Transformation that works

Visiting Primary Care's Past, Looking Toward Primary Care's Future

Categories  |  Healthcare Leadership

 |  By Catherine MacLean

Recently, the CIPCI Team visited an historic Hartford landmark, the Isham-Terry House. Our team hoped to learn a bit about one “Primary Care Office of the Past” as a complement to our work on the Primary Care Office of the Future. From 1896 until his death in 1949, the house was home to Dr. Oliver K. Isham, a practicing physician. Dr. Isham lived in the ornate and stately house with his mother, father, and sisters.

His sisters lived in the house until their deaths in the 1970s. They left Dr. Isham’s office, and the whole house, largely untouched after his death, so his black doctor’s bag, forceps, and other instruments remain just as they were on his last day of practice.Dr. Isham primarily practiced what today we would consider Family Medicine—delivering babies and providing prenatal and obstetric care to women, and taking care of whole families for the balance of their lives. The neighborhood was once a thriving community including many recent immigrants, and Dr. Isham made house calls, while also seeing patients in a small office in the house, his front hallway doubling as a waiting room.

On Dr. Isham’s desk was a blotter advertising an iron compound—a giveaway from a drug company in the 1930s or 40s. This particularly struck me, because I had always thought about pharmaceutical advertising as a recent development in medicine, but it is much older than I ever would have guessed. Dr. Isham may have acquired the desk blotter at a meeting or conference he attended, or a pharmaceutical representative may have come calling at his practice, just as happens today.

Our wonderful guide to the house, Laura McCarthy, retrieved some items from the archives, including many of Dr. Isham’s handwritten notes, kept on scraps of paper or in his prescription pad, as well as medical journals and textbooks of his day.

Also retrieved from the archives were the forms Dr. Isham had to submit to the IRS declaring how many tablets of morphine he had on hand for tax purposes. This regulatory rule was not in place when Dr. Isham started his practice, and it was interesting to imagine how he dealt with change over the course of his career, as new medications, treatments, tests, and regulations came and went. The necessity of keeping up with change is still a familiar part of the primary care physician’s practice today. One of CIPCI’s major goals is to assist providers in keeping pace with this change through support and educational offerings.

Laura also spoke about the changes in medicine at the end of the 19th and beginning of the 20th century. Previously there had been many varieties of practitioners that a family might have called for help - from midwives to compounders to faith healers, and physicians were included in that roster. As the 19th century ended, physicians sought to consolidate their professional prestige and establish their scientific authority. This drove the establishment of new professional societies such as the AMA and the ACP, and new medical journals. However, this also pitted different types of providers against each other, and made collaboration difficult.

Each of these—the pharmaceutical ad, the regulatory paperwork, and the professional consolidation of medicine—reminded me that many of the problems we face in primary care are much older than we would first assume. The historical perspective the Isham-Terry House provided is important to consider as we look forward and attempt to solve some of these very old problems, and deal with new ones that arise. In many cases, the future of primary care may end up borrowing from the distant past: doctors may soon come in to a patient’s home via telemedicine technologies for virtual “housecalls”, and a wide variety of providers will be involved in a single patient’s care, though now as a coordinated team rather than competitors.

While CIPCI prides itself on envisioning the future of primary care and transforming the present, it was a treat to be able to learn about, and learn from, the primary care office of the past.                                                                                                            

All photos courtesy of CT Landmarks, Isham-Terry House
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