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Interview with Andrew Hutchinson, January 23, 2005 | UNCW Archives and Special Collections Online Database

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Interview with Andrew Hutchinson, January 23, 2005
January 23, 2005
Dr. Andrew Hutchinson of Whiteville, NC, shares details regarding his diverse medical training, including his pharmaceutical and osteopathic training and his decision to specialize in surgery. He also discusses his practice in North Carolina, citing causes for the prevalence of vascular disease in the area, and offers his opinion on the current health care system.
Phys. Desc:

Interviewee: Hutchinson, Andrew Interviewer: Zarbock, Paul Date of Interview: 1/23/2005 Series: SENC Health Services Length 56:30

Zarbock: Good afternoon. My name is Paul Zarbock, a staff person with Randall Library, University of North Carolina at Wilmington. Today is the 23rd of January in the year 2005, and we're interviewing in Whiteville, North Carolina. Good afternoon doctor; how are you?

Andrew Hutchinson: Good afternoon.

Zarbock: What is your name?

Andrew Hutchinson: Uh, Andrew John Hutchinson.

Zarbock: And you are a physician here?

Andrew Hutchinson: I'm a doctor of osteopathy.

Zarbock: Okay. And a surgeon-- is that correct?

Andrew Hutchinson: That's correct.

Zarbock: But you have an interesting background-- well, an interesting start in the healthcare delivery system. Uh, where did you go to college, and what happened after that?

Andrew Hutchinson: I went to college at uh.. Philadelphia College of Osteopath-- excuse me-- Philadelphia College of Pharmacy & Science uh.., which is now the University of Sciences in Philadelphia. (tape glitch) and changed their name to University (glitch). Uh.. it's a uh.. it's the oldest pharmacy college in the (glitch) -ation, and uh.. (glitch) and, I like to think, very prestigious one, 'cause my father went there before me.

Zarbock: It's-- it really has a reputation of being the, well I-- this may be a little flamboyant, but the gold standard in schools of pharmacy.

Andrew Hutchinson: A lot (glitch) of research is from our Phila- (glitch) Pharmacy & Science, and uh.. and they've (glitch) made a lot of strides uh.. in uh.. the world of pharmacology. (wind chimes in background)

Zarbock: You know, one of the interesting things, for me, (glitch) about doing these interviews, is that I sometimes ponder, what are they-- how clear are we going to be in our language 50 years from now or 60 years from now. So let me make sure I understand this. You graduated from high school when you were what, eighteen?

Andrew Hutchinson: That's right.

Zarbock: And you went directly into the college of pharmacy?

Andrew Hutchinson: That's correct.

Zarbock: (glitch) What was the curriculum like?

Andrew Hutchinson: Well, uh.. the first year I actually went to uh.. (glitch) University, my first year, uh.. because I thought I'd (glitch) more than my father. (laughs) And uh.. he had uh.. stated that (glitch)-- I was becoming a physician or going into the healthcare practice at (clears throat)-- excuse me-- (tape glitch) pharmacy would be an excellent background no matter what I wanted to do in the future. Uh.. and it turns out he was right-- only I didn't listen at first. And for the first year I went as a uh.. a biology major at Temple University. (glitch) now that, at Temple University, probably 80 percent of the uh.. students taking classes with me were pre-pharmacy. Uh.. and so I ended up taking the same curriculum as a pharmacist anyway.

I decided to re-apply to Philadelphia College of Pharmacy & Science and, in my second year of college, was a- accepted to the Philadelphia College of Pharmacy & Science uh.. and uh.. (glitch) my second year. For the first, second and third year it was a plethora of uh.. biochemical sciences: biology, pharmacology, patho-physiology (clears throat)-- things there were extremely interesting uhm.. the one thing I found not-so-interesting was physics, but uh.. but managed to make through uh.. make it through physics uh.. with flying colors. Uh.. everything else was uh.. was quite exciting, (glitch) organic chemistry, and it was well-taught uh.. and very individualized. Uhm.. I was a lab technician in organic chemistry uh.. to further understand that science. Uh.. the fourth and fifth years of pharmacy school uh.. were dedicated to (glitch) more specific areas of uh.. pharmacy uh.. pharmacy theory-- in that uh.. not so much the technical science portion, but (clears throat) the applying it to uh.. specific diseases and (glitch) interacting with the body in a positive and negative way.

Zarbock: (glitch) What about humanities and social sciences? Did you have any courses that--?

Andrew Hutchinson: You were required to have some uh.. some uh.. art classes uh.. arts being everything from drama to composition-- and we were uh.. required to-- I did take a drama course at the Philadelphia College of Pharmacy & Science. And we were required to do some acting during that course. It was uh.. it was fun, and it was a very well-rounded curriculum. Composition was uh.. also well-rounded. We- we read Chaucer and Keats, and it's a very well-rounded program. It does narrow in on the sciences, but uh.. we did get our share of uh.. of the arts.

Zarbock: But you did perform in some sort of presentation?

Andrew Hutchinson: Yeah. Actually, it was uh.. presented in such a-- the drama teacher never made such a lasting impression uh.. as any teacher I've ever had. He was phenomenal. Uh.. he actually took pieces of songs and made them into plays so that the youngsters could relate. Uh.. one song was uh.. from Pink Floyd, The Wall-- and he took an entire section of uh.. of a Pink Floyd song, "Comfortably Numb," and made it into a play that we all had a piece in. It was- it was amazing. He was a brilliant guy-- very brilliant.

Zarbock: Well, so you graduated from the-- you are now degreed as a pharmacist? Is that correct?

Andrew Hutchinson: That's correct. I have my Bachelor's of Science in Pharmacy. And it has since changed since I graduated. You were given the option of going on one more year for a six-year curriculum for a Pharmacy doctorate. I chose not to do that, as I was interested in going on to my medical degree at that time. Uhm.. and so I did not take the optional year, although some of my classmates did. It was not en vogue at that time-- now it's mandatory. (clears throat) You must have your Pharm-D to graduate pharmacy school and become a pharmacist at-- it's now mandatory. There are no more Bachelor of Science degrees and--

Zarbock: Throughout the United States?

Andrew Hutchinson: That's correct. So now you--

Zarbock: That is a sea change of considerable degree.

Andrew Hutchinson: They uh.. they wanted to increase the level of knowledge in pharmacists like did physical therapists, who must have their masters degree. Uh.. physical therapists can get a bachelors degree in physical therapy but cannot be certified without their master's degree. So--

Zarbock: A pharmacist is licensed?

Andrew Hutchinson: Licensed by the state. Now you can have your Bachelor of Science degree in pharmacy, but uh.. you would need to further take the state examination in the state you wish to practice, or multiple states if- if uh..

Zarbock: And what year did you graduate?

Andrew Hutchinson: I graduated in 1991. (phone rings)

Zarbock: 1991? (phone rings)

Andrew Hutchinson: That's correct.

Zarbock: And you were how old?

Andrew Hutchinson: And I was 23 years old-- 23 years old.

Zarbock: Well. I assume you graduated in, perhaps June, May or June-- spring of the year probably?

Andrew Hutchinson: Actually, our- our college had the option of going to school all summer long, and I finished a half-a-year, one half-year early. Uh.. I finished in January. My actual graduation date was in June, but I was able to take my boards early and practice for six months before my actual graduation date. So--

Zarbock: So you really were involved in the clinical practice of pharmacy?

Andrew Hutchinson: I practiced pharmacy throughout the summer after graduation uh.. and through my four years of medical school.

Zarbock: (laughs) Well, how long after you graduated-- you said in January?

Andrew Hutchinson: Uh-huh.

Zarbock: How long after you graduated in January did you enter medical school?

Andrew Hutchinson: It was the following August. I was already accepted into medical school by the time I graduated pharmacy school.

Zarbock: And where was the college of osteopathy?

Andrew Hutchinson: Uh.. Philadelphia College of Osteopathic Medicine is uh.. City Line Avenue in Philadelphia-- uh.. on the outskirts of Philadelphia.

Zarbock: Give me a little background on the school, how big, how many students-- how was the faculty?

Andrew Hutchinson: It uh.. was not the first osteopathic school, but it is the largest. I believe it was the third osteopathic school in the country. Uh.. Kirksville, Missouri was the first. And so uh.. from there on-- actually, osteopathic medicine was developed, though, in Philadelphia. Doctor Andrew Taylor Still was an allopathic M.D. who felt that the body as a whole, including the skeletomuscular system, affected the biochemical changes in the body-- and started applying different techniques to the skeletomuscular system to affect change in the biochemical body; such as blood pressure changes, uh.. stress changes, uh.. some say lowering cholesterol and things of that nature. There are studies that all corroborate that uh.. with osteopathic manipulation. And Andrew Taylor Still is the uh.. is the first physician who started osteopathic medicine. He was an M.D. from Hahnemann [ph?] University. So it actually started in Philadelphia (clears throat)-- first school was in Kirksville, Missouri.

Zarbock: If you had to draw an artificial line-- and most lines between disciplines or even between people are artificial-- but assume for the purpose of this date that you could draw an artificial line between osteopathic medicine and-- what technical term am I going to use for it?

Andrew Hutchinson: Allopathic medicine.

Zarbock: Yes-- and an M.D. would be?

Andrew Hutchinson: Allopathic.

Zarbock: Allopathic.

Andrew Hutchinson: Yeah, but osteopathic and allopathic physicians-- that's right. Uh..

Zarbock: Where is the boundary-- the intellectual boundary?

Andrew Hutchinson: The basic differences between the two?

Zarbock: Uh-huh.

Andrew Hutchinson: Uh.. essentially, the reason I chose osteopathic medicine was because of my pharmacy background and my desire to add more components to my background knowledge. And I just thought uh.. that that would make me a more well-rounded physician-- pharmacy background with manipulative techniques, plus your traditional medicines, plus surgery. And so I just thought that that would make me a very well-rounded physician uh.. to treat the whole person. Uh.. the differences between the two uh.. stem from uh.. just what I said. Uh.. the allopathic-- uh.. the allopathic discipline tends to treat uh.. body systems, traditionally. Uh.. this is- this is a very wide variation between but uh.. and there's a lot of plus-minuses. But (clears throat) it tends to be a system-oriented uh.. discipline; whereas, osteopathic medicine is a- is a global-type discipline where uh.. every part of the body affects another part of the body. Whereas, uh.. in the allopathic physicians uh.. the supposed is uh.. is a uh.. a systems-type approach where one system affects that system and can affect another system, but they treat it-- they treat systems individually.

Zarbock: For sure. How long was your medical school training?

Andrew Hutchinson: I went through the osteopathic school for four years. Uh.. I went through a one-year internship, which was a general rotating internship. This is also a difference between the allopathic world and the osteopathic world. Uh.. allopathic uh.. physicians will enter their chosen discipline, whether it be surgery, psychiatry, internal medicine, family practice-- uh.. upon graduation. Osteopathic physicians are required one year of a general rotating internship where everything must be learned that year uh.. from every discipline. You do rotations that year uh.. as a physician, in every discipline.

Zarbock: How many disciplines were there?

Andrew Hutchinson: There's-- every month was a different discipline. So there was 12 different disciplines, and every month you changed discipline from psychiatry, internal medicine, gastroenterology, uh.. hematology, uh.. OBGYN, uh.. surgery, orthopedic surgery, uh.. urology-- and I'm sure I'm leaving out some. Uh.. but we- we kind of got a- a very good understanding of how to generally treat patients before we went into our specific, chosen discipline. Like--

Zarbock: But this strikes me as learning on the absolute top-speed run.

Andrew Hutchinson: Uh.. it is. It is. Uh.. it's actually a nice continuum, because your fourth and fifth years-- uh.. excuse me-- your third and fourth years of medical school are also spent on monthly changes in discipline-- only you have less uh.. you have less responsibility. On your third and fourth years of medical school, you're basically learning to interview patients-- learning to formulate diagnosis and treatment plans and making suggestions to an intern and your higher-up hierarchy of residents and attendings. Uh.. when you're an intern, you're actually and integral part of making that decision, and you have the power of the pen, which is to write orders, at that point-- which is a- which is a very scary thing at first-- very scary. Because every-- every time your pen touches a paper, you have changed a person's life in some way by any medications or order you may have written. And that's where the difference comes in. So it's the next level on the same continuum.

Zarbock: So involved in this stressful environment, or stress-producing environment, you're also practicing pharmacy?

Andrew Hutchinson: Uh.. during my internship year-- you can't. Uh.. and that's a state rule that you cannot prescribe and dispense in the same state. And so, if I wanted to practice pharmacy, I would have had to go to a different state. But during my third and fourth years of medical school, I did uh.. practice pharmacy. When I became licensed as a physician in the states of Pennsylvania and New Jersey, I had to uh.. make my pharmacy license inactive.

Zarbock: But that must have been a very, very long day-- or it must have been some very, very long days.

Andrew Hutchinson: Yeah. Yeah. In the third and fourth years of medical school, and the first and second years-- uh.. there were very long days. I would uh.. leave school or rotation at 4:00 or 5:00 o'clock and work until 10:00 o'clock, and then go home and study until midnight or 1:00 a.m.-- and get up for school the next day. And so-- but it-- it wasn't uh.. it wasn't as tiring as you think because it was interesting. It was uh.. it was something that I wanted to do and accomplish and uh.. (clears throat) you really have to love what you do. If you don't, you won't have any desire to do it. It's, but there was a great desire to do, uh..

Zarbock: What year did you get your medical degree?

Andrew Hutchinson: Uh.. 1996 is when I graduated medical school.

Zarbock: And you were how old at that time?

Andrew Hutchinson: I was 27, 27 years old.

Zarbock: Okay. And what were the options open to you?

Andrew Hutchinson: Well, uhm.. I had yet to complete my year of internship. Uhm.. it's quite a process. Uhm.. (clears throat) your first two years are-- of medical school, are based in the general sciences again-- in pathophysiology, which I had a fortunate ability to have already had at pharmacy school. It made it quite easy. Uhm.. medical school was breeze compared to pharmacy school. I- I would say to anyone pharmacy school was much, much more difficult than medical school-- uhm.. much more difficult. And uh.. and actually when I went to school, the suicide rate for pharmacy students was quite high because of the stress. And- and I realize that that has decreased now, but there was a great deal of stress placed on pharmacists, as they were the number one respected profession in the country when I went-- over clergymen, over physicians, over--

Zarbock: Dentists?

Andrew Hutchinson: Right. Over- over everyone. I'm not sure if that's now. It may be third now-- I think one pharmacist just told me. But they still have consistently ranked in the top five uh.. most trusted professions. It's a very noble profession-- I- I was very happy to have been a pharmacist. Uhm.. my year after graduation-- like I said, there's a very-- it's a very difficult thing. I'm not sure many people realize-- after your first two years of medical school-- after you have the basic knowledge-- you take a test your first year-- your first part of your state boards. And you pass your first state-- your first part of your state boards, and you're allowed to go into your third year. You complete your third year on rotations in medical practices. After your third year, you take your second part of your boards-- you're allowed to progress into your fourth year. You're allowed to continue on with your rotations. After graduation from medical school, you take your third and final part of the state boards. If you pass, you get a state license enabling you to write prescriptions and medications in that state.

Zarbock: Give me a glimpse into what sort of questions would be asked on any of these.

Andrew Hutchinson: Well, it can range-- it- it correlated with every year that you've just completed. And so, it- it increased -- it increased in depth, but it uh.. decreased in uhm.. difficulty. And I'm not sure if that was because you've every year gotten a more firm understanding of the information, just continually being repeated, or if that's uh.. because the test was designed easier, I'm not sure. But it seemed like uh.. that a lot of the uh.. questions during your internship were much more readily-- the answers were much more readily available than during your third year. Uh.. and that's- and that's, I think the way it should be. The more experience you gain, the better you should be able to answer in-depth questions.

And it- and it ranged in all different disciplines. There was a certain number of questions uhm.. based in the more heavily-- the more heavy disease states, such as cardiovascular disease, had- had a higher weight than did psychiatry. And because uh.. psychiatry was-- had a much smaller amount of patients and- and less emphasis was placed on different things. Uh.. but in osteopathic school, probably 80 percent of the physicians become primary-care physicians. And uh.. that ranges from family practice to internal medicine, to OBGYN. And, the reason being, and I-- think that uh.. these questions were asked during the state boards-- basically concentrated on general practice questions. And so uh.. if you had concentrated on a specialty your first four years, you were gonna have a difficult time uh.. with the testing.

But uh.. they did ask questions on surgery, and they asked questions on orthopedics, and so on and so forth. But they were more related to your diagnosis of the patient and referral to a specialist. And so uh.. those are the type of questions. More specific questions uh.. were asked in uh.. pharmacy uh.. questions, medications, treatments of disease states, uhm.. and how would you treat them-- uh.. in the medical discipline, with physiotherapy, with surgery, uh.. radiologic testing-- so on and so forth. You-- every aspect-- laboratory testing uh.. was- was involved in one question. A case scenario would be given uh.. a 42-year-old white female would walk into your office with a certain number of complaints uh.. and uh.. what questions would you further ask to help you in your diagnosis; what ta-- lab tests would you order; what radiologic studies would you order? And they'll give you results of the test that you order, and you go on from there to formulate a diagnosis and a treatment.

Uh.. after your internship, then you-- each t- each time worrying if you're gonna make it to the next level-- internship level-- your fourth year is spent uh.. trying to match a program that you want to match it. Uh.. you pick a-- you pick a hospital that you want to train in. Uh.. you interview at that hospital with who knows how many others, and in a national matching system you place your rank. If the hospital ranks you the same number that you rank them, then you will match that hospital, and you'll get to go there for your internship. But it may not-- then you may end up not getting your first choice and going somewhere that you-- you thought was okay, but it may be far away from home and so on and so forth. It's kind of like the military in that sense-- where you don't really get a choice. Uh.. and residency is similar. Your full year of internship, aside from every other night call, every other weekend call, uh.. and going through each discipline every month-- is trying to find out, first of all, what do you want to do with the rest of your medical career? Such as, what specialty? Uh.. and when you finally choose a specialty, where do you want to go for that training? Uh.. and then after you choose that, you apply to as many different places in that discipline that you want. And again, there's a matching system. And you go and interview at those hospitals-- you rank those hospitals, and they choose you. And hopefully you match at the-- at the institution you would like.

Zarbock: You know, as you speak about selecting a specific career option, I'm reminded of the work that's been done on the sense of identity. As you pass through life-- a younger age, you begin to say, "I want to do that. No I don't want to do that. No I don't want to do that." So you begin to dismiss, until you get to the point where you begin to say, "Well, of the five options, I find this to be more interesting than the other four." Well, with that as a background, and without indicting any of the other subsets-- some of the disciplines may not have been very attractive to you. In order to sort of probe your thinking, why did you dismiss-- I don't know-- ophthalmology or psychiatry or dermatology? Why weren't you drawn to those? And then I'm going to ask you, what were you drawn to and why?

Andrew Hutchinson: Okay. Uh.. some of the disciplines that I- I was not drawn to uh.. included, you say psychiatry and things of that nature. Uh.. reasons for that stem from uh.. not feeling uh.. as an integral-- not feeling like I could be much help. (laughs) That's basically what it was. I- I-- I mean, I wanted to be-- I wanted to use my skills uh.. in the best way possible. And, you know, psychiatry was very interesting-- and I could honestly tell you there's no discipline that I went through that I didn't give my all on. You'll find that patient-- you'll find that people will have chosen their specialty their first year of medical school, and everything else can go by the wayside. I think that having that type of closed mind makes you uhm.. not the best physician that you could be. Uhm.. you really want to take advantage of-- uh.. thirty days is a short amount of time in our lives, and you really want to swallow and absorb as much information in that thirty days as you possibly can. Uh.. it's true, you really do.

And uh.. and I tried to do that. I may not have been interested in hematology-- and that was looking at slides and trying to figure out cell types, and we re- reverted back to histology, which I hadn't thought about in four years and had to review. And uh.. things like that didn't- didn't interest me, but I did use them. And I think it helps me to this day because there's little tidbits that you remember about certain diseases, even now relating to surgical specialties, where I can't- I can't name the number of times where I've had a patient come in-- uh.. patients don't just have one disease a lot of times. And you really don't wanna be bamboozled by that. You really want to-- you really want to be a surgeon, but you also want to be a doctor. And that when patients come in with surgical diseases, I cannot name the number of times that we've diagnosed other diseases by uh.. routine blood checks and things like that. It's that, "Well, you know, this white blood cell count is uh.. quite high, and it has an abnormal percentage of lymphocytes," --let's say. The patient has been feeling weak and tired and so on and so forth-- yes, their gallbladder has to come out, but in the same token, let's send them to a hematologist, because maybe they have lymphoma or leukemia or-- and we have diagnosed many, many problems that way. And I think, by going through each individual discipline, although it may not be my chosen discipline-- uh.. helped greatly with diagnosis of other diseases. And so, uhm.. I didn't choose those diseases because I didn't think I would be very good at them. But I did choose the one that I thought I could be very good at uh.. and take little pieces from everything else.

Zarbock: Did an individual or series of individuals influence you into selecting surgery?

Andrew Hutchinson: Well uh.. it's a funny story, actually. I went to medical to be a pediatrician. Uh.. and the reason for that was my pediatrician uh.. growing up, had a great deal of influence. He was a well-respected man uh.. who had a incredibly busy practice. Uh.. everyone who was anyone in the area I grew up in went to see uh.. this physician. Uh.. and he was kind enough during my high school years to let me uh.. come and see uh.. shadow him for a few days uh.. and s- and see if I liked that type of profession. And I knew I wanted to be a doctor, but (clears throat) what changed my mind, after getting into my rotations third and fourth year, was actually doing a pediatric rotation and having-- uh.. it's a very difficult thing. The children aren't so difficult-- uh.. the parents are quite difficult. Uh.. and that was a difficult thing for me to handle. And also, I- I really did not like the fact uh.. that uh.. I had to uh.. injure children to make them better. Injure probably isn't the best word, but giving anyone an injection or drawing blood from a child and things like that. That made me feel uncomfortable. And so I didn't think I would be uh.. very good at that profession. And so, I said, "Let me go through the rest of the disciplines for the next two years. Uh.. it'll come to me." I knew I wanted to help people and- and use the knowledge I've gained, but I'm not sure how. Right from the get-go, uh.. surgery was a-- uh.. was- was it.

I knew I had an interest uh.. in immediately affecting patients. Uh.. you don't have to give them medication and wait two weeks and re-check it. You uh.. you don't have to- you don't have to uh.. wait around for your diagnosis to be confirmed. You make a diagnosis; you open a patient; you take out uh.. the problem, or you- you repair the problem. It's immediate. The patient goes home from the hospital better because you operated. And uh.. that's what-- I like the immediacy of it. I also like the- the stress-- the high level of trauma of vascular surgery. Those types of situations I was good at. Uh.. making split-second decisions that had to be right, and not knowing why, but just knowing that they were right. And that was consistent, and very few mistakes got made. And I started to notice this about myself and said that this would probably be a good uh.. discipline for me.

Zarbock: Can you recall a specific case as illustration?

Andrew Hutchinson: Oh. Uh.. just in the trauma situations, uh.. you could-- you would run one of the trauma codes, which means someone was injured in some type of accident, or on purpose with a gunshot or so on and so forth. Uh.. and you could make a split-second decision, such as a collapsed lung, with just listening to the lung and not hearing the breath sounds and uh.. placing a needle in the chest. The patient was coding, and now you're saved them. Uh.. their lung re-expanded with you--

Zarbock: Excuse me. What do you mean by "was coding?"

Andrew Hutchinson: Coding is uh.. they had a respiratory or cardiac arrest secondary to their accident. And so, uh.. they were essentially dead and you're reviving them. And you find the problem immediately within 30 seconds to 60 seconds, and you correct it. The-- another instance, which uh.. still astounds me, and I can't believe that it was just-- some, something- something that guides your mind. The patient was down having a radiologic procedure done, and all of a sudden their heart stopped. And uh.. she could not be revived. Uhm.. the surgery team was called; I responded, and uh.. went down. And we did uh.. chest compressions and uh.. the normal coding type things, epinephrine and uh.. CRP and shocking the heart-- nobody could figure out what was going on. And by the rhythm on the uh.. on the monitor-- again, using the knowledge I gained from a cardiology rotation, uh.. I saw something called PEA, which is Pulseless Electrical Activity. Uh.. and when you see that, sometimes the patient may have a cardiac tamponade, which is fluid that has gathered around the heart, compressing the heart-- not allowing it to fill with blood, and it stops the heart. And uh.. on a whim, I stuck a long needle into the sac around the heart and drew off, you know, probably three cups of fluid-- and the patient regained their heartbeat uh.. and was transferred, flown, to another facility and saved. And uh.. things like that (piercing beep) really-- excuse me.

(tape break)

Zarbock: Okay. We were interrupted briefly. Did you want to finish up what you were saying? 'Cause I've got another question.

Andrew Hutchinson: Uhm.. just the immediacy of surgery and trauma. That's what's intrigued me; and I knew that that probably was the discipline that I would uh.. be- be good enough to treat patients uhm.. treat patients very well.

Zarbock: In other interviews that I've conducted with other physicians, I usually get around to this type of question. And I'll try and be as diplomatic as possible. The answers, by the way, to this question, are strikingly uniform. The question: Given the situation of a patient who is medically beyond assistance. You know that the condition is terminal. Number one: What does that do to you and how do you handle it? And number two: Communications skills. How do you convey this to a physician-- I'm sorry, to a patient?

Andrew Hutchinson: Uh.. those are-- it's probably the most difficult part of the job. Uhm.. how I handle it personally when I find someone-- it's- it's sometimes easier than others. And what I mean by that is, uh.. it may be a patient who you don't-- who you have not had a relationship with uh.. in the past, i.e.-not a long-term patient of yours. It may be a first time referral that is seen in the hospital, and you do something as simple as endoscopy and find a large cancer uh.. and do further CAT scans and find the cancer has spread throughout the abdomen-- uh.. at which time the patient is most likely terminally ill. Uhm.. in that case, I have not known the patient very long, maybe a day or two. That makes it slightly easier uh.. not easy, but slightly easier. Uhm.. it's a human being-- normally the family is there. Uh.. you try and put yourself in those shoes. This could be a father, a grandfather; it could be a mother, a sister. And I put myself in those shoes. I've- I've not yet become desensitized to emotion, which I'm- I'm very glad of.

Uh.. and I speak with the-- first of all, I- I am always upset by uh.. that type of diagnosis. Because I know the numbers; I know the prognosis; I know the treatments, and how they're not going to help. And so, the patients don't know that-- and you try and paint a picture of hope, but you also want to be a realist as well. Uh.. and I- I am always forthright with my patients. I don't say, "Well, we need further testing. We need this." I- I'm usually fairly confident of my diagnosis. And if I've made a diagnosis, taken a biopsy, confirmed-- say cancer-- uh.. done further testing and found out that it's nonresectable surgically-- uh.. it can't be helped with radiation or chemotherapy. Uhm.. I basically will have a conference with the family and the patient and say, "This is what we're dealing with. These are the numbers. These are your prognosis over the next five years. You have a 20 percent chance of surviving the next five years. Uh.. you have a six-month survival rate."-- and so on and so forth. In terms of, say pancreatic cancer or something.

I've uh.. I've had many patients come in weak and tired uh.. and jaundiced, with no other medical history-- uh.. and done a CAT scan of their abdomen, found a pancreatic mass-- and done a biopsy and confirmed pancreatic cancer. Uh.. in which case, their lifespan is less than six months from the time of diagnosis-- that's a sad thing, and I will tell the uh.. families exactly what I think. But I also use a failsafe as well. I tell them there's nothing that can probably be done and the prognosis is 6 to 12 months; however, uh.. I say, "Things that you should do are: get your affairs in order; make peace with your family; make peace with your Lord." Uhm.. I also tell them to enjoy the next 6 to 12 months, and I do things uh.. surgically and medically uh.. to palliate the patient. If they're obstructed and I know they can't be helped as far as whether we can cure their cancer, no. But I can relieve their obstruction and allow, say a simple thing such as eating-- rather than having a feeding tube. Options that improve quality of life, even though you're not making a change in their long-term survival, you are making a change in the amount of time they have left as far as quality-- spending it at home with their families instead of in a hospital-- uh.. spending it in less pain, uh.. and so on and so forth. Those things are important to me, and I've-- many times-- probably once a month-- sat and cried with a patient uh.. and told them there's nothing more that can be done.

Uhm.. and I've shown up at many funerals, and so on and so forth, for terminally ill patients who we've had a good rapport with. And even if we've just met them, I like to think that we-- we get close to our patients very quickly. And some say that that's not the correct thing to do. I always say that that's the correct thing to do. I always get close to my patients, and I treat them in a way that I would want my own family treated. And I think that makes a difference.

Zarbock: In the broad range of responses that humans make, have you ever had a situation in your clinical practice of a patient receiving news of a terminal condition, where they flew into a rage at you?

Andrew Hutchinson: Uh.. no. No I haven't. I- I have had them be very upset uh.. and question whether the diagnosis is correct. Uhm.. they've never been enraged. Uhm.. I have had patients ask for a second opinion. I uh.. in fact, I welcome a second opinion, because hopefully I'm wrong. And I'll send them to a tertiary care facility such as a large institution-- Sloane Kettering Cancer Center in New York, uhm.. Duke University Medical Center, M.D. Anderson in Texas. Uh.. these place that maybe can confirm my diagnosis and will, and usually do, confirm the diagnosis-- but can maybe offer the patient some new DNA uh.. type treatment, or a new biochemical treatment that they've been testing that isn't widely available to the general population or physicians but can be done in their testing facilities-- and things like that. Uh.. I never lose hope. And uh.. and I don't want the patient to lose hope either. And so, I- I do transfer them or refer them to a tertiary care center. Uh.. even if they don't ask for a second opinion, I usually do that because uh.. in the practice area where we are all of the resources are not readily available to you.

Zarbock: Which of course begs the next question. In this general discussion of referral patterns, what's a nice guy like you doing in Whiteville? And how? And why?

Andrew Hutchinson: Yeah. It's an interesting question. I'm from Philadelphia and Southern New Jersey. Uh.. the big city, and uh.. and to come to a small town of 7,000 to 10,000 people uh.. in the general vicinity. And it's a-- a town that's primarily a farming town. Uh.. it's interesting what brought me here. I had uh.. said to my wife from the very first week that I met her, uh.. that I would not be staying in Southern New Jersey. And there's many reasons for that. The first and foremost reason was uh.. I wanted to be needed. I wanted to feel needed. Uh.. practicing in the city and being a general and vascular surgeon, uhm.. you could trip over one. You could swing a cat and hit one. Uh.. and- and so really I didn't feel like I could make much of a difference over and above what was already there. And so, uh.. why not go to a place that needed that type of specialty. And so uh.. my requirements for finding a place to practice were uh.. being near uh.. within an hour's reach of the coastline, uh.. because that's how I grew up in Southern New Jersey, close to the beach. And so my wife and I had that requirement. Being in a small uh.. town was another requirement. Uh.. I don't really have the desire to be a little fish in a big sea. Uh.. I don't really have the desire to be a big fish in a little sea, but uh.. I did want to come somewhere where I could improve the quality of healthcare. And so, there was no vascular surgeon here. There are other general surgeons. Uh.. I figured that I could bring uh.. some of the procedures that are not readily done in this area and had to be transferred to other facilities-- I can bring those to this area uh.. and make it more convenient for patients, improve the uh.. healthcare of this area, and so on and so forth.

Zarbock: That question that slipped by me-- that I just thought of-- where did you do your residence?

Andrew Hutchinson: I did my residency uh.. at the college that I graduated uh.. medical school from, which uh.. even coming from that college was a difficult uh.. residency to get into. Uh.. I- I did my residency at Philadelphia College of Osteopathic Medicine. Now, most residencies are at one hospital. Uhm.. I had, I think, the fortunate ability to have my residency through a college of medicine, which was able to contract with all the top hospitals in the area so I could get the best of the best in each specialty. And so, uh.. for my trauma rotations I went to uh.. Cooper Hospital in Camden, New Jersey-- a Level 1 trauma center. For my uh.. surgical oncology I went to Sloane Kettering in New York for three months every year. Uh.. I couldn't beat that type of- of training. Uh.. I went to Medical College of Pennsylvania (MCP) for general surgery. Uh.. I went to other small community hospitals to learn about, sort of, bread and butter surgeries uh.. from hernias to breast biopsies and so on and so forth. And so, I just think that uh.. having that type of well-rounded uh.. training made me better.

Zarbock: And how long was the residency?

Andrew Hutchinson: Uh.. four more years after the internship. So a total of five post-graduate.

Zarbock: Are you paid during this time?

Andrew Hutchinson: You are paid a stipend. Uh.. it's uh.. it's a lot less than I made as a pharmacist. Yeah. It's just-- it's a minimal amount of money.

Zarbock: By the way, were you practicing pharmacy while you were in your residency?

Andrew Hutchinson: No. No.

Zarbock: Oh, again, the conflict of--

Andrew Hutchinson: You can't-- you couldn't do that in the same state that you practiced in. So-- and then after uh.. general surgery I did one extra year in a fellowship at University of Medicine & Dentistry in New Jersey uh.. for vascular surgery, endovascular surgery, stinting, angioplasty, and conventional bypass surgery.

Zarbock: What year did you finish your residency?

Andrew Hutchinson: Residency was finished in 2001-- fellowship in 2002, and I moved to North Carolina in the summer of 2002 and began practice in 2002.

Zarbock: What have you found surprising in your practice here? Culturally, historically-- any dimension that you want.

Andrew Hutchinson: Yeah. The most astounding thing that I find practicing here is, I cannot believe-- and it just reaffirms my reason for being here-- I cannot believe the amount of pathology in this small town. Uh.. I mean, just to give you an example, during my fellowship in vascular surgery I covered seven hospitals uh.. and worked every day, was on-call every day of that year. Uhm.. I had nowhere near the pathology-- although I did 700 cases that year, I still had nowhere near the pathology that I had when I became an attending here. Things that you've read and studied about uh.. in your fellowship and residencies uh.. but had never seen even in a area where there's 30 million people, like Philadelphia and New Jersey. Uh.. you come to an area that has 10,000 people, and uh.. because there's never been anyone here to diagnose these things uh.. you have uh.. horrendous disease-- plus diet, and tobacco usage here is much greater than uh..

Zarbock: Well, could you illustrate some of the diseases that surprised you in number and--?

Andrew Hutchinson: Yeah. Uh.. there's a lot of uh.. there was quite a bit of renal artery stenoses disease there, and hypertension. That's where I trained. Here it's tenfold. Uhm.. you know, we did uh.. some angioplasty and stinting of the renal arteries. Uhm.. at the seven hospitals combined I probably did maybe 10 angioplasty and stintings. Over the past year here, we've probably done 50. Uh.. it's just uh.. exponentially uh.. greater in this area. Uh.. vascular disease in general is greater here. Uh.. and things uhm.. such as uh.. subclavian artery stenosis with symptoms in the arm or dizziness caused by this-- and doing a carotid subclavian bypass. Uhm.. those are few and far between, even in a- a heavily populated area. And we found two or three of those just in this 10,000-person area. And it's just uh.. it's just a cornucopia of vascular disease here.

Zarbock: And a variety of contributing conditions that led--?

Andrew Hutchinson: Absolutely. I think that the environment and the cultural differences here in this area certainly play a part uh..

Zarbock: Can you pick that apart a little bit, when you say environment what--?

Andrew Hutchinson: Oh, yeah. The diet. I mean, the diet here-- I think, from the area where I grew up and practiced uh.. in my training uh.. were more socially aware of the dangers of the fat and cholesterol and things of that nature. It's a part of life here. Uh.. and it's, and I have to admit-- it is good. Uh.. and everything uh.. that I've ever had here, as far as from a homemade standpoint, has been excellent. But when you find out the ingredients uh.. you know that uhm.. real lard is used. And uh.. they're not worried about mono and saturated fats uh.. all that much-- or even cholesterol. And uh.. fatback is a staple here and--

Zarbock: And a lot of salt.

Andrew Hutchinson: And- and there's so much sodium uh.. you know. And that's uh.. that's no- that's no blame put to the south. It's just a cultural difference. Uhm..

Zarbock: What about genetic pool?

Andrew Hutchinson: I think that plays a big part in it as well. Uh.. one of the biggest uh.. things regarding genetics has gotta be diabetes in this area. There is uh.. a tremendous-- diabetes is heavily spread throughout the world-- however, just in this area, from what I was used to uh.. there's a huge percentage of diabetes here. And that probably does come from families, because it seems to me that families uh.. don't move from this area. They stay here; they're- they're given land. Uh.. they stay; they farm the land uh.. and it's all they've known, and they stay. And uh.. which is a great thing, because uh.. you have that closeness here. And that's very nice. I love that uh.. part of the town. Uh..

Zarbock: And supporting what you're saying, if you go to a family funeral, especially in a rural area, and you get to a rural graveyard-- people can look back generation after generation after generation of people who lived right, you know, within a few miles of where the funeral takes place.

Andrew Hutchinson: It's a very endearing thing uh.. about a small town. The other thing that contributes to the increased vascular disease, and just disease in general, is to- tobacco use. Uh.. it's just uh.. smoking is probably the number one changeable cause of vascular disease in this area. Probably, if cigarettes were never invented, 50 percent of these patients would not have any vascular disease uh.. including, but not limited to, heart disease, carotid artery disease, stroke, lower extremity disease, loss of limb, ulcerations uh.. gangrenous feet. Uh.. all of these things are solely caused by smoking. Uh.. and then you have your diabetes on top of that, with smoking.

I have patients uh.. who come in who are diabetics who smoke, who were never counseled on uh.. they are counseled on the importance of keeping their blood sugars, but uh.. no one can get them to stop smoking. And uh.. that is one area where I'm very adamant on health-maintenance. And I basically, even on the first meeting, will tell the patient uh.. if you're a diabetic and you smoke cigarettes, I can almost guarantee you will lose your legs before the end of your life. And uh.. I will tell a patient that straight out. And uh.. most of them won't listen. The ones who do will keep their legs uh.. and the amazing thing to me is that uhm.. you give the patient a second chance, say with a bypass of the lower legs, uhm.. and tell them, "You can no longer smoke because if your bypass goes down or blocks from cigarette smoking, you have no more chances after this. Your legs will have to be amputated." Uh.. and the- the unbelievable uh.. disregard for that-- patients will continue to smoke. And I've had many come back a year after repairing their legs with another blockage in it and a black foot-- at which point there's nothing to do. And you have warned the patient, and no one learns until it's too late. And it's an upsetting thing-- but smoking uh.. if I had to pound any point home-- smoking really is the number one cause of a lot of the diseases. And I'm not even touching on lung cancer. Lung cancer is huge in this area. It's huge. I haven't even touched on lung cancer at this point-- just arterial disease. And you know, probably a lot of healthcare dollars and a lot of lives could be saved just from the eradication of smoking.

Zarbock: What about alcohol?

Andrew Hutchinson: Alcohol is uh..

Zarbock: Relative to your discipline.

Andrew Hutchinson: Uh-huh. Alcohol is big in that uhm.. I see a lot of cirrhotics with ascites. Uhm.. they have uh.. cirrhosis-- they won't stop drinking, and uh.. and so on and so forth. Probably uhm.. related to my discipline-- the most- the most fatal incidence uh.. relating to alcohol is uh.. is automobile accidents. And uh.. that relates to my profession in that I'm a trauma surgeon. Someone gets in a car accident, almost-- almost 90 percent of the patients that I see in motor-vehicle accidents, whether they be an innocent bystander or the driver of the implicating car, has had some type of alcohol that day uh.. and usually reeks of it. Uh.. it-- a common odors in a trauma are blood and alcohol. Uh.. I-- and it's a- it's a completely nauseating smell. It's something that you can never get used to. It's just-- it's like burning hair or flesh. You can't get used to it. And when you have someone come in uh.. who uh.. you're trying to get their airway and you just, you just are thrown back by the amount of alcohol you're breathing at the same time that they're exhaling. It's tremendous. The whole room reeks of that type of odor. Uh.. it's a fruity-- it's a fruity, sour alcohol smell, and it's uh.. it won't-- it never leaves you. Once you smell it, you know before you walk in the room that the patient has been involved in alcohol abuse or-- of some sort. Uh.. and that's how alcohol relates. It's more of a-- it's an immediate killer here, rather than a long-term killer.

Zarbock: Doctor, have you got any comments that would care to make on, looking into you crystal ball, the delivery of healthcare. What changes might you think would take place?

Andrew Hutchinson: Well, uh.. the pendulum has swung two different ways so far in my career. Uh.. I got in medical school and pharmacy at the end of the pay per-- the fee for service era-- when uh.. doctors and healthcare-- allied health professions in general-- could charge what they wanted and get paid for it. Uhm.. and this became a dishonest system. And uh.. and I can't say I blame uh.. the government and healthcare uh.. healthcare payers for putting a stop to that.

Uh.. by doing that, as in everything, the pendulum has swung the entire opposite direction uh.. and I think that there's too stringent uh.. a stronghold on that now. Uhm.. you know, patients aren't getting the care they require, physicians aren't being reimbursed appropriately. I mean uh.. for instance, in the days when you could do fee for service-- uhm.. doctors were admitting patients with lumbar back strains and putting them in traction, which we know is no longer needed. Uhm.. and they were keeping patients in the hospital for two weeks and generating that type of income. Those things they knew were wrong. Uh.. and so that made it worse for us now. Uh.. just those types of situations-- just uh.. inappropriate billing uhm.. practices.

But now, uhm.. just to get paid for seeing patients and doing emergency surgeries uh.. is very difficult. You really have to fight for your reimbursements uh.. and denials are a normal part of your uh.. weekly uh.. paperwork. Uh.. and it's all because a code was wrong, a number on a birthday was wrong, uh.. the patient's uh.. diagnosis doesn't match their procedure code. Uhm.. things like this that are just uh.. just ridiculous. Uh.. the way I see it going uh.. is-- it's gonna swing back. And hopefully there's gonna be a happy medium. Now that we've been to both extremes, I think uh.. if- if we don't forget, as often we do, uh.. if we don't forget what happened in the past and what's happening now-- we can come to some kind of happy medium.

I don't think socialized medicine is the answer. Uh.. I think that patients will definitely suffer then, because you become a number-- and if you don't meet certain criteria uhm.. you're permitted to die. And you're no longer-- you are no longer needed. And I don't think socialization is the way to go. Uhm.. I think that uh.. if you do socialize medicine you take the personal component out of it. Uhm.. you don't get care, and that's the whole reason I went into medicine uh.. and surgery, because I love-- I love people. I love to talk to people; I love to help people. I help people uhm.. with their financial problems sometimes. If they come to me and say they don't have enough to pay their light bills or-- I have a patient who can't afford uh.. any of her-- she has no insurance. She can't afford her light or health bills. Uhm.. we sent her a five-course uh.. Thanksgiving dinner. Uh.. things like that just make you feel like you're part of the community-- feel like you're doing one small thing for one person uh.. to help them. And uh.. and that's what it's all about. I think if you socialize medicine you're not gonna have that. And so I don't really know what the answer is uh.. but I do know that- that having something in between fee for service and this strict uh.. no fee at all (laughs) would have to be uh.. some compromise has to be come to.

Zarbock: Doctor Hutchinson, it's pleasure to know you.

Andrew Hutchinson: Thank you.

Zarbock: Thank you for the time.

Andrew Hutchinson: Appreciate it.

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