Society of Teachers of Family Medicine

Remembrances of Lynn Carmichael, MD

Before I applied to medical school I knew I wanted to be a family doctor, but I didn’t know—in truth—what it meant.

He would say, “When the specialists say there’s nothing left to do for a patient, the patient needs a doctor.”  He would say, “This patient needs a doctor,” with the emphasis on the word doctor. This very sick person needs a doctor, a doctor to be there, just to be there—to provide care and reassurance, to bear witness, to listen, to explain, to share the small gains, the many losses, joys and pain that illness, particularly fatal illness, invariably brings.

He was not enamored of medical technology. As one of his residents I joined the eye rolling when he refused to embrace a new technological innovation. We would have to provide very good evidence that the new test or intervention or drug or treatment would provide outcome superior to the current tried and true way—and he questioned the “tried and true” too. He loved to say that family medicine could be done without electricity.

We learned never to refer to a medication by its brand name—only the generic was acceptable—and we would be  chastised for accepting anything from a pharmaceutical representative, the notion being we doctors should be well above being ‘bought’ for a ball point pen. From him I first heard the term “me too” drugs, drugs manufactured solely in the interest of market share.

When I was a senior resident in charge of the ward team, he would come to rounds weekly in order for the interns to report to him, on the day of admission, how long the patient would be in the hospital. He wanted the hospitalization plan completed by rounds on the first day. Why? The hospital is a dangerous place for people and we have to get them out as soon as possible, and too, emphatically, it’s too expensive. He would often ask, rhetorically, why was it so expensive to provide such bad care to people, especially poor people? He knew we were doing the best we could, even as he labored to change the system.

He taught me to touch all the patients I see, no matter what the reason for the visit. He taught me to put my arm around my patients when I listened to their heart. He knew that the embrace probably provided more for the patient than all that listening for murmurs or extra beats. 

As the number of years out of medical school and residency grew and my responsibilities in family medicine grew too, I’ve recognized on many occasions the prophecy of his perspective and of his practice. We now have names for what he taught: Evidence Based Medicine, Comparative Effectiveness, Generic Prescribing, Cost Containment, the Patient Centered Medical Home.

He taught the primacy of the patient. He taught the doctor patient relationship. He taught simplicity. He taught me the most important lessons of all of my medical education. He taught me—in truth—what it meant.

—Kathleen Klink, MD
Columbia University

I am so saddened to hear about Lynn's death and I also know, from our recent conversations, that it was his time and that for Lynn, as well as his family, difficult times have passed.

Lynn played such an important role in my life and modeling becoming a "missionary" for Family Medicine. His contributions to Family Medicine, and all of Medicine, in the US, were tremendous. In the current struggles about health, I frequently pull his articles to look for guidance and wisdom.

—William Shore, MD
University of California-San Francisco

Dr. Carmichael was like a father to all of us. His legendary contributions to the health care of poor and underserved in Miami-Dade County will last for many years to come. All of us in Miami will carry our fond memories of Dr. Carmichael with us forever.

—Behnam Djahed, MD
University of Miami

He did his life well. He influenced many lives for the better and always acted for the best. His effect will go on like the ripples from a pebble dropped in still water, but never ending.

—Sonja Lessne, MD

I first met Lynn Carmichael in the early 1970s when he was the only physician who would back up the medical students who were offering a free clinic at our Center for Dialog. I was immediately impressed with his courage and his dedication to justice. A lot of hippies hung out at the Center, so main stream physicians and others didn't want to get involved.

In 1972, Lynn invited me to join the faculty of his new department. Prior to that I had been working as something of a community organizer, so his focus on community fit my hopes and dreams perfectly. I also greatly appreciated his emphasis on the family and his devotion to his family. (He spoke very proudly of his 3 children.) Among Lynn’s many innovations, he advocated a team approach to care and truly seemed to value the opinions and perspectives of those of us who were not physicians.

I did some videotaping of Lynn with patients and had many other opportunities to observe him in his role as family physician. He was consistently kind, gentle, respectful, and caring. A terrific role model who was loved by his patients.

Hill met Lynn in the early 1960s when Hill was at Rochester. After Lynn attended the family health fellowship in Boston, he went to Rochester to meet with Bob Haggerty who had been the organizer of the fellowship. Because Hill was the lead person at Rochester at that time regarding medical education, Bob invited Hill to join them in some of their discussions. 

When the new field of family medicine was getting started, Lynn had the foresight to realize that most of the future leaders of family medicine were likely to come from practice, not from academia, so they needed to be prepared for this role. So, starting in 1967 Lynn brought Hill in to do a national workshop. Lynn and Lee Blanchard thought that maybe 25 people would show up. After all the discipline of family medicine had not yet been approved. Instead 95 people showed up. Many of the workshop participants went on to become the first chairs of family medicine and the first  directors of family practice residencies.

—Jane Westberg
—Hill Jason
Boulder, Colo

I was Virginia Williams in the 1970s at Lynn’s practice on the Jackson site. There with Linda and Heather and Hank Thompson and others. I often remember how Lynn hired me—one meeting and I was hired! He was very special and I kept him and his wife in my prayers when I learned of his dementia. His principles and love live on in his children and those of us whose lives he tenderly touched. My resume says that I worked with the ‘Father of Family Medicine’. Thank God for Lynn Carmichael.

—Virginia Harvin, RN, MS
Florida International University
Miami

I first met Lynn sometime in 1973, at the house on Banyan Drive, and I last saw him a few years ago in Berkeley, when stopping by a Christmas gathering at Cindy’s I think--a span of well over thirty years. When we first met, he was gracious, warm and friendly to the 17 year old interested in his daughter (a position I have now occupied several times myself—though I’m not sure about the gracious, warm and friendly part). In our last meeting, he embraced me with a long and loving bear hug, a sweet coda to our connection over the years. Lynn was a vital influence in my life, an ongoing source of support, affection, and lively conversation, as well as a model of the possibilities of living an engaged life. By engagement, I’m not only thinking of the social and ethical commitments he embodied, I am also very aware of his energy and immersion in daily life---he always seemed to be working on something--puttering around the house or in the yard, or tackling issues with the Family Medicine program or turning towards his patients—and he was always interested in something-nature, politics, his family. Thinking back, these energetic commitments meant a lot to me—not because they always mirrored my own interests, but because they seemed to embody a kind of gravitational pull towards the world---a life force that helped me counter my own anxieties and retreats.

Naturally, I have a storehouse of memories of Lynn. I think of his various outfits: the long nightshirt he would wear on his night time raiding of the kitchen (I somehow remember a stocking cap, but I think I’ve added that in); his stethoscope wrapped round his neck; the undershirt and shorts meant for hot days; the Christmas vests and regalia.

There are all the meals taken together, and the countless turkeys and Sunday dinners. Trips of various stripes, to various places: Dominica, Key Largo, Tucson, Taos, Austin, Louisville, New York, Philadelphia, Wilmington, St. Louis, Daytona, Palm Beach (a post hurricane Andrew escape). Speaking of which—the hurricane that so decimated the landscape of the house that he loved.

I remember the absolute joy and pleasure he spilled over with at the birth of his grandchildren. Accompanying Hallie in her first hours to the Jackson maternity ward. Taking up Lucia in his arms. Taking up people in his arms, hands, heart and mind was the essential Lynn Carmichael, which I was lucky to be able to observe first hand in the years of working closely with him at Family Medicine. He gave me the chance to offer my own version of this holding and healing, and I remember well the intersection of our work in the many hours of faculty meetings, private conversations, and his attendance at some of the Balint groups I ran—he had a genius for getting to the inner core of an interaction with a patient, I think in part because of the courage he had in looking into himself as a full participant in a relationship—not a transaction or encounter, or whatever the word is these days.

Of course, I saw him speak countless times. I particularly remember the time he gave a keynote address in St. Louis, and I was admonished for not keeping Hallie quieter in the aisles. I felt wronged because Lynn wanted his family around him. There was a cold (by Miami standards) night, a week or so after Hallie was born, where he insisted that she be brought to a public dinner so that he could enjoy showing her around (I held a different germ theory than Dr. Carmichael). I also remember the most nervous I ever saw him (not the most worried, that came when someone was ill or hurt, the day of Chris’ accident at Mt. Shasta for one)---he had come out to Berkeley to give a talk to Cindy’s medical school class at the joint medical program. He gave a lovely talk to the small gathering—but he was clearly anxious (at least clear to me), sweating a bit, and doing a lot of that gesture of reaching over his head with his arm to fiddle with his ear on the other side. It was touching to see this inspirational and practiced speaker grow anxious at the prospect of disappointing his daughter’s classmates.

And though I associate Lynn with doing—with putting things into action, and with quiet—sitting silently on the porch as the evening darkened, I also remember a lot of talk. Talking about economics, history, and politics, talking about medicine, psychology, and social action. Talking about memories. There are few people with whom (other than with psychoanalytic patients of course) and few times in life where such sustained conversation is possible or obtainable. 

I got to see him inspired, tired, energetic, flagging, and on more than a few occasions upset and angry. His upset was not something you wanted to come your way, and luckily I don’t recall getting in the line of fire. Maybe a moment or two when I couldn’t get out of my own way on the sailboat, or some residency problem or disagreement…but what really stands out is his capacity to reach out beyond his preoccupations of the moment, when it really mattered. His children and grandchildren really mattered. The people he loved and cared for really mattered. I know that I draw on his example.

Of course the last years have been sad and painful. It was a terrible thing—even from afar—to know of Lynn’s decline from his vital and searching life and mind.
I remain grateful however for all the times that I had with him, for all the ways he touched and taught me, and for his continuing impact on those I hold close.  

I miss him.

—Jed Sekoff, PhD

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