About Us

Here’s two vignettes. There’ll probably be lots more as soon as I have a spare hour.

Christmas parties

Lynn and Joan threw the best Christmas parties! Their generosity and understanding of the true meanings of the holiday were a refreshing escape from what has become the materialism of the season. Lynn always had a Christmas tie, jacket, hat, socks, or all of the above. The most touching thing about Christmas, however, was how hard Lynn and Joan worked to make it a family affair. Children of residents, faculty and staff were all encouraged to attend!

The nail clippers

One of Lynn’s most endearing traits was that he practiced what he preached. He often said that “specialists ultimately get to the point that there’s nothing they can do. For the generalist, there’s always something we can do!” To prove his point (or more correctly, to live his creed) he carried with him a pair of nail clippers. When all else failed for his elderly, frail patients, he would clip their nails! They invariably left happier than they arrived!

—Arthur M. Fournier, MD
University of Miami Leonard Miller School of Medicine
Department of Family Medicine

Because of his 1965 article in JAMA on family medicine education (Teaching family medicine. JAMA 1965;191:38-40) Lynn Carmichael is seen by many as the first to stake out the  academic discipline of family medicine. His belief in new ways of educating doctors to do personal care in communities infected the entire country. If you ask those who started the first 15 residency programs in 1969 and those in the Academy who finally supported the idea of family medicine moving beyond general practice, everyone had been touched by Lynn. He inspired, pushed, cajoled and argued colleagues into the movement. He had the necessary tenacity to make family medicine happen. He was an evangelist, a preacher, a union organizer and a prophet.

Most of you know of Lynn and a few of you have met him, but you should have known what it was like to have him as a teacher.  A group of us began as residents in the Miami program in 1971, brought there almost literally from around the world - Alaska, Vietnam, Chicago, Texas, Cuba, Nova Scotia. In those days, Miami was like the Ellis Island for the discontented and the unsettled. Carmichael - as he has always been known to all of us - was a pied piper whose uneasiness with the status quo tapped into most of our own discomfort with authority. He was an authority figure who didn't trust authority. It led him to do general practice in the first place, and as that got comfortable in Miami, to move to a fellowship at Harvard studying family care at the least generalist friendly medical school in the country, and then to move back to a private medical school in Miami with his wife and colleague Joan to start a training program and a department. In some of my research at the Center for the History of Family Medicine, I ran across the budget Carmichael sent to the Dean at Miami for supporting the what would become the first model family practice center in America. It came to $25K and change in 1967.

Lynn was never much of a writer but what he did write, often published in hard to find journals, was always worth reading. His description of what in late 70's he called "the relational model of family medicine"  and the four elements of that model; affinity, intimacy, reciprocity and continuity; is the intellectual core of patient centered care. He read more widely than almost anyone I have ever met. He would bring handfuls of articles from obscure health policy journals, European journals, Science magazine, the New York Review of Books, or anthropology or psychology journals -to the morning resident seminars and began to talk. We dutifully sat there as he described how 90% of the doctor patient interaction was social grooming, like primates picking through each other for nits. We watched tapes and videos on sex education because he thought, rightfully, that there was little of that done in medical school and residency and it was an important part of family medicine's contribution to medicine. He taught us how holding old people's hands and cutting their toenails was a crucial component of geriatrics. In a prescient piece of administrative fiat, he banned drug companies and drug lunches because he believed they would influence our prescribing behaviors. He took us for semi-annual retreats to an island in the Florida Keys with seminars on everything from health politics to Rolfing and massage therapy. He brought people to speak about auras they could see around dying patients and people who could describe these new machines - computers - that they predicted would take the place of doctors and do everything better than we could do, except touch patients and listen to them with compassion.

Carmichael, in his peregrinations, had met and talked with family doctors and GP's from the whole world. He was the consummate social networker. He sponsored a seminar on research in family medicine in the mid 70's which was attended by almost every major figure in international family medicine and they all seemed to have spent time with Carmichael at some point. As people began to reform systems of general practice in countries throughout the world, they had inevitably heard or met Carmichael. He and Joan were invited to teach everywhere.

In 1971, he left to be a visiting professor in New Zealand for three months shortly after a group of us started as second year residents. He handed the keys, so to speak, to the residents and told us to run the program while he was gone - but said we had to keep good notes, learn to understand that with authority came responsibility, and that we had to write it up. We did. It was my first published article.

Carmichael was a runner before running was cool. He did not have a long skinny runner's body.  He was built like a fireplug. He pounded along driven, I think, more by determination than desire. He would always talk about how running was the only time he could think - it freed him up for something to enter. It was his time of Zen and of understanding what he was doing and thinking. Running helped heal him for whatever in life was the problem. And there were lots of problems, as there still are.

At the ceremony at the chairs meeting when Lynn retired, one of my residency colleagues, Don Cauthen, said "we often criticize people for not being able to think outside the box. I wish that Carmichael would, just once and a while, think INSIDE the box".  We never caught him lurking inside the box very much. He was infuriating, often frustrating, and didn't much like being disagreed with. Sometimes we argued with him. I don't remember ever winning one.  But he loved to be in the conversation. Always.

He started a discipline, a residency program, a department, the Society of Teachers of Family Medicine, and a journal. But  he always believed that there were more teachers out there, trying to show him something if he just listened. He was a constant searcher for new ways to do medical care. Rules didn't seem to hinder him. The list of things we did as "residents" would never qualify for any RRC list of essentials.

He partnered with migrant centers and community health centers and jails and prisons and little hospitals. We delivered medical care to protesters and delegates at political conventions. We even did rotations on the island of Bimini in the Bahamas, getting enough money from the residency program to get there but having to earn enough money over the long weekend to buy a plane ticket to get back home.  He never believed in the primacy of the physician in medicine but rather  that we served a principal role in the grand plan. We needed others - psychologists, social workers, nurse clinicians, community organizers, health advocates, and on and on - to make it work in communities.  Carmichael believed that doing family medicine was a group enterprise.

On one occasion, he said, in a room full of doctors, that he thought that the whole CPR thing was a medical industrial conspiracy to sell defibrillators and showed a medal that he was wearing that said "NO CPR". I asked him for a copy of it and he sent it to me.  I have it in my file, if not, yet, on my person. It actually says "I do not consent to the use of extraordinary measures to prolong my life."  I thought of that medal the last time I saw him. As we were walking to dinner, he took my elbow. He seemed fragile and his hand shook a bit. He said that he wanted me to know he had Alzheimer's. It seemed impossible that this man of such indomitable will who had birthed me into this discipline, whose eclectic ideas and community organizer's soul had pushed many of us to stretch beyond our careful, comfortable selves, was going to fade slowly away from his own memories and take up residence in ours.

Toward the end of an interview Lynn did in 1991, Bill Ventres asked him what his thoughts were about what had happened since the discipline started. Lynn looked at the camera and said "sometimes I think if I had stayed in practice I would be more content now".   Carmichael will be a searcher and an existentialist until the end.  I wish you all had known him.  He is our ancestor, yours and mine. We should thank him for what he has given us. But continuing to do what we do with skill and passion and joy, whether as leaders, or teachers, or researchers, or holders of old persons' hands is the best way to honor him. It is what he would prefer. I am sure of that.

—John Frey, MD
University of Wisconsin

I met Lynn for the first time in 1972- not without apprehension because of his brilliant credentials and position in the medical field. However, within minutes of meeting him, his quiet self-confidence and grace eased me into a totally comfortable zone. I came away wondering what his secret was, and concluded that here was a man who did not focus on himself but on those around him. Over the years I was struck by his total commitment to the welfare of patients. The patient always comes first has become a cliché, but observing Lynn was to really appreciate the genuine application of the sentiment. His kindness, gentle touch during medical examination, and humility were an integral part of his personality. This reinforced the fashioning of my own style of according medical care to my patients. From Lynn I learned that it is vitally important to listen to a patient instead of lecturing. Hold the patient's hand when checking the pulse- touching irons out tension and apprehension and makes for laying a foundation of a sound Dr./ Patient relationship. Make the patient feel at ease and render encouragement & above all hope, while being totally attentive and aware of the physical and mental stresses assailing the patient. Unfold and explain all options. Allow the patient to be in control of the best choice.
 
Each according to one’s own strength.  Some can lift more than others.  The important thing in life is to do one’s best. Not everyone can be like Lynn but trying to be like him is in itself an accomplishment. His vast knowledge, great understanding, incomparable humility, gentle demeanor, vision for the future of Family Practice, dedication and utter decency towards the sick and needy evident at all times remain- and always will be- an inspiration to me. I consider it my good fortune and privilege to know him. During this rough period of his journey he is in our prayers.

—Madhvi Sisodia
North Charleston, SC

At this time there are very few leaders in the medical school or at Jackson who are still here or who have not passed away themselves. No one remembers the “thorny” Lynn Carmichael. There are still many grateful patients who are in the community who I hope we will be able to encourage to fund an on-going legacy in the department in Lynn’s memory. It would really please me, if we could figure out how to obtain the resources to name the department in his honor. I think that would be a living legacy that he would have appreciated.

—Robert Schwartz, MD
University of Miami
Department of Family Medicine and Community Health

It must have been around 1957 when I first met Lynn. It was at Doctors' Hospital in Coral Gables, Fla. Dr. Corso introduced Lynn as his new partner. We shook hands and smiled politely. When I went home that day I told Meredith, my husband, that I had met a most unusual Dr. that afternoon. I told Meredith that this Dr. had the most beautiful blue eyes, and, I felt certain "he would go places"! The rest is history! I remember Meredith saying that he had never heard me say that about any of the many physicians I had met since I began my work as a nurse, so he had to agree this young Dr. must be special.

Some time later Joan visited Europe and stopped in Denmark and visited my parents. So we got to know each other better and became friends. When Lynn asked me to join his staff at  the department at family medecine, I accepted with joy. It was interesting and inspiring to watch Lynn teach his students to become family physicians.

Not one of the hundreds of people who benefitted from Lynn' humane approach was ever considered a patient but a human being, a unique being to be treated with love and respect.

We had a teaching session every day at the center at our lunch period and the students were often taped, interviewing a patient, and then critiqued by Lynn and their fellow students. A most effective teaching tool.  Of course it caused some anxiety, and I remember being approached by one of the students who asked me how he best could come through that ordeal. I told him to listen to the patient, not to write on the chart before but afterwards, to ask to the patient's family and to show genuine interest. I reminded him what Lynn always said, "Listen to the patient; he, she will give you the diagnosis.

It is only right that Lynn should receive so much accolade in his time, both from his own country and the many countries he and Joan visited all over the world.

I believe I was one of the first health educators attached to a Family department, and I remember one convention when a Family Dr. came up to me and said “I heard you were a member of Dr. Carmichael's staff, and you are not a Dr. I would never have a person like you on my staff for what do you know that I don't know better? I simply said to him "that is your choice, Sir, but it clearly shows the difference between you and Dr. Carmichael, you see he is a very courageous man that is why he is known all over the world." So there!!!!

What can I say that has not been said ever so much better!

Lynn is a pioneer and the world is a better place because of his loving, caring and intelligent approach to his fellow man.

—Vibeke Stewart

More remembrances