Fighting City Hall: The People's Medicine in Action (cont'd.)
Dr. Dan Doyle, a family practitioner who has devoted his career since graduating from the Worcester Family Practice Residency in 1977 to his rural practice in the coal-mining country around Scarboro, West Virginia, is a case in point. His practice at the New River Health Center in Scarboro treats some of the poorest of Appalachian families. As he wrote in a 1980 profile of his work, his first exposure to Southern Appalachia and the source of his admiration for its people, came from the region's music and from books by labor organizer Saul Alinsky. Doyle's practice philosophy, only 2 years after residency, helps to underscore why family medicine residents might have been disproportionately involved in the job action at WCH: "[One] thing I hope to accomplish, maybe the most realistic, is to raise people's expectations of what health care should be." Doyle's practice philosophy in fact captures the blend of political engagement and medical holism that were at the heart of the early family practice era. He called for physicians to make a "concentrated effort … to explain things to people, to learn and speak their own language in describing medical things, to perceive and to speak to their unvoiced fears, to treat the emotional anguish of illness as well as the physical, to discourage dependence on professionals and, instead, to encourage people to know their own bodies and be self-reliant … to demythologize the role of the health professional without denying the real role."(88)
After graduating from Notre Dame University and Harvard Medical School, Doyle took a break for two years to work as an orderly at Boston City Hospital and engage in community organizing and health education. Perhaps significantly, only a few years before Doyle worked there, Boston City had been the site of both a "heal-in" by the residents and a show-down between the senior medical staff and City Hall. In both cases, these actions were a response to the terrible conditions at the hospital for both patients and their providers. When Doyle began his residency at Worcester City in 1974, it was not long before he and the other residents discovered conditions akin to those at Boston City and many other municipal hospitals. A year and a half after the start of their program, the Worcester Family Medicine residents began to write up "Incident Reports" to document problems with patient care on the hospital wards.(89)
Clearly, the plight of City Hospital and its surrounding neighborhood were a moral provocation to some of the residents in this reform-minded cohort. Moreover, unionization for medical professionals was burgeoning, as we have seen. Once the residents began to consider how to organize, therefore, they made contact with the union organizer, Eugene (Gene) Petit, who lived in Worcester and was in contact with other house staff organizations in the northeast. Worcester blue collar culture had reached, according to Petit, a crossroads where the city's intensely anti-union manufacturers were losing ground to successful organizing efforts by government workers such as teachers.(90) At the time, Worcester was administered by a long-term City Manager, Francis J. McGrath, and his second in command, the lawyer Demitrios ("Dee") M. Moschos, the head of the city's Labor Relations Office. These were the men to whom City Hospital's superintendent reported. McGrath and Moschos, by effectively controlling the administration and budget of the City, also effectively controlled the budgetary decisions related to City Hospital.
The hospital's Main South patients, to the extent they registered and actually voted, were technically McGrath's bosses along with their chosen city councilors. But poverty, language barriers, and perhaps even employment by the city, often reduced the neighborhood's potential for active political engagement. Yet, Gene Petit, the residents' labor liaison and chief organizer, recalls a community of recent immigrants who did publicly protest on behalf of their neighborhood hospital and its young medical staff. At the height of the conflict, for example, the recently formed "Community Coalition for a Better City Hospital," as well as the specifically all-Hispanic "Committee for Organizing the Puerto Rican Community," organized public meetings and demonstrations.(91) This, he believes, was a testament to the residents' own engagement with the community. Petit, who also ran a local radio program featuring folk music, jazz, and bluegrass—often with local artists, remembers a strong ethos of community activism among that early Family Medicine cohort. He told us:
For the Family Practice docs, I think that unlike maybe some of the surgical residents or some of those folks, these were people who were out there in the community. They were really I think just starting up a lot of the family clinics … So they were out doing rotations into the family clinics, so they were seeing people in the community and stuff a lot more maybe than what some of the other people were. There was an attachment, I think, to the community. The family practice docs as well, on the whole, tended to be people who were interested in activities related to the people that lived in the community, whether it be cultural or music or whatever it happened to be. They found themselves not just treating people in the community but also in some cases going to some of the functions that were held. At some point some of that went the other way where the house staff association had a couple of functions that invited the community to come, and they were very successful. They were very well-attended, but more than anything else, I think it was the fact that the family practice docs were really "the heart and soul" of knowing what was happening to that hospital in terms of why it needed to be supported and why it needed to have adequate staffing and budgetary needs met.(92)