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Transcript on deposit at The Southern Historical Collection, The Louis Round Wilson Library
Citation of this interview should be as follows:
“Interview
R-0019, in the Southern Oral History Program Collection #4007,
Southern
Historical Collection, The Wilson Library,
University of North Carolina
at Chapel Hill”
James Slade was the second African American to attend medical school at the University of North Carolina at Chapel Hill. He started there in 1952, embracing the challenges and limitations of attending UNC-Chapel Hill, including one racist professor. Slade eventually decided to become a pediatrician: the specialty attracted warm-hearted doctors less prone to prejudice. He began private practice in Edenton, NC, in 1965, where for many years he was the only black physician. In this interview, he recalls the gradual integration of medical practice in Edenton and describes his experiences as one of very few African-American medical professionals in his area. Slade, who is joined by his wife, Catherine, focuses on the challenges of medical care at the intersection of race, poverty, and rural isolation. Poor patients, black and white, had a unique set of needs that Slade worked to serve despite limited access to medical technology and peers with whom to collaborate. As he did so, he earned the loyalty of a black community that in addition to its unique medical needs—such as treatment for diabetes and hypertension—made unique demands of its doctor. Toward the end of this interview, Slade also describes some of the changes that have affected the business of medicine in the past few decades and his concerns about the health of the black community.
Pediatrician James Slade and his wife, Catherine, discuss their experience of race and medicine in Edenton, NC.
[START OF TAPE 1, SIDE A]
Earlier, North Carolina would supplement black students to go out of the state. When I applied to medical school, it was 1952. At that time, I also applied for out of state funds, because North Carolina was just beginning to accept black students. In fact, there was only one black student accepted before I was. Before I was notified whether I had received any out of state funds, I had been accepted at UNC. I did get an offer to go out of state, to Meharry Medical College in Tennessee, but I turned it down. I think shortly after that they discontinued that program.
What made you choose UNC over Meharry?
I could say it was closer to home, but not really. When you're young, you don't mind challenging things. I felt that I could do as good a job as those guys at Duke and Carolina and other places. It was a challenge. I applied to about five medical schools, and got accepted to two. Even if I had gotten some funds to go to Meharry, I didn't really want to accept it on that basis. It was supposed to be for when you couldn't go to medical school in North Carolina, yet they were willing to give it to me to go out of the state, which I felt wasn't the way it should have been done, so I turned it down and went to UNC.
At UNC, things were pretty good. There were a few instances. There were only two of us at the time. The other student was named Edward Diggs, he was two years ahead of me. He helped me over some of the ropes and things. Some of the guys in my class would come over and study with me, so it wasn't that bad. There was one professor who thought blacks were inferior. I will say that in his grading he was fair, so he didn't carry that over into his classroom. The only weak spot in training at Chapel Hill was in OB, because they wouldn't allow the black students to do deliveries, except on black patients, and there weren't very many black patients in OB at Chapel Hill. Even so, I learned obstetrics, even though that wasn't what I wanted to do. I did OK academically, but from the practical standpoint, it was limited.
That professor that you mentioned, was it generally known that he thought blacks were inferior?
He would write in the school paper, he didn't try to keep it secret.
Was there ever any kind of personal competition between you?
In the classroom, if you hadn't read the article in the school paper, you wouldn't have known it. He was fair, he didn't try to bring that into the classroom at all. He graded you on what you did, so I didn't feel that was a handicap at all. Aside from weakness in obstetrics, everything else was pretty straightforward, and pediatrics was great. I eventually went into pediatrics.
How did you get interested in pediatrics?
It really began in medical school, because you were not limited in any
way on the pediatrics floor. The residents were good, and the head of
the department was nice, so you had a full range. It seemed like I could
Do you think there's anything about pediatrics itself that made it that way?
It's hard to discriminate against children if you've really got a heart. A sick child is touching regardless of what color they are. The fellows who went into pediatrics, if they had prejudice, they probably lost it along the way. But they did not demonstrate it from what I could determine. That was back in the '50s. From there, it was really the beginning of my love for pediatrics. The other services weren't as open as pediatrics was. The classmates were fine, we got along OK and didn't have any problem. I will say that all of the professors were open-minded. They didn't bend over backward, but they didn't try to hinder you at all.
One of the things that really surprised me, and they could have easily left it off, was that I was accepted into the honor society my senior year. I didn't know it existed! I had never heard of the Alpha Omega Alpha honor society. They did induct me into that, and they didn't have to do that, because I didn't know anything about it. They could have easily kept me out of it, but they didn't. So I thought that spoke well for the faculty at Chapel Hill. Experiences were pretty good, except in obstetrics.
I graduated in '57, and went to an internship at the University of Pittsburgh Medical Center. I got married after my internship, and then went into the army for 28 months. After the army, we went out to Los Angeles County Hospital for my residency in pediatrics. We stayed a year and worked out there on the staff, and then I took my boards in pediatrics and came back. We arrived back in North Carolina in September of '64, but we didn't begin practicing until March '65, because there were a lot of things to get straight. This was the days when no hospital guaranteed your salary and provided you an office space, like you have these days. That was foreign. You got out and found your own office. If you needed some money, you borrowed it, and developed your own practice. It took us a while to get the office fixed up straight. But eventually, March 1, 1965, everything was set up, and we got started.
Was it difficult for you to set up a practice solo? So many people practice in groups now because of the expense.
It was a little challenging. Nobody helped you out, except your family. My wife and I would go over to Norfolk and buy office equipment and haul it back.
So Norfolk was the closest place you could get equipment?
Because we were looking for some that wasn't too expensive.
We got some used equipment over there. We didn't have any
help from anybody locally, so it took us a while. We dealt with Wayne
Drug Company, and he was real nice in letting us have supplies, and
Carolina Surgical. They
You also did general primary care?
Yes. I did not do obstetrics, except for a while, I'd follow the ladies until the fifth month, and then I'd turn them over to the guys who were doing OB, but I eventually gave that up. Even though we saw adults, our primary interest was children, and people had a sense of that. If people had a real sick child, they would bring them by, even though I did see adults. Probably '66, the head of the health department in Plymouth County came over, and asked me if I would run the clinics there. I told him yes, and I've been running the clinics in Plymouth since. I started out once a month, and now we do it twice a month, since the late '60s, early '70s. Then Elizabeth City asked me to do theirs, then Hertford [County], and finally Edenton. We've been doing those since then, except Elizabeth City, since they have several pediatricians now. I haven't been doing theirs for seven or eight years.
When you started practicing in 1965, how many primary care physicians were in this area?
We only had one specialist, a surgeon, when I started. The medical center had six physicians, and there was Dr. Walker and Dr. Holly, who was about to retire. About seven in primary care, I would say.
Would you consider this an underserved area at that time? Because for a rural county that's actually pretty good.
You have to think about a place like Hertford, that had only one. Hertford County is much larger than Chowan County. Edenton has never been declared underserved since I've been in practice. For the size of Chowan County, with about 12,000 population, we had more physicians per population than the surrounding counties, except maybe Elizabeth City.
Of those physicians, did all of them serve black patients?
Yes. And there was one black physicians who was in his late eighties when I started practicing. He died shortly thereafter.
: So after he died, you were the only black physician in the county. Did that continue to be the case?
Until about two years ago, when we had a psychiatrist come to town. I should qualify that. Since the emergency room has begun to hire physicians, several black physicians serve there.
Another doctor told me that the physicians in the town would serve on emergency room duty.
Absolutely. We did that for many years, and that was one of the reasons
why I didn't want to move to far away from the hospital. A
lot of
Were you able to get admitting rights to the Chowan County Hospital?
Yes, that was no problem. It probably would have been difficult for them to have done anything. What did happen, the black physician who was here, who was close to 90 when I arrived, he was on the hospital staff, but not the emergency room staff. When I applied, the administrator told me that there was a section of Chowan County that if I was on the emergency room staff, I might run into a problem. What happened was, the doctors, who were mostly around my age, didn't like the idea of me coming on staff and not taking the emergency room call. That just meant more work for them. So I was put on emergency room staff with no problem. The interesting thing is, the very section of the county that he thought would be a problem was the first section I had white pediatric patients from. I've never had any problem in the emergency room from patients from any section of the county. He was not up to par in his thinking.
Since you were the second black student admitted to the UNC Medical School, did you ever have a sense of how you ended up being the one to be accepted? It must have been quite difficult.
At that time, you applied to medical school with all your credentials, and then you had to go down for an interview before they would accept you. I had an advantage, because I had already been accepted into Meharry. When I went down, I wasn't "I've just got to get in," that kind of attitude. We interviewed and the fellow asked me, "Why do you want to come here?" And I said, "It's close to home, and it's cheaper." He told me, "We've got ten slots open, and 25 applicants." And that's the way we left it. I wasn't all that worried, because I'd already gotten accepted, and if they turned me down, it wouldn't be that big a deal. But they did accept me.
It's a good time to get into things when you're young, because you don't think of all the possibilities that can go wrong. I had done OK up to that point, of course, it was all in black schools. Some of the fellows were very friendly. We never had any arguments at the table. There were four of us to a cadaver at the anatomy table, and we worked together. The only thing they didn't want you to do was learn too much, and make it difficult for them to learn, doing your dissection ahead of class. We had no real basic problems there.
The first exam we had in anatomy, I think it was histology, I made a
"D." So that told me I had to study differently than
the way I had been. That was the
During the time your were in medical school, and I've asked other people I've talked to who went to UNC this same question, did you ever have a sense that some of the outside events like the 1954 Brown vs. Board decision, or the Montgomery Bus Boycott, those very publicized civil rights activitiesߞdid you ever think that those things were going to impact medicine?
It was the end of my freshman year when Brown vs. Board went through. You knew it was happening, but you wondered if it was ever going to reach down to a place like Edenton. Of course, eventually it did. That's one of the nice things about Chapel Hill. We went in, and the law students were in under court order. But the medical school, there was no court order, not even for the first one, they just did it on their own. Since the law students had gone in under court order, the medical staff was wise that they should go ahead and not have to go through all that. The medical school didn't want a lot of publicity from having to be forced to take students in. Diggs went in with no problem, and when I went through, there was no write-up or publicity. I never went to the newspaper to tell them I'd been accepted, I just told my family and the people at the college who had sent my references in. We didn't make it a big event.
One of the nice things, I used to work for a family in Greensboro. The man I worked for was well to do. He had gone to the University of North Carolina. He told me once, by the time you get to go to medical school, the University will be taking blacks. He was willing for me to go to the same school he went to. He made provision for me to borrow some money to go for the first year. Britt Armfield. He helped me get a loan for about 900 dollars. That was a big help to get started. I didn't have to pay him back until I got out, and I paid him back when I went into the army. Just before I got ready to go to medical school, he developed cancer. He had asked me to come by and help with his illness. You don't see it too much now, but they actually did the embalming right there in the home. So I helped with that, and helped the family until it was time for me to go to medical school. That atmosphere sent me off to a good start. The people at Chapel Hill, the Dean was nice. There weren't too many barriers, except book money, you had to try to get that.
Had you ever thought you might go outside the South for medical school?
I had applied to Boston, University of Chicago, one other outside the South. I really wanted to go to Boston, because I'd heard a lot about it, but I'd never been there before. But I didn't get accepted there.
Were you surprised when you got into UNC?
It wasn't as much of a surprise as it might have been, because Diggs had already been accepted, and Mr. Armfield had told me I probably would get accepted. It came as a pleasant surprise, but they had had me come down for an interview.
When you went away to Pittsburgh and California to do your training, was it hard to come back to North Carolina? Did you ever want to go somewhere else where there might be more opportunity?
When I went to the University of Pittsburgh, that was my first time out of North Carolina as far as education. All of my training from kindergarten through medical school had been in North Carolina, so I figured it was time to go somewhere else. I didn't go there to stay, I went for my training. Then, after I got married and went into the army, I didn't really go to California with the idea of staying there. By the time we got through with the training, all four of my kids had been born. So she didn't want the kids to stay away from their grandparents. She wasn't opposed to coming back at that time. I always wanted to practice in an area where there was a need. At that time, there was only one pediatrician in northeastern North Carolina, Dr. Harrell in Elizabeth City. I felt with the training I had, I would be able to offer something to the area. When I was ready to practice, Edenton still had no pediatrician. The need was here, so I that was the basic reason. I didn't go there to stay, so it wasn't that hard to leave. The weather was nice. I've had people who have tried to talk about going elsewhere since we've been here, but I never had any real desire to go anywhere else, because the need has never gotten away, the need is still here. It's not as strong now as when I first started, because a lot of the guys coming out now in family practice receive a fair amount of training in pediatrics. At that time, most of the fellows in family practice had just taken a rotation during their internship, some of them had done some residency training, but not necessarily. When I came to Chowan Hospital, we weren't doing intravenous infusions in children. Maybe some were done in a crisis, but if a child had a real serious problem, they had to send him away. That was one of the things I felt reasonably competent in, especially in children with diarrhea, meningitis, severe pneumonia.
We had some rather interesting cases over the years. I'll give
the local doctors credit, particularly one of them. If he had a problem
with a child, and he didn't feel comfortable, he would call
me in. There were no race barriers there. Eventually, all of the doctors
would refer. They didn't do a lot of referring, but they did
at times, usually the real difficult cases. Didn't get no
referrals for bread and butter cases, like tonsillitis or ear
infections! But you did get referrals for meningitis. One of the most
interesting ones was a child eighteen days old. He called and said he
had a child in cardiac decompensation, that means it's in
congestive heart failure. He had a heartbeat of 241, his breathing was
80 to 90, and his liver had begun to enlarge. This was the only time I
can remember when the nurse was a little too slow for me. I got the
medication myself, drew it out, and gave it to the child, because the
child was so sick. By the next morning the child was out of heart
failure. We found out later that it had Wolf-Parkinson-White syndrome.
We continued to treat this child until it was two years old, and I got
to thinking, maybe we ought to send this child to Chapel Hill, to make
sure we'd been treating for the correct thing. Sure enough,
it was. The child is grown
It sounds as if you treated a variety of black and white patients. Were most of them able to pay a fee, or did you take care of indigent cases?
A lot of patients we took care of free. I started practicing before the days of Medicaid and Medicare. We never turned anyone away because of inability to pay. In fact, we didn't even ask them to pay until we had already treated them. A lot of them told us, "see you next week."
What did you charge for an office visit to start out?
An office visit was four dollars, and if we did a urinalysis, it was an extra dollar. If we did a complete [workup] in the hospital on the day of admission, it was ten dollars, and five dollars for taking care of them in the hospital for a day.
So was that within the reach of most people to pay?
No. One time, I started figuring up how much money was on the books, and I got up to $18,000 and quit. That was a long time ago, so it was quite a bit then. I never worried about it, we did the best we could. Once Medicare and Medicaid came in, at least you got something.
Before those two programs came in, can you give a general estimate of about what percent of your patients were paying versus non-paying, or not fully able to pay?
I would guess about 50 percent. It was a large percentage that did not pay, particularly the ones that went into the hospital. Many of the patients that went into the hospital, we never got anything on.
Was that hospital subsidized by the county or the state?
Chowan is a county hospital. But the subsidy never went to the physicians. The hospital might have gotten money for indigent care, but never the physician. You treated them, but never received pay for it, if the patient didn't pay you or didn't have insurance.
Along those lines, what were some of the changes you saw from the beginning of your practice until now in the kind of economic status people had? Did you have a lot of poor farmers or people who worked in industry? And what were the major health problems when you started practicing, and have those changed over time?
In pediatrics, one of the major things we saw a fair amount of was
severe diarrhea, dehydration. I would say in the last 15 or 20 years,
that has dropped off dramatically. I haven't seen a child
with severe dehydration in 15 or 20 years. I think part of that is due
to the fact that these people have Medicaid, so when the child get the
least little bit sick, they take them to the emergency room. With the
advent of stuff like Pedialyte Oral, electrolyte solutions that are
readily available have made a difference. They
In terms of adults, you don't see as severe pneumonia. By the time you see them, it's patchy pneumonia, as opposed to whole lobe consolidation. If you get pneumonia, it's at an earlier stage than it was back in the '60s. Hypertension is about the sameߞyou still see a lot of that. It's hard to change the dietary habits of people. They'll come in the office and say, "Doc, I've been off my diet," and you can tell it by checking the blood pressure. That is one of the major areas, particularly among the black population, that still needs a lot of work. It will probably be the next generation.
About what percentage of your office patients were black?
Probably 80 to 90 percent. We always have seen whites, and most of our white patients have been children. But we do see a few adults who insist on coming. Word of mouth gets around, if you treat a child and he gets better, they spread the word.
Have you seen economic conditions change in this area, and has that affected your practice?
I think economic conditions have improved for a large group of people. But what has primarily made the difference in medical care is Medicaid and Medicare. Other doctors might see more paying patients, but I see a tremendous number of Medicaid and Medicare patients. These people are getting better care, particularly with Medicaid, since you can take it anywhereߞdrugstore, hospital, doctor's office, not so much with Medicare. Particularly when you've got a large number of single parents. Without Medicaid, they don't have a good source of income, so that makes a difference. That has been a real boon. There has been industry coming into the area, but I'm not so sure that has impacted particularly the black community that much. Some, yes. But I think from a health standpoint, it's been those two programs that have really made a difference. A lot of times you'll see a child in your office who needs to go to the hospital. A lot of times the mother doesn't have the means to go, and will try to treat them outside, and keep them away until almost the last minute, until they're so much sicker. Now they don't mind bringing them in earlier, because they know there's a means of reimbursing.
Earlier in your practice, do you remember some of the ways people would try to treat themselves to avoid going to the doctor?
We had grandmother's remedies!
So you didn't encounter that much fear of doctors even early in your practice?
No. The thing that has surprised me over the years, there's been a black physician present in Edenton for a good while, with Dr. Holly who preceded me. He started his practice I guess back in the '30s or late '20s. At one time, there were three black physicians practicing in Chowan County, Dr. Hine, Dr. Capott, and Dr. Holly, that's years back. The presence of black physicians in the county is nothing new.
But why do you think there were more a long time ago than there were all the time you were the only black physician?
A long time ago, a lot of the physicians were dedicated to coming back
to their home, to practice in the area they grew up in. Those three
doctors' roots were in this area. When I got out of medical
school, I didn't have any debts, except $900. I
went into the army, and paid it off, $100 a month. Now
you've got doctors coming out with debts of up to
$80,000, depending on where they go to school. When
you've got that kind of debt on you, it's very
difficult to go back to a small town and try to set up a solo practice.
When I went to college, we paid as we went along. So I think that has
made a difference with all these doctors who want to go somewhere they
can get into a group and have an immediate income. I didn't
have that pressure. By the time I got out of the army, I had paid my
loan off, had a little bit saved, my car was paid forߞthe one
out there sitting in the yard!
Do you think that's partly the result of a change in medical ethics, and do you think it had anything to do with black physicians being trained outside historically black institutions like Meharry?
[END OF TAPE 1, SIDE A]
[START OF TAPE 1, SIDE B]
Black physicians can pretty much go anywhere in the country, and have no real problems getting onto hospital staffs. As time has moved on, hospital staffs have opened up to black physicians in the larger places, although some maybe not as readily as others. Probably, that's part of the reason why black physicians don't think about going back home, because they have these other opportunities available to them. A lot of them become friends with white physicians, and in big cities, maybe even go into practice with them, which is something that years ago wasn't heard of. You might have had multi-specialty groups, but you didn't have multi-ethnic groups, which is no longer the case. I think all of these opportunities, plus the pressure of economics, makes it difficult, unless you get an unusually dedicated one who wants to come back to a smaller town. Even the ones who are dedicated, the pressure of finances can weaken that dedication. It's hard to pay off a $90,000 loan unless you're getting some definite income.
Do you think medical school used to intentionally instill a certain kind of medical ethics that would encourage someone like you to go back to Edenton, for instance?
I think perhaps, but in some ways, they're trying to do it now. One thing that sounds good, but I'm not sure how great it really isߞyou never heard about money in medical school. You learned how to practice medicine, and economics was not really a factor. When you got into practice, you had to learn how to set it up on your own. You learned a little about practicing medicine in the community, but none of the mechanics of running an office. When you came out, you made a lot of errors, and you didn't run it very efficiently, which made it difficult. Solo practice is pretty well becoming a thing of the past, although there are still a few brave souls. I think the medical schools are now beginning to talk more about finance, especially with managed care coming on the scene. But years ago you just didn't hear about it. We didn't even have much on legal medicine. Our idea was to practice the best type of medicine that we could, giving every patient the best that we could give them. When I started practice, it never dawned on me to have malpractice insurance. I practiced for five years without it, until one of my fellow physicians told me I might better get it. We were trained to consider our patient first and foremost, and they're trying to get back to that, somewhat. By the same token, it's hard sometimes to give your patient the best if you don't have a sufficient income. More so now than years ago, because you didn't have all the instruments and ways of doing things you have now. With all the technological advances, computers and all, it's more difficult to practice that kind of medicine. You've got to consider finance, otherwise you're going to be out of business.
Do you remember anyone in your medical training who really modeled that idea of considering patients first?
I would say Dr. John Sessions, who's still at Chapel Hill. He
taught me physical diagnosis, and that to me is the basis of the
practice. If
Do you remember the Simkins vs. Cone case at all?
No.
It was a 1963 case that desegregated the federal Hill-Burton hospital construction program. It seems like a pretty important case, but no doctor I've asked so far has ever heard of it.
I can tell you what I do remember. I think this hospital was built with Hill-Burton funds. When I came here, I had no problem getting on the staff, but the black patients were on one ward, and the white patients were on another.
That was in '65?
Yes. Let me qualify that a little bit. They didn't stay
segregated. If they had a bad patient that cried or hollered all night,
you know what ward they went on. One guess!
They really had a wing or end, they weren't on the same ward.
If they had one of the noisy white patients disturbing people, suddenly
integration was OK.
Was that when the built the hospital with all private rooms?
That was in 1970. That was after Medicare.
So do you remember when Chowan County Hospital completely stopped assigning patients on the basis of race?
I think it was when Medicare came in, because they needed the money.
This court case was in '63, and then Medicare was passed in '65, so they came right together.
I started practicing in '65, but by '66, it had
changedߞthat practice was no longer in vogue.
They were not in supervisory positions, even though they were qualified. May I address some of the things that he's said?
I'd love for you to!
You were asking him about problems when he went to medical school, and
he said he never had any real problems and they seemed to accept him. I
think that was because he was a good student. He had something that they
needed, and that's why the students would come and study with
him. You
At one time there were three, because there were two black law students.
Two black law students and one black medical student had one whole floor in the dormitory! On the other halls, they were three in a room.
It's hard to complain about that, though!
You were also asking about why many doctors didn't come back to Edenton, and why he came back to North Carolina after he was away. Although he could go to many other places, he is not the type of person who's looking for big city lights or any of those things. He's very happy and comfortable and pleased right here in Edenton, because it offers everything he needs or wants. As far as some of the cases he has treated, now with us getting a little older, it's not infrequent that we'll meet someone, and we won't have any idea who they are, and they'll say, "You saved my child's life." I remember before his office was ready, they were still working on it and we had moved back to North Carolina, there was a child that was struck by a car. We both came to the hospital with this child, and started to Virginia with the child, to try to get him to a neurologist at another hospital.
They didn't have helicopter service.
The child died before we could get there. Some of the people felt that he was being over heroic, trying to save the child, and felt like you should just let him go. We felt that we should try to get him someplace where he could be helped. As far as diabetics, he has had some very, very sick, almost dying, diabetics. I can think of a couple of them, they were children. You don't see as many bad diabetics now.
There was one girl, she was already in the coma. She had a pH around six, which is way up.
He treated a boy with meningitis in the first or second grade. They were used to sending meningitis patients away, and he treated this six year old fellow. He was real sick, and it got real touchy at times. It was difficult for him [Dr. Slade], because he had come from a big medical center and teaching hospital with people who he could consult with. I feel that one of the reasons we don't see as many sick peopleߞI used to work with EIC, and we had family planning clinics, and I would help in the health department. With EIC, I would visit in a lot of the homes, and one of the problems would be transportation. That's not as much of a problem. Education was a problem. With TV and clinics and all these things, people now don't let their children get as sick. They don't still keep them home without recognizing that they should get them to the doctor. We used to see a lot of babies who had not had their shots, and they would say it was a problem with transportation, plus taking off from work. The husband might have to take off work if the wife couldn't drive. That was a problem.
These sick children that you used to see more of, what kind of background were they coming from?
I think they were coming from people who were low-income and uneducated.
Not all of them, though.
Were they isolated in rural areas, or why were they uneducated?
Some of them, it was like parent like child. A lot of the parents didn't make it through fourth grade, and the children would drop out too, especially with single parents. Some of the sick ones we saw came from relatively well to do families, like the diabetics.
Some of that was becauseߞI don't know if they just didn't recognize it, or what it was, but they had gotten pretty low. Some of them had gone to other doctors. A lot of the tests and things that they do now more frequently, they didn't do them with children back then. I don't think doctors routinely would check blood.
We did urine tests, primarily. We didn't do blood sugar, because you didn't have office glucometers when we started out. We could do hemoglobins in the office, and urinalysis. We had the dextrose test, but it wasn't very reliable.
It just wasn't something they automatically did, like using x-rays to find pneumonia. A lot of them didn't do chest x-rays.
We had to really battle sometimes to get chest x-rays. I was getting chest x-rays day and night, and they weren't used to going x-rays here at night too much. They did it, but they fussed.
Did you have an x-ray machine in your office?
No, we had to take them to the hospital. They had a lab there, but it wasn't open after hours. I had to read my own x-rays at night, because the radiologist only came once a week. I remember one lady in particular who wasn't all that happy about doing an x-ray. She did it, but didn't her husband call afterward?
We don't know who called, but somebody called in the middle of the night and threatened him.
We didn't let that stop us. The person who didn't
want to do the x-ray finally did it, and the next thing I knew, she had
her children down at the office!
The radiologist only came once a week?
At first, only on Thursdays. All the x-rays had to stay until he got there. We read our own, but the official reading was done only once a week. Now we're a long ways from that, we've got our own radiologist. But that's the way it was when I first got here. He did the G.I. series and barium enemas, and read all the x-rays that had accumulated from the previous Thursday. We read them ourselves, and got to where we could read them pretty good.
One thing I didn't tell about at Chapel Hill, it was a minor
point but interesting, in the dining room at the University, there was
no discrimination, if you had your money! But at the hospital cafeteria,
Diggs who was ahead of me had said that it was OK to eat in there. So I
went in, and I could tell the girls who
Just made the corner a little bigger!
Yeah! What made it so nice, was that my classmates came over and sat down with me, one of the two girls in the class and some of the fellas. That ended that, after the cashier looked over.
He had said to me that Diggs was a fair-skinned black, so they
weren't used to having anyone as black as he was.
My dad told me, "One thing about you, when you get there, there
won't be no doubt about you!"
I think another thing that has helped him is that they didn't
feel threatened as far as the girls were concerned, because he was not
one who was making eyes at the girls. He was more concerned with his
work.
No time for that!
Did you join the county medical society when you came here?
No, I didn't. It's not that I couldn't, but again, it was the money. Plus, the medical staff of the hospital met, and there wasn't but one doctor in Perquimans County at the time, so the county medical society was almost one in the same. We benefited from it if someone came to lecture, so there wasn't any pressing need to join.
Do you know anything about the Old North State Medical Society?
Yes. I never joined the Old North State Medical Society, but I did join the local group of dentists and pharmacists and doctors who all got together. They don't keep separate. It was a part of the Old North State, but it was also part of the other [professional groups].
Do you know how long that society continued to exist, does it still exist?
I think so, we still get mail from them.
Did they ever merge with the North Carolina State Medical Society?
No, they're still not merged. Some people belong to both.
Did you ever try to join the North Carolina State Medical Society?
Noߞthat was more money than the Old North State!
So joining the North Carolina Medical Society wasn't a priority for you.
No, not at all, not in the least.
How about the AMA?
No, same thing. Once you go so long without belonging to them, it becomes more of a challenge, since you've done without them that long.
I'm not sure what the advantages are to belonging to them, except being able to socialize.
The social part is part of it, because if you just attend the scientific part, most of the time, there's not much advantage.
One advantage, though, I had heard that the North Carolina Medical Society had the power to appoint members to certain state boards, there were positions that black physicians were barred from because they weren't in the state medical society.
The board of medical examiners I suspect might be that way.
But I read that you were the medical examiner of Chowan County, so there was no problem with that?
What happened there was that Dr. Wright was the medical examiner, and he wanted help, so he asked me about becoming one. Sure enough, when I got in it, he got out. I guess I was medical examiner by myself for about 20 years. Finally one of the other doctors in town became one. Now we have four, which is good. We used to attend meetings up at Chapel Hill.
What does the medical examiner do?
Anyone who dies accidentally or is poisoned, any suspicious death, you have to go investigate. It's what the coroner used to do, but we don't have a coroner system in North Carolina anymore. You don't necessarily always have to do an autopsy, but you have to determine the cause of death.
One thing we haven't covered is your public health experience. What was it like to practice in those public health clinics when you first started in '66?
Initially, when we began to do those public health clinics, they were state-funded. Now they pay you something like $20 an hour. Initially, we saw fairly sick children. Many times, I would have to refer a child from the clinic to the hospital. One thing I always tried to do was not refer them to myself. But a lot of times they wound up seeing meߞif they come to you, you have no choice. We tried to be careful not to refer patients to yourself. Initially, practically 100 percent of the children we saw were black. With the advent of Medicaid, and the passage of time, we began to see more white children come into the clinics. Now, it's still more black than white, but it's not unusual to have white children in the clinics these days.
Why do you think that changed?
I suspect part of it was because of school desegregation, since they had to go to school together.
So you think it became more acceptable to go to a public health clinic after school desegregation?
I think so, because it's not that there weren't poor whites, but they either did without care or some of the white doctors saw them. As time went on, it became no longer a problem. Even in the public health clinics, though, you had very few black nurses. I can only remember one or two. The children who come are less ill. You very seldom see a premature baby in the clinics anymore. I have seen babies around three pounds in public health clinicsߞyou don't see that anymore. I think again, it's because hospitalization is not a problem for these children. The midwives were very active in those early years, and they're not that active now.
Also, they have programs in the health departments now where they provide formula.
When did that start?
It probably began in the early '70s. We used to have milk and formula in the office. In addition to the public health clinics, I also work in the migrant clinics. It's still through the public health department, but it's a different division.
When did this area start getting a lot of migrants in, and when did those clinics start?
It might have started before my time. It was well established in '66 when we started going over there. They would have probably 500 migrants or more in the area.
Were those migrants African American at that time?
Yes. No Hispanics back in the late '60s, early '70s. Occasionally you would see a Caucasian, not very often but once in a while. Most of the clinics were held in Pasquotank County, we'd have to drive over there. A lot of times, they were busy. There were two physicians when I started, one other physician and myself, and sometimes my wife would work with us. We would both work until one or two o'clock in the morning before we got through, and we weren't just sitting around chatting, either.
What were some of the problems that y'all saw that were specific to migrants?
A lot of epilepsy. Occasionally, we'd find tuberculosis. Part of the epilepsy problem was due to lifestyle. There's a lot of alcohol consumed among the migrants, I guess that's part of the socio-economic status, and the pressures and all that. Hypertension, diabetes, although not necessarily insulin-dependent. A lot of rashes. With the diabetics, a lot of times you'd see foot ulcers. Occasionally, you may run into someone with a cardiac problem, but hypertension was the biggest thing. Sometimes some of the ladies would be pregnant and we'd take care of the newborns. That's what I'd like, when we had a baby to look after. Makes you feel more at home.
You mentioned midwives a minute ago. What were some of your experiences with the midwives? Were most midwives at that time black?
All the ones I knew were black. In Plymouth, particularly, they had midwives, because one lady in the clinic worked as an aide, but she was also a midwife. You'd see these children in the clinic, three or four pounds, and you'd think they should be in the hospital, but they were doing pretty good. Chowan County has not had a lot of midwives in recent times, because the physicians that did deliveries weren't all that enthusiastic about midwives. They had a project in the early '90s with a couple of midwives at Chowan Hospital. They stayed about six months, and then kind of petered out. These particular ones, I think one of them made an error, and that didn't go over too good. With Medicaid, they have access to the physicians, and unless they've got a real good rapport with the midwife, they prefer to go to the physicians. For many years, we didn't have any midwives in Chowan County, and the physicians did all of the deliveries. We had four obstetricians, but one has retired. When I started out, all the physicians in town, except for myself, were doing deliveries. With the advent of malpractice suits, and increasing rates for malpractice insurance, all the physicians except those who are strictly OB/GYN have ceased to do deliveries. No primary care physicians except OB/GYNs now do deliveries, where all the family practitioners were doing them before. When it got to be $18,000 for malpractice insurance and you didn't do but one delivery, it became financially noncompetitive.
You say there were quite a few midwives when you first came?
Maybe not "quite a few," mostly in Washington County, not in Chowan County.
Do you have a sense of why midwifery died out?
Two reasons. She mentioned transportationߞif these ladies can get in the rescue squad and be in Chowan County or Washington County Hospital. But Washington County has not had the medical coverage that Chowan County has. We now have three OB/GYNs who do deliveries, and are fully board certified, whereas Washington County only had one, and they lost that one. We see a lot of people from Washington County who come to Chowan County for deliveries. So transportation is no problem now. They had a choice of staying home with the midwife, but if they got in trouble they'd have to go to a physician anyway. Now, I think midwives have to have so much certification.
Had those midwives when you came in been through certification courses?
I don't think soߞif there was any such thing at that time. Did they even have certified nurses aides at that time?
No.
Maybe their grandmother taught them, but certification came later.
I know a long time ago, especially in rural areas where doctors
couldn't get out to people, a lot of people of both races did
deliver with midwives. It seems to me from what I've read
that midwifery became
I've never known a white midwife.
There was that lady who was going to go to schoolߞdid she go?
I think she finally decided to be a lawyer! She was an RN that used to work in the public health clinic, and she decided she wanted to be a midwife.
One reason people used midwives was because they didn't have to pay as much money. It probably was easier to get her than to get a physician.
Once they have one or two successes, that's all they need.
You had mentioned what a big impact Medicare and Medicaid had. Some physicians I talked to were hesitant to take those, and had a lot of concerns about socialized medicine. It sounds like you started taking them right away?
I was practicing before they existed, and we saw all the patients who
came to be seen. We didn't turn anybody away. In fact,
sometimes we went out of our way to treat people in their homes. We used
to make housecalls frequently, and sometimes she'd come along
with me and start an I.V. right in the house. If we knew then what we
know now, we could have started home health care!
[END OF TAPE 1, SIDE B]
[START OF TAPE 2, SIDE A]
As far as the amount of socialized medicine, that's never been a big thing among African-American physicians, as it has among non-African-American physicians.
Why do you think that's true?
When you look at blacks as a whole, group things seem to mean a little more to them, like in terms of the church. That's one of the institutions that's really meaningful to blacks, it's not just a club, it's more of a family gathering, although they don't always act that way. White physicians can go to the country club and play in the golf tournament on Sunday morning, or whenever it is, whereas the black physician, I know some now who go on the golf course, but back when I was coming along, you probably couldn't find half a dozen black physicians in the country that played golf, particularly in the South. The church was the uniting force, and its a social gathering place. Helping somebody in groups has never been a threat, so I think that's one reason why black physicians have never been threatened by so-called socialized medicine. You don't turn anybody down anyway, or it's a lot more difficult for the black physician to turn away the poor people, particularly the blacks.
Another thing, you find very few rich people in the black race. Most of them might have been in the same situation at one time, until a better opportunity came along. So they know what it's like.
Also, if the black physician starts turning away his own people, he gets into all sorts of trouble. He's not going to attract a lot of non-blacks just because he turns away blacks, and he puts himself in a bad position with his own race, because people say, "Now he's a big shot, he won't even see us." Basically, he's taught not to reject his own.
It's a loyalty thing. As I think about it, I can remember hearing people get very upset with him. If he didn't have time to make a housecall or do something they wanted him to do, they would go over to a white doctor who they know wasn't going to go on a house call. But because [Dr. Slade] wouldn't do everything they wanted him to do, they were going to go to someone else. They expect more of you.
The patient would go to the other doctor to punish you, even though they wouldn't get any better service with that doctor?
They're not getting any better service, they just didn't like it if you turned them down and wouldn't make a house call.
But they're going to get out of the house to see the other doctor, because he's not going to make no house call, either! By the same token, they're also more loyal. I have patients who will wait in that office for three or four hours before I get to see them.
Maybe they give more, but they expect more.
It amazes me, by and large. Maybe a few white patients would wait, but
most of them, if I'm not there close to on time, they take
off.
Some of the doctors I've talked to have said that Medicaid and Medicare were all right to begin with, and the government pretty much gave you full reimbursement, but as time went on, there was less reimbursement and more paperwork, and that really made them hesitant to keep accepting those patients. What's your opinion on that?
There are two factors here. One, physicians' prices have jumped quite a bit. Naturally, if you're charging $20 or $25 for an office visit, and next year you jump up to $35, and the following year you jump up to $45, and finally you get up to $50, Medicare is not going to jump along with you. When you're charging $50 for an office visit and Medicare is only paying you $25, that looks bad. But our office rates started off lower, and right now, we're up to $25 for an office visit, and Medicaid pays it all. From our standpoint, Medicaid is doing good, but if I charge $50 or $75 for an office visit, then it looks bad. Of course, I'm not saying they're not justified in increasing their fees, but that's part of the problem. Maybe they've increased them because they've brought more people into the office, or bought more computers. And the same thing with the hospital. I think a urinalysis in the hospital runs about $30, and in our office, it's $10.
Why are you able to do it cheaperߞyou can do it at a third of the cost, why is that?
I don't pay my people that do it as much as the hospital does. They have to have trained technicians. I train the girls that do it myself, and they do it just as good. Then of course, the hospital has more fancy equipment, and that's part of why they charge more. Even though I charge $10 for a urinalysis, Medicaid will only pay me about $5 or $6. But that's what they do.
Especially as a solo practitioner, have you had a hard time with paperwork? A lot of doctors say they've had to hire a full-time person just to do the paperwork.
We have a lot of paperwork, but I guess it depends on how you organize
it. The girls I have now, as I see the patients, they start on the
paperwork. By the time the patient's out of the office, their
Medicaid blank is all filled out. We've got a computer, but
haven't started doing it by computer yet, but we hope to
soon. I can understand a lot of doctors, if they have a large volume,
then there's extra paperwork to be done. If they run it
through the computer, then they have to train somebody on the computer.
But better to have the paperwork increase, and have the green paperwork
increase along with it!
When did you hire an office assistant?
From the beginning. My wife worked with me for the first three years, and then another lady worked for me for 24 years, and she was the only one in the office. Once in a while, we'd have someone else come in.
So you've always had an office assistant, but have you really had to increase the number of people you've hired for paperwork?
Not really.
You have two people in the office now, where for twenty-some years, you
only had one. One thing is, through the years, he has lost money because
of not getting his issuances and Medicaid in on time. He was not able to
see that maybe it would pay him to hire someone extra. He has not really
concentrated as much as he should have
Then they think you're rich even though you ain't.
No matter how much you have, everybody thinks doctors are rich. I tell him all the time, I wish I could visit the president, or write an article, to let them know that all doctors are not rich. A lot of times, you're working so hard, and then have to borrow money for income tax, because so many of the things are not deductible that we spent our money forߞa lot of it was education. When our children were young, child care was not deductible, but we had to get someone to take care of the children. Then after that, it became deductible. We sent all of our children to academy and college, and helped them the best we could in graduate school, and none of that was deductible. At one time, the interest on the loans was deductible, but now they've even taken that. The middleman like us, you make too much to get anything, but you don't get enough to live the way people think you are living. <