A Short History of Family Practice and Christ Hospital

In 1994, the UIC-Christ Family Practice Residency Program was born. But as is said of most human endeavors, we stand on the shoulders of those who have gone before. Our present success has depended upon that of the Rush-Christ program before us; and its success upon the vision of several family physicians at Christ Hospital in the mid-1970s. But it was not out of an historical vacuum that these physicians forged a new family practice outpost in the Chicago metropolitan area…

To trace the earliest roots of family practice, one has to go back to a time before computers, before antibiotics even before the germ theory. One must go back before the birth of Christ. . . . Born about 460 B.C. on the Greek island of Cos, a man founded a school of medical thought which moved away from the strictly supernaturalistic views of his day. He taught that each disease had natural causes and proceeded according to its natural order. (It is because of this that we speak today of a disease's 'natural history'.) But this is not the only thing which set Hippocrates apart in the history of medicine. His inclusive approach to patient management was revolutionary as well -- he taught his disciples to consider individual and environmental factors; he wrote: "it is necessary for the physician to provide not only the needed treatment, but to provide for the patient himself, and those beside him, and for his outside affairs." Indeed, this approach (not to mention the Oath which came from the Hippocratic ethical tradition) presaged that of modern family practice, which practices wholistically -- treating the entire patient in the context of the family and community.

The centuries which followed brought many great physicians. Galen, the Roman physician of 200 A.D., was a disciple of Hippocrates and served to pass on Greek naturalistic medical thought. Then it was Islamic physicians such as Avicenna of 11^th century Persia, who preserved classical Greek medical thought. During the middle ages, priest-physicians served in what were called 'hospitia' -- the term which has become "hospital" in modern English. These medical facilities were generally adjacent to a church or monastery and intended for the care of sick travelers and victims of disaster.

In 1543 Copernicus died just before the publishing of his magnum opus: "On the Revolutions of the Celestial Spheres." That work was the opening shot of the scientific revolution. And when Vesalius' work ("De Fabrica") was published that same year, medicine was vaulted into the scientific revolution as well. The advent of science altered the course of medicine as nothing before. The history of medicine is rich with great pioneers responsible for the relentless, stepwise progress which has led to the high quality of medical care of the present day, culminating in the development of Family Medicine.

In 1628, British physician William Harvey wrote about his discovery of the circulation of blood caused by the pumping of the heart, paving the way for cardiology. In 1796, English physician Edward Jenner developed a safe inoculation against the dreaded smallpox, paving the way for immunology.

After the United States won independence from Great Britain in the late 18^th century, a signer of the Declaration of Independence worked as a professor at the University of Pennsylvania for many years. In 1812 he published "Medical Inquiries and Observations upon the Diseases of the Mind." Benjamin Rush had written the first American treatise on behavioral medicine, taking the revolutionary position that mental disorders were as subject to medical treatment as physical ones. He firmly advocated for humane treatment of the mentally ill.

In the 1840s, several American physicians independently demonstrated the use of ether to bring painless surgery to human history for the first time. Pasteur and Koch established the germ theory of disease, and Lister then used Listerine -- no, carbolic acid -- as the first antiseptic. Roentgen used the X-ray for medical purposes, and then medicine was poised to enter the 20^th century with great potential.

In 1910, Abraham Flexner, commissioned by the Carnegie Foundation, completed a study of 155 U.S. and Canadian medical schools. His scathing report found standards to be low, and profit was seen as the top priority of most schools -- only six schools (including Johns Hopkins) received passing evaluations. In the wake of the Flexner Report, marginal medical schools were closed in droves, and American medicine was elevated from the "lowest to the highest status in the civilized world." In 1930, 80% of medical school graduates were general practitioners -- but the 20^th century has seen astounding scientific medical advances -- from sulfa drugs in the 1930s to polio vaccines in the 1950s, to new surgical techniques, organ transplants and diagnostic imaging techniques. As one disease after another was cured by this incredibly advanced science of medicine, many physicians were seduced into the belief that all disease can be reduced to the lowest common denominator -- a biological cause. Medical fragmentation into specialties focusing upon specific organ systems occurred. During WWII, the U. S. Congress approved military exemptions for medical students after graduation provided they went into residency training -- and there were no residencies in general practice. It is no surprise that specialty residencies burgeoned from 5200 in 1940 to 22,000 by 1952. G.P.s began to be in short supply, and health care was becoming increasingly depersonalized and expensive. Because specialists were expensive and clustered around hospitals in cities, there arose a problem of access for the poor and the rural.

Out of a sense of urgency for respect and even survival, GPs established a national society in 1947 -- the American Academy of General Practice. And they attempted to work together to answer the problems they saw, but with little success. By the 1960s, many in medicine saw the ART of medicine to be a poor substitute for technical knowledge. Hippocrates would have grieved.

It would be wonderful to point to the vision and collaboration within the Academy as the primary force leading to the great changes which followed, but in fact, it was external forces in the 1960s which gave the needed impetus. Even after the Medicare bill was signed into law in 1965, many found it difficult to find doctors to care for them and their families. Also, the rising social consciousness of the youth created idealistic medical students who believed strongly in the concept of personalized, comprehensive care. In 1966 the drive for a new 'specialty in breadth' was moved forward with several significant political steps. The National Health Council's Folsom Report, urged that every citizen should have a personal physician concerned with prevention…social, emotional and environmental issues, and with the patient as a whole and the family, establishing a relationship of a continuing nature. The AMA's Millis Commission and Willard Committee called for a specialty of physicians who focused not on "individual organs and systems, but upon the whole man", and recommended that the training of new family physicians should include extensive experiences simulating a family-oriented medical practice. (Such as our Family Practice Center.)

On February 8, 1969, the new "specialty in breadth" -- called Family Practice was approved, and the new specialty offered its first certification exam in 1970, at a time when only some 20% of the nation's physicians were general practitioners.

In 1961 Christ Hospital was established on 95^th Street in Oak Lawn. During the important years of the late '60s, a family physician from Christ Hospital was the chair of the education committee of the Illinois Academy of General Practice, and represented the southwest chapter of the IAGP in the national AAGP reference committee meetings … along with others, Dr. Martin Shobris argued in favor of the name change from AAGP to AAFP -- from "general practice" to "Family Physician." And in 1971, the Academy did change its name to the American Academy of Family Physicians, and it saw dramatic growth.

General practitioner Dr. Robert Heck heard the AMA's John Millis speak in Chicago in 1966. He unsuccessfully appealed to the Christ Hospital Medical Staff Executive Committee for a new Family Practice training program in 1968. But in 1971 a new relationship with Rush and state funding paved the way. In 1973, the chairman of the Department of Family Practice at Christ Hospital was Dr. Mark Kanaris, who supported the appointment of Dr. Robert Heck as the founding program director of what was tied for the 3^rd family practice residency program established in Illinois. And after securing the core teaching physicians, Dr. Heck welcomed the first class of eight residents to our program in July of 1974. In September 1975 the first FPC on 2 South was ready for patient care -- two fine young nurses, Doris O'Connor and Kathy Kieffer, were there to open the doors for the first time. It was a smaller, quieter, gentler FPC and during years when health care was kinder and less complicated. The nurses recall that in those days a non-FP attending said that the FPC was a waste of space and nursing. Dr. Eric Brueschke began volunteering one day per week for teaching at Christ in the year of our nation's bicentennial. Affiliation with Rush University in 1978 made the Christ Hospital Family Practice Residency the first university-affiliated family practice residency in the State of Illinois. Dr. Eric Brueschke, the department chair of Family Practice at Rush and Program Director, worked with Center Director Dr. Charles Range to train the first class of the Rush-Christ program -- including its future program director, Dr. William Schwer. In the year that Ronald Reagan was first swept into office, two new faculty members were added who would turn out to be two of the most important hires in the history of Christ Hospital Family Practice: Drs. Kevin Sherin and Robert Zitter. The program did well during the Rush years, adding such faculty as Dr.Thomas Dent (who served as FPC Director in the '80s), Dr. Diane Homan (who began Family Practice OB Training), Dr. Linda Douglas (Adolescent Medicine), and Dr. Cynthia Waitkus as Director of Research.

It was decisions in high places which brought about the dis-affiliation of Rush and EHS/Christ and the new relationship with UIC in 1994. But it was not a full severing of ties, as Dr. Jacquelline Bardwell, a 1987 Rush graduate (and former advisee of Dr. Sherin) then a new faculty member, agreed to stay on and become UIC faculty along with Dr. Zitter. Drs. Schwer, Homan, Douglas and Waitkus were the "transition team," maintaining a high standard of training for Rush and UIC residents alike as the new UIC faculty was being assembled. Dr. William Schwer and Dr. Elizabeth Burns (the UIC Head of the Department of Family Medicine) were able to locate Dr. Kevin Sherin who had wandered about in the public health sector for 1/2 dozen years or so. He agreed to become the first UIC-Christ program director. Dr. Sherin then met with a physician couple in late 1994 and wooed them away from their practice on the South Side. So Drs. Karen and Kevin Shannon started in June 1995, joining Drs. Bardwell and Sherin as the new UIC-Christ faculty.

In the spring of the year of President Clinton's re-election, Dr. Alex Li joined UIC-Christ after he finished training at the Ravenswood program, and a few months later Dr. Sangili Chandran came on board from the Swedish program. Also in 1996, an effective community preceptor, Dr. Stephen Bennett, was finally convinced to transition out of his private practice, and begin in a part-time capacity the same month as Dr. Chandran. So it was that the original core UIC residency faculty was compiled by Dr. Sherin. A year later Dr. Bennett transitioned to full-time capacity. But it was a great pleasure to bring a UIC-Christ graduate on as faculty for the first time in 1998 when Dr. Jane Kuzas (a former chief resident) came on board.

Early in its history in 1975, there were some 250 Family Practice residency programs in the U.S., including the new Christ Hospital program. By 1996, there were over 450 Family Practice training programs, and we became the first specialty to have residency programs in all 50 states. At Christ we have done what Family Practice residencies all over the country have done -- we have focused on our local needs -- whether they be the underserved communities in southern Chicagoland, or the preparation of family physicians for effective practice in a heavily managed-care environment, or the preparation of family medicine educators. Three such Christ graduates excelling in family practice academics are Dr. Edward Foley, the Program Director of the Rush-Copley FMRP, Dr. Carolyn Lopez, the Chair of the Department of Family Medicine at Cook County Hospital, and Dr. William Schwer, the Chair of Family Practice at Rush University. Last year we received RRC approval for an alternate underserved FPC in the South Shore community. Our partnership with Trinity Hospital, and notably Christ graduate Latifa Sabree, will allow us to begin outpatient training in this underserved South Side community in July 2000.

And today we at Christ Hospital train family physicians in the same way as our many fellow residencies across the nation and across the years -- to provide comprehensive, high-quality care in any medical setting; to see the patient in the context of family and community; to value the art as well as the science of medicine; to have the privilege of sharing a unique relationship with patients built upon trust and mutual respect and high ethical standards; and to be the patient's advocate in a complex and confusing medical and social environment. These wholistic goals of the specialty of Family Practice present a challenging endeavor in our day -- an endeavor of which Hippocrates would be proud.

...researched and written by Kevin Shannon, M.D., M.P.H.

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