the, um, department itself rated with other departments of surgery around the country, when you came, and by the time you left? GRIFFEN: Oh, I think that it was a recognized department. Everybody in the country knew about it. Uh, and we did some, some things, our, as a department, I always said and I said it in the, in the three narratives I wrote, that the, uh, our biggest deficiency was research. We did not have a high-powered research effort. Uh, but I felt that a department of surgery ought to be teaching medical students the principles of surgery and residents both the principles and the techniques of surgery, and if we did that well then we deserved to remain as a viable department, and I think we did do that well. Uh, in fact, I think we did it a lot better than a lot of other surgical departments in this country. I'll never forget it when one of our graduates, Ken Coster, went up to, uh, the Brigham in Boston. Uh, he called me up one night and he said, "You know, I had forgotten all about how ex-, how residents are exploited in big surgical programs." I said, "What are you talking about?" Because I remember he was a graduate of UK, went to Ohio State for his internship and halfway through his internship called me up and asked me if I had an opening in the surgery department down here because he felt that he was getting the shaft up there in terms of just being dumped on all the time. And, uh, he, when he got up to Harvard he got the sa-, he, he saw how the, the residents were getting dumped on all the time and how poorly trained some of them were. And I said, "Ken, you know, you and I both know, if you put, uh, five Harvard trained doctors and three Columbia trained doctors and one, uh, Yale trained doctor and a Kentucky trained doctor in front of a patient and said, now, this, these people are from Harvard and these are from Columbia, these are from Yale and this guy is from Kentucky, and you've got this serious operation you need to have done, who do you want to have done it-- do it?" The Kentucky guy would be the last one that they would think of and yet you and both know, Ken and I both know that you know how to do it as well as, and probably better, than most of those people even though they come from famous programs. Um, so I know that we were training them adequately. One other thing yet I can tell you. I was home one night and I got a call from a colonel who was flying to Washington and had stopped off at Louisville. He had been in Vietnam and one of our people who had been in our surgery department for only two years, he'd been, two years and then he'd been drafted through the Berry plan was over in Vietnam and, uh, this colonel kept asking who was in the medical corps, kept asking this, uh, person that trained with us, uh, where did you do your training and what year did you finish your training? And he kept saying he was, he'd only had two years. And, uh, the colonel called me because he wanted to verify that he'd only had two years. And I said, "Yeah, he was only here for the two years." He said, "Oh, my god." He said, "I can tell you, you ought to be proud of him, he can operate better than half of the people who have finished their training that c-, I've seen over there in Vietnam." And I said, "Of course, he got taught how to do it." That made me feel very good. That man, by the way, is still a professor of urology down at, uh, Emory. SMOOT: Hmm. GRIFFEN: When he came back, he'd seen so much kidney business over there and everything, gotten so, so interested in it that he, uh, went into urology. SMOOT: Hmm. What do you think has been the impact then, of the medical center and the department of surgery in particular. I suppose I should start locally and, and branch out, uh, on the standards of practice and competition and all these types of things. GRIFFEN: Oh, I think that it's done nothing but help the medical community in Lexington. I don't think there's any question about that. Uh, and I, and, and it always will, uh, and I think it ought to. Uh, I certainly know that surgery has had an excellent impact on the, uh, community. I think it's had an impact on, uh, the practice of sur-, again, certainly surgery throughout the commonwealth. First of all, we've turned out a lot of residents, many of whom are out practicing in smaller towns throughout, there's two up in Morehead, there's one in Winchester, there's Danville, uh, London, they're spread out and they, and they're doing good work. There are several over in Louisville, there are several here in Lexington and I, and they do do good, uh, safe, competent surgery. So I think from that standpoint it's had an influence. Uh, I like to think that the department of surgery has been a positive influence for the non-surgeons in the rest of the commonwealth, too. Uh, we always had a sort of open door policy. People could call us up and, anytime, night or day, and we'd take care of their patients and always have and I used to climb all over a resident and I'd get--somebody would call me up and say, your resident gave me a bunch of stuff last night when I called him. And I'd call him in the office to find out what went on, well, often times it wasn't quite that way, but I still told, would always say to the residents, you know, whenever a doctor calls you, you take the patient. You don't ask questions, you don't say, how much money do they have or can't you take care of this locally or anything. If they want to send a patient up here, take it, and if it gets up here and it happens to have a nonsurgical problem, so be it. We'll get the patient in the hospital and get it sorted out later, but that's what we need to do. I mean that's the sort of thing when, when they, one of the things that bothered me most about the way in which Dr. Bosomworth ran the, his shop was to always get in survey teams from outside, uh, various Touche Ross and all this sort of business and they'd come in and survey things and tell, they'd tell them what was necessary. The last one they had told them, one, they shouldn't get involved in trauma, because it was always lose money, and two, they ought to cut down on their Medicaid population from 33 percent, they ought to cut it in half so we had only 15 percent Medicaid. Um, those group, that group never went and talked to a single referring physician. They only talked to people at the medical center. I only saw that group for about an hour, uh, and that was partly my fault because I was out of town, but that's neither here nor there. The fact is though, they didn't talk to a single referring physician and when that announcement was made, and I got up at the buf-, at the pre-announcement thing and I got up and I said, "Who's going to take the blame for cutting out, cutting down on Medicaid? Is the administration going to take the blame or is it going to be thrown on us again?" Because if it's going to get thrown on us, we're going to g-, have egg all over our face and it's going to be those bad doctors up there at the medical center who are just greedy for money and don't want to take care of the poor folk, et cetera, et cetera and of course that's exactly what happened and the administration didn't take the blame for it and I knew it was going to happen because I knew good and well because we were, we're at the firing line. But the fact is, they didn't talk to the referring physician. The next time, one month after that announcement was made, I was part of the ATLS team, giving a course in advanced trauma life support, which Rick Bell had set up and which went all over the state along with Lou Flint. And I'll never forget it, because one of the sections is given on the relationship between the referring doctor and the accepting doctor. This is a, a, a form lecture of the ATLS program and they always have a question and answer period afterwards. And the first question, since Rick had gotten me to give that talk, the first question was, why did you all cut, why aren't you guys taking Medicaid patients? That was the first question. It wasn't--it didn't have anything to do with the ATLS and it came out, I mean they were upset, the referring docs were upset by that. And I, I never understood it either because I said when, at the time, I said, "You know, we're a state university hospital. What is our job?" Our job is to take care of the indigents in the state. That's one of the problems, I mean I tried to get Scotty Baesler to give us some money. Uh, and, you, because Jefferson County gives University of Louisville around six million dollars a year, I don't know how much it is now, but somewhere. Fayette County has never paid a dime to the University Hospital and we, and, a third of the indigent patients that we take care of come from Fayette County. SMOOT: Um-hm. You knew Dr. Bost of course, Howard Bost. GRIFFEN: Oh, yeah. SMOOT: How did that chime with what he had done? I mean after all, the man had been intimately involved with the development of Medicare, Medicaid programs in-- GRIFFEN: Well-- SMOOT: --Kentucky and the nation. GRIFFEN: Howard, Howard Bost and I, uh, although I operated on him twice, uh, were philosophically poles apart. SMOOT: Um-hm. GRIFFEN: Uh, I think he felt very strongly that, uh, doctors were paid too much, that they should take care of, uh, indigent patients and I do too. I think the worst representatives that the medical profession has are these self-righteous doctors who get up and say that they take care of every indigent patient that ever comes to them. Uh, sure, they take, make money doing what they do, but they take every patient, you know. Those are usually the physicians who do a wallop biopsy first and then send the patient on. And there are several in this town who do that constantly and yet they are the most vocal about providing care to indigent patients. That's the worst thing, it-- I mean, and we're, medicine is going to, if it hasn't already, gonna out price itself by these things. I don't, I th-, I personally think there should be a cap on how much an operation costs, but I also do not agree with Dr. Bost and the feds and a few other people who think that we should be, uh, salaried and sit there and take of anything that comes down the pike. Uh, I think medicine is headed in that direction and when it happens, what's going to happen is you're not going to see the doctors who are willing to put in twelve and sixteen-hour days. They're going to put in eight-hour days like, just like everybody else. And you're going to see a shift of doctors, rather than a single doctor taking care of you. And I personally think that's terrible medicine because that's when patients get taken care of by committees instead of by an individual who really knows what's going on with the patient. SMOOT: Do you think that might also be, uh, an idea that, there also might be an idea that this would be able to take of the s-, the surplus that is being projected for, uh, physicians in the future, uh, -------- --(??) ? GRIFFEN: Oh, yeah. I think if, if it changes that way, there won't be a surplus because, because the docs are going to spend, are gonna do eight-hour shifts. That's one of my, uh, complaints about emergency room physicians, because I, I, I can see the time when coming when there's going to be a trauma victim down there, they're going to be giving cardiac massage to, the bell is going to ring because five o'clock is up and the one physician who's giving cardiac massage is going to climb off of the cart and another physician is going to take over doing cardiac massage because his time is up. SMOOT: Hmm. GRIFFEN: I mean that's, to me that's what happened to nursing. Nursing is in deep trouble because they really are more interested many times in their shift hours and things like that than they are in providing professional care to the patient. And there are a lot of docs that are that way now, too. And I think between the, what we talked about before, the docs not spending much time with the patient and the, and the enormous fees that are being charged, it's going to kill medicine as we know it today. SMOOT: Hmm. GRIFFEN: And we, it deserves to be killed if it goes in that direction. SMOOT: Hmm. GRIFFEN: On the other hand, I just read in the paper this morning that, uh, my, one of my good friends, Charlie Preston, who's an OB-GYN man in town is getting sued by some gal because they didn't make the diagnosis of that there was something wrong in her blood and her child has now got a brain defect. That's the biggest bunch of nonsense that there is, but that's why the premiums for OB-GYN docs in New York state is second only to neurosurgeons for their malpractice insurance. SMOOT: Hmm. GRIFFEN: And why many OB-GYN guys aren't practicing OB anymore, the risk is simply too high, but that's a problem. SMOOT: Would you be willing to compare the administrations of Dr. Willard and Dr. Bosomworth? GRIFFEN: Well, I couldn't really do a good job because I didn't know Dr. Willard's administration that well. I mean, I, I only saw it for a year. Uh, I think that, uh, but I, I can say, I think that Dr. Bosomworth tends to allow things to happen rather than making a decision about something. Whereas, I had the impression that Dr. Willard made decisions. Uh, I may be wrong about that, but that would be my overall impression, um, and I, and I don't know whether that's good or bad. The other thing, of course as I've said, I've already said, I don't like this idea of bringing in other organizations outside of your group to make surveys. Uh, I know that Pete likes that, is very much in favor of that. I just don't like that style and as a matter of fact, I encouraged Pete at one time to read Up the Organization II, which is the second book by Bob Townsend, in, uh, which he says that if you have to bring in a, an outside group to provide a solution to your problem, you're the problem. I just sort of got the feeling that, uh, you know, we would say thin-, we as a faculty, would say things and, uh, say, this is the way we need to go and we never got listened to, but if a survey team said the same thing, then they got listened to and that's what had always bothered me. And then sometimes I think the survey team didn't do as good a job as they might have, uh, in looking at things. Uh, but then Dr. Willard had a very small group as compared to Dr. Bosomworth. I mean, you know, Dr. Bosomworth now is head of nursing and allied health and pharmacy and all that sort of business and, uh, it's a much more complex kind of an arrangement. SMOOT: Is that good? GRIFFEN: Not necessarily. Big is not necessarily better. SMOOT: Um-hm. GRIFFEN: I think, I mean, the tragedy of the, part of the tragedy of the medical school is with a capitation. They went up to the, whatever it was, 108 students or however many. They did so, by the way, without increasing faculty or space or anything, and it really did strain the system. And I'm not sure that we did a better job of educating the students because we had more students. And I hear that complaint too from these huge schools like Illinois and Minnesota, uh, and just, you know, two hundred and fifty students in a class, you can't get, possibly get to know the students. I mean, we had, uh, eighty-one in our class and w-, every professor knew every student. And that was the way it, that's the way it should be, I think, and I'm glad to see us starting to ste-, medical studen-, schools starting to cut back on students because I think that's important. SMOOT: Um-hm. What about the relationship between the University of Kentucky and the University of Louisville? Uh, you know, there's been a lot of talk about that and, uh, particularly in the early stages, before you had really come to Kentucky. GRIFFEN: Right. SMOOT: Did you ever experience any problems along those lines? GRIFFEN: No, but, uh, uh, again, I think the medical schools have been more, talking more to each other than the universities have for a long time, and it's always been that way. We've never had any problem. We didn't divide up the state or anything like that. We just, uh, did our thing and we used to--I mean, Hiram Polk would come over here and talk and I would go over there and talk and so would some of our other professors back-and-forth and, uh, um, I think that a lot of that is media hype business, as far as the medical school is concerned, I mean, it may be true of the universities, but it certainly wasn't true of the medical schools. I know that, uh, after I was gone there was the big flap about the higher edu-, council on higher education saying to close down the dental school and put a dental school here and a medical school there and all that sort of stuff and that maybe, at, at, that may not be all wrong. Uh, a state of Kentucky may not be able to afford two dental schools and two medical schools and two law schools, et cetera, et cetera, et cetera. Um, but you could have predicted that it was going to cause furor when it happened, uh, anybody could have predicted that. SMOOT: Hmm. What about the individual governors, uh, uh, over the years and their support of the medical school and medical center, as for it and so forth? GRIFFEN: Well, of course I don't think that they, they did support it, but I don't think they ever got challenged to support it, uh, in a, any meaningful way, which I guess is another, uh, strike at the administration. I used to say to, to all the deans that I was associated with, and to Pete on occasion, that I thought that they ought to be up there fighting tooth and nail for any kind of state dollars that came through and I certainly think that they should have been up there vieing with, uh, the University of Louisville in terms of getting equal, uh, equal, uh, support, which we did not get, as far as I'm concerned. I don't think the University of Kentucky got nearly the support the University of Louisville did. Now, I knew, know that Louisv-, University of Louisville was coming into the system and you'll always, always get more corning or going, uh, but I think that Louisville did get the better of the thing and I'm not sure whether it was because of our administration not really putting its best foot forward or whether it was because the power base in this state has been, and continues to be, uh, Louisville oriented as opposed to the rest of the state. I used to go down and give talks in Eastern Kentucky and I used to hear it all the time, there's Louisville and there's the rest of Kentucky. And I know you know, you're well aware of that, I mean, that's just the way the state has been for a long while. Uh, but I think we could have perhaps done a better job of, uh, convincing the state that the University of Kentucky, uh, needed something. I know that Dr. Singletary's approach was to get a good athletic program going and then the legislators would come over to the school and that is a viable approach. There are a lot of state schools that have go-, done just that, Ohio State is a perfect example of that. Um, I just would like to have seen it being done in some other ways, but, uh, and of course, I think that, I, I don't, I'm not privy to all of the things that went on administratively, but I do know that the budget for the medical center was sort of put in with the rest of the budget; it never was, uh,we-- our people were never allowed to sort of go up there and push our own ideas, uh, uh, which I'm not sure was a good way. That's why I say, the merger of the two schools under one head that would be sort of the same, at the same level as the two presidents, uh, is not all bad. Not all bad, I don't think. SMOOT: Think it'll ever come? GRIFFEN: I doubt it. I doubt it. It's going to take a lot of burying of hatchets to get done I suspect. SMOOT: Hmm. Um, you're in a unique position right now, uh, executive director of the American Board of Surgery, and you see a lot of different problems in a lot of different medical schools all over the country. Uh, what do you see as the major problems right now in medicine, uh, the trends? GRIFFEN: Well, I've said, I think I've said most of them, I-- SMOOT: Um-hm. GRIFFEN: I'm concerned about medical education, I think we're doing it poorly, uh, and I, that's not just UK, I think many medical schools are doing it poorly because we aren't teaching them medicine, we're teaching them technology. I, I say often, the last time I was on service was in May of 1984. We used to go around every afternoon and make rounds with the entire group, the students, the residents, everybody. Uh, one of their, uh, on-, the, one day we went around and this student gave the following history, we'd tell the students they should give a, the highlight, they'd do it in two minutes, but give the highlights of the history, the highlights of the physical examination, uh, what was found on laboratory testing and, uh, what the diagnosis is. This is what the student told me, this forty-eight year old lady came in through the emergency room last night with abdominal pain, her ultrasound showed gallstones. That was the entire extent of the presentation. I said, "Wait a minute, uh, there wasn't any other history? I mean, she's had this before or did it come on after meals or with the meal or what kind of pain was it, did you do a physical examination and what did you find on phys-?" Oh, yeah, we did all. I said, "Why didn't you say all those things?" He said, "Well," said, "the important thing is that we found gallstones with the ultrasound." I said, "Yeah, right." That's what I mean about edu-, medical education, I think we're in trouble as far as medical education is. Because we're not teaching them that, because we are aiming them at this technological explosion, which admittedly is fantastic. I mean, you can get to see inside of a head now, which we never could do before, without sticking a needle anywhere. Ah, that's just, but because of that I think that doctors are spending much less time with their patients and that's a complaint that I hear about from patients. But they are charging them more at the same time that they're spending less. The public isn't going to put up with that for long. They're just not going to put up it. Uh, the lawyers have convinced the American public that, partly the lawyers and partly television and a few hundred other things, they have convinced the public that if there is a bad result, it automatically means that the doctor has screwed up and so the patients then start looking for a way to be recompensed and the way to be recompensed in this day and age is to, is to put a malpractice suit out. And malpractice is driving the cost of medicine up by leaps and bounds. And I have a lot of lawyer friends who absolutely insist that is not true, but I think they are crazy as can be, because you, all look at what the premiums are costing, uh, but they've done a very good job of convincing, the lawyers, of convincing the American public that all doctors are rich, that you aren't suing your doctor, you're suing the insurance company and that a bad result means that the doctor screwed up. And that's all it takes to get lawsuits started. And although many of them do not go anywhere, they still are costly, both in time and in money and in stress, to the doctor. So I think that's a big problem in medicine. Uh, but I guess it all boils down to the fact I think that we're just, we're not educating people correctly and that may not be, it may not just be in the medical schools, it may start way down here, I mean, as you well know, colleges nowadays have, they're all aimed at getting a job, it's not at getting an education. And, uh, so those are the big, those are the big areas I think that are, uh, affecting it and I, from my own standpoint, when I look at, you know, we a parent certificate in surgery. Now we're giving out these certificates of special qualifications in whatever and our board has consistently said, those certificates are, uh, not to be used to deny people the privilege of doing an operation if they're capable of doing the operation, but that's exactly what they're being used for and people who possess the certificate of special qualifications, in vascular surgery, for example, are now trying to use it to keep perfectly well-trained general surgeons who have been doing vascular surgery for years from doing vascular surgery at the hospital because they don't have it. Bad way to go about things. SMOOT: What about the growing commercialization in, uh, medicine? GRIFFEN: Well, that, that's, I guess that's what I'm speaking about to some extent. I mean, uh-- SMOOT: Partly, I'm, I'm looking more towards a specific, in, in the private industry coming in, in the medical school in educate-- GRIFFEN: I understand, I understand what-- SMOOT: Yes, sir. GRIFFEN: --you're saying about the for-profit hospitals. SMOOT: Right. GRIFFEN: Well, I've, I have written it. Uh, I think it's, I don't see why a resident has to be educated in a poorly run hospital, mainly a teaching hospital. I don't see any reason why they can't be educated in a well run hospital. The problem that comes to it is when the resident decides they want to do something that's going to cost a little bit more money, but is out of the ordinary. Is he going to be allowed to do it or not? And if he isn't allowed to do it, you're going to stifle education, uh, and that could happen in the for-profit hospital setting. It may not, uh, and it possibly hasn't happened yet at the University of Louisville, but I think it may come to the point where it going--where it could happen. Uh, and I think that's going to be a very interesting time when it does happen and see what goes on. SMOOT: Hmm. GRIFFEN: Uh, but I think that the commercialization in terms of advertising, I think that can be bad because the problem is, is that you get the charlatans who are advertising and probably slicker at advertising than the non-charlatans. Uh, I just think that all those trends are bad, just because of the media hype kind of thing. I mean the tin heart program over there in Louisville is a perfect example of what I think is enormous media hype. Uh, I happen to think that, uh, we aren't far enough along on the artificial heart business to, uh, use it clinically, but those who want to use it clinically, that's fine, but why announce that, two days ahead of time that they're going to do it at seven a.m. on such and such a time so that they can get it all over the TV. I mean, we never did medical research that way before. We did it quietly and effective-, now I know that you get all of these reporters and they get on your case and all that sort of stuff. In 1966, I did a, uh, liver transplant over here. Um, and I wasn't even out of the operating room and they were, the reporter was calling. And I said, "Well, I can't tell you anything about this." I said, "It's going to be a year before I'll know whether this thing takes or not." It didn't, the patient happened to die at four months. But, uh, they said, "Well, okay, if you want it that way. I'll just get the information from one of the OR techs." Well, then what do you do? You know, then you agree to have an interview, which I did and I got my name and face on the front page and all that sort of stuff and what did the professor of pediatrics say? Why don't you learn how to take care of some of the common things in pediatric surgery before you go off and do those liver transplants? You know, in a way he was right and because he thought I was doing it just to get my name splashed around and I really wasn't, but that's the problem that occurs. Uh, and that's why you have publicity departments now or media departments or whatever it is. SMOOT: Hmm. GRIFFEN: But it's a bad scene. Those, that aspect of it is very bad. And as I say, it isn't all the legal profession, I think that, uh, expectations of patients are driven sky high when you have those kinds of, uh, television programs we have. It, here, you'd think every transplant in the world worked like a charm when you listen to some of the things that are said on television, it isn't true, and all the doctors know it. You'd think that we were on top of cancer for crying out loud, because of all these great breakthroughs in cancer. The mortality rate for cancer of the breast is the same as now, as it was when I went to medical school. SMOOT: Hmm. Interesting, because you would get that impression. GRIFFEN: Sure. Sure you do, sure you do. SMOOT: Well, do you see, in the future, some, uh, changes being made that will rectify these problems? GRIFFEN: Oh yeah, I think it'll change. I think what's going to happen is that we're going to go through a period of time when medicine is going to get put down greatly, uh, and the public, uh, is going to get fed up and, uh, at that point I think everybody in medicine is going to start looking at things and saying, you know, we've got to change the way we're doing something. And it may well be that we're going to change and not have a fee for service kind of arrangement, uh, but there's still going to have to be some kind of incentive for guys to put in the hours that docs put in. Uh, they're just not going to do it otherwise. Um, but there's also going to be a change because the young doctors that I see aren't going to work the way we did. Now, I don't say that the way we worked was right, we were probably crazy, uh, but I mean we used to take pride in the fact, if we had to stay up seventy- two hours straight to take care of surgical patients in one night, young guys aren't going to do that. They just aren't going to work that hard, uh, and that's not all bad, but I think from that aspect it's going to change and if it changes from that aspect we probably are going to not, we're going to go to some other system of payment and that's happening, look at all the HMOs and the PPOs and all those things that are developing now which are basically prepaid systems. Um, and if they can provide the, the best and finest and le-, up, most up-to-date kind of care, so be it; I think it'd be great. SMOOT: Hmm. Are there any other subjects you think we should be touching upon in, in discussing the history of the medical center and the department of surgery in particular? I try to ask this of everybody because there's so much that's in-- that is involved in a complex organization like this. GRIFFEN: No, I think that, uh, you have to look at the whole of medicine. You have to look at, uh, medicine in the United States as opposed to medicine in other countries. SMOOT: Um-hm. GRIFFEN: We haven't touched on that and, you know, of course I'm prejudiced, but I think medicine in this, and I haven't been to every country either, but I think medicine in this country is the best brand of medicine practiced anywhere in the world. Uh, they are, uh, the patient doctor relationship is a very special one as far as I'm concerned and needs to be preserved and if it is preserved, it, it, uh, will get, do away with a lot of this, things that we've been talking about. But I mean, you go over to a place like England, they s-, they practice superb medicine, they never tell the patients anything though. I mean, I've seen them pat a lady on the shoulder and say, well now dearie, you've got a tumor in your breast, and we'll take care of it tomorrow, and that's what she gets told. That's hardly, uh, informed consent. Uh, in Japan, they're even less communicative with their patients, even though they do, they, again, they practice good medicine, but the patients don't really know what's going on and I think it's good for the patients to question the docs and that sort of thing and, uh, and to be, uh, I think it's terrible when a law has to be passed that a doctor must give the alternatives to a patient. I think the doctor ought to give the alternatives to the patient that they want to. Uh, but I, I think it's still, it's the best brand of medicine practiced anywhere in the world and it is the most up-to-date. That's why more people come here than go elsewhere, and they're still doing that even though they're, um, so that I th-, and I think that the, so you have to look at the global, you have to look at this country, then you have to look at this state. And I think that this state is lucky to have a place like the University of Kentucky and I think it's a great organization and despite my complaints about the administration and a few other things, I do think that it's a, it's a viable, uh, organization and which I happen to love very dearly, uh, and have a great deal of respect for. SMOOT: Obviously, you came down from Philadelphia to-- GRIFFEN: Yeah, see, I came all the way down from Philadelphia, of course the fact that my children live here, some of them, that doesn't have anything to do with it. SMOOT: Are there any other topics you would like to touch upon this, this morning? I suppose it's still morning. GRIFFEN: No. Yeah, well, it's about time. SMOOT: Just, just barely. GRIFFEN: Uh, not really. I'd have to think about it a little bit more. Uh, and there may be some other things that I might, I could either write you or we could have another interview or whatever. SMOOT: I would appreciate that. GRIFFEN: I don't want to cut you short, but I do want to, I've got to get out to my farm and do a little bit of financial counseling and a few things like that, so. SMOOT: Well, my, I want to thank you very much on behalf of the University of Kentucky, and the medical center in particular, for giving so much of your time. GRIFFEN: You're quite welcome, I'm happy to do it. SMOOT: Thank you, Dr. Griffen. [End of interview.] Dr. Ward Griffen, Jr. (Chair of the Department of Surgery, 1967-1986) discusses becoming a surgeon, attending Princeton, Cornell, and the University of Minnesota, and then coming to the University of Kentucky as associate professor of surgery. Griffen speaks at length about the state of medical education, which he believes is in decline, and the state of medicine in general. He discusses the need for better training of medical students and the large role of technology in medicine, to the determent of patient care. Other topics include his time as the chair of surgery, analysis of Willard, Eiseman and Bosomworth’s administrations, the financial end of running a teaching hospital, and the relationship of the UK and U. of Louisville medical schools. insert here