M.D.s and D.O.s Today

Dr. Stuart Chesky, DO, interviewed by Dr. Michael Seffinger, DO

in the home of Dr. Stuart Chesky
October 9, 2005

Dr. Seffinger: Dr. Chesky let’s start out by telling everyone who you are, where you grew up, where you were born and where you went to school and how you got involved with the osteopathic profession.
Dr. Chesky: Thank you Michael. I was born in Chicago, Illinois. I attended elementary school and high school in Chicago. I had a life’s ambition from the age of seven to be a physician. In my last year of college I looked into osteopathic medical schools and applied to the Chicago College of Osteopathy, that was the name in 1964; the name changed to the Chicago College of Osteopathic Medicine and it is currently a college under the auspices of the Midwestern University. I attended the Chicago College of Osteopathic Medicine (CCOM) from 1964 to 1968. Upon graduation, I received the DO degree; I stayed at the Chicago Osteopathic Medical Center and did a twelve-month rotating internship that was completed in 1969. Following my internship, I was accepted into a four year OB-GYN surgery residency at CCOM; I completed that in the late summer of 1973. I then joined the faculty of the Chicago Osteopathic Medical School and was on the staff of the Chicago Osteopathic Hospital as an OB-GYN Specialist. I stayed in that position and taught at CCOM until 1974, after which time I went into private practice. I practiced in the Chicago area until 1977, when I decided to go to California. I actually had received my California license to practice osteopathic medicine in 1974. I was in the second group of DOs to get the license after the DO board was reactivated in 1974. From 1974 to 1977, I looked for opportunities in California. The reason I wanted to move to California was the “California dream”, the land of sun and perpetual vacation experience. I heard that the Pacific Hospital of Long Beach had an OB-GYN on staff who was in the process of retiring, and the hospital was looking for someone who could take over the practice; that was Dr. Earl Waters. He was an MD who was a former DO and took his MD degree at the merger. I made arrangements to go to California. I interviewed at the Pacific Hospital. I met Dr. Waters and we liked each other. We worked out an arrangement for me to take over his practice. At the end of 1977, I left the Chicago area and migrated to California. I began work in California the first of the year in 1978. Having taken over Dr. Waters practice, I had a very nice practice. However, Pacific Hospital of Long Beach at that time did not have an obstetrical department. All of the deliveries were being done at the Long Beach Memorial Medical Center, which is approximately a 2,000 bed MD institution about two and half or three blocks from Pacific Hospital. I applied for privileges on the staff of the Memorial Hospital and achieved the unique distinction of being the first DO as a DO to get privileges at the Memorial Medical Center with full privileges. I did my obstetrics and some of my surgery at the Memorial Hospital and I did surgery at the Pacific Hospital. The Pacific Hospital of Long Beach was a former osteopathic hospital after the merger became a mixed staff hospital, approximately 200 beds. The hospital itself had a rather limited informal educational program for some American medical students that were doing training in Guadalajara and some of the other offshore or foreign medical schools, who needed to do a student clerkship. When I arrived at Pacific Hospital , I had the most academic experience and training as a DO then any other staff members and I was made the Acting Director of Medical Education. We continued to pursue getting students into the program. The College of Osteopathic Medicine of the Pacific had started a couple of years before that. The first class of students needed clinical experience. It was just a natural segue for those students to come to the Pacific Hospital, as clinical clerks (externs), where a DO was in charge of the training program; that in of itself started the resurgence of the post-doctoral training program, DO students coming from the College of Osteopathic Medicine of Pacific. I realized the COMP students would be graduating in a short period. I campaigned to develop an internship program at the Pacific Hospital, I presented my ideas to the Board of Directors and the powers-that-be at the hospital and I was able to convince the majority of the physicians that a reactivation of the DO post-doctoral training program might be in the best interest to the hospital. It certainly would give credibility to a small community hospital if it had a formal a training program. The public would look at that in a very favorable way. If the hospital had a training program, it must be a good place to receive healthcare. MY presentation was accepted. The executive committee of the medical staff assigned the responsibility to me of completing the application for the internship and to comply with all of the regulations of the American Osteopathic Association. An application package was created and submitted. (I believe the archives of the medical education department at the Pacific Hospital contain the original application form. The medical executive committee approved and budgeted for eight interns. When the application was being filled out, I instructed my secretary, to not put eight in the slot but rather 25. My thoughts were: that if we ever want to expand the program, we wouldn’t have to go through the entire process of reapplying; and if we get approval for anything above eight, we are comfortable for future growth. The American Osteopathic Assocation’s committee on post-doctoral training, approved the twenty-five slots all-be-it we were budgeted for eight, we took eight interns in our first class and these were graduates of the College of Osteopathic Medicine of Pacific. At that point I was given the position of the Director of Medical Education elevated from the Acting Director - nothing changed except the title - the responsibility was exactly the same. Our graduates from the internship program went into practice; most of them went into various locations outside of the Long Beach area. The problem in Long Beach was the DOs that finished the internship program could not get privileges at the Memorial Medical Center because the Crendentials Committee felt that a one-year post-doctoral educational program was not as adequate as the allopathic graduates who would have a three-year residency in post-doctoral family practice training. The idea of expanding our internship to a family practice residency program was conceived at that time! To compete with the allopathic programs and to get our DO graduates privileges in some of the premiere medical institutions. If they had the same amount of post-doctoral training, it would be possible for them to apply for staff privileges and perhaps obtain them. During this same period, we needed experience in obstetrics for our trainees, since the Pacific Hospital did not have an OB Department; I was able to arrange with the Memorial Medical Center to allow our interns to go there for a rotation in obstetrics. We were also able to work out an arrangement for rotation at the medical center at the L.A. County Hospital and some of our trainees went there to complete the requirements of the obstetrical experience.. The majority of our students that went to the Memorial Medical Center had a favorable experience; they also did a good job and left a very good impression on the people at Memorial. –At the same time, my campaigning for the family practice residency program was started and the medical executive committee agreed with the stamp of approval of the Board of Directors. I was directed to apply for a family practice residency program under the auspices of the American Osteopathic Association. This application was submitted, physicians that were under the direction of the American Osteopathic Association completed inspection and our program was approved since we had the requisite number of beds and the requisite number of physicians that would be participating in the educational program. The first class that completed our two year family practice program, were still not able to get privileges at the Memorial Medical Center because the Credentialing Committee said it was only a two-year program and the allopathic physicians had a three-year program. Well, I looked at the semantics of that and realized that if we had a post-doctoral trainee that spent his internship for twelve months and twenty-four months in family practice residency shouldn’t that trainee receive a certificate stating 36 months was completed in post-doctoral training in general and family practice. I created that particular certificate and I am sure that it can be located in the archives of the medical education department at Pacific Hospital. That, , achieved the requirement of three years of post-doctoral training for the DOs to get privileges at the Long Beach Memorial Medical Center. An interesting aside, one of our former Pacific Hospital interns - Dr. Melvin - Susan Melvin, D.O., and a graduate of COMP. After finishing her internship at the Pacific Hospital,. Dr. Melvin took a allopathic family practice residency at the Loma Linda Medical Center; completing that, she applied and was hired as the Assistant Director of Family Practice Residency at the Long Beach Memorial Hospital. Susan called me and thanked me. I asked, “Why are you thanking me,” and her response was, “I was the first DO on staff; made a favorable impression; and allowed the gates to be opened so someone like herself could be an educator in the Family Practice Training Program; This was a very nice compliment that she bestowed upon me. It was something I never thought about. It was totally unexpected and greatly appreciated that that was acknowledged.
Dr. Seffinger: She’s still there...
Dr. Chesky: She is now the Chair of the Program. I believe Dr. Steve Brutton, left that program and Susan stepped in as Director. The other principals that were involved in the education program at Pacific Hospital was Dr. Stanley Galanty who was a former DO who took the MD degree, but was dedicated to his osteopathic roots. Unfortunately, from my understanding, he was caught in the shuffle of the merger and became neither a “fish nor a fowl” in relation to his documentation for certification, but he still had the skills and the academic ability to participate in the training program. He was very instrumental in helping to develop the curriculum and from what I understand, he is still actively participating. The title that I gave him at that particular time was the Dean of the program. He could not be the Director of Medical Education because a DO was required to have that position, I gave him the title Dean and he was appreciative of that. Other DOs that participated in the educational program at that time was Dr. Thomas, Dr. Vinn, Dr. Adams. One MD - Dr. Franklin Horowitz - a general surgeon who was very instrumental and supportive of the osteopathic program and a great educator, received accolades from his students as being a great teacher. He was wonderful for the program. He had a style in his teaching that was a little bit different then the Dos.. He and I became very good friends. I was very thrilled that he was so supportive. It was his support as an MD that was really instrumental in getting the other MDs to become supportive of the post-doctoral program. I was on the faculty of the College of Osteopathic Medicine of Pacific; became a full professor and Chair of the OB-GYN Department; held that position until I left California in 1993; and migrated to the Midwest where I am currently residing. I continued practicing. Just a little background away from the osteopathic experience; when I relocated to Ohio, I became active in the osteopathic organization; became president of the Loraine Academy; and was on the Board of Directors of the Ohio Osteopathic Association; continued to practice in clinical practice until November of 1999 when I developed a neuropathy and could no longer do surgery. It was decided in the best interest to my patients and me to perhaps retire from clinical practice. I did that, went through an increditable adjustment, but being active as I was and then not being able to work, I decided to go back to school. I attended Ohio Northern University and law school. I received the JD degree in December of 2002. I passed the Ohio Bar and I am currently actively practicing as an attorney with a 30-year background in Osteopathic Medicine and Obstetrics and Gyunecology. Other things that I should perhaps mention, historically; when I migrated to California not only did I become active in academics, I became active in the osteopathic political structure; became a board member of the Osteopathic Physicians and Surgeons of California, the OPSC; actually became president of that organization. I do not remember the exact year at this time, but I know it was a gubernatorial...
Dr. Seffinger: 1990.
Dr. Chesky: Gubernatorial election year 1990, and what was interesting, candidates on both sides wanted our support and they all came to talk to us with hands extended not for a handshake, but to have money cross their palms. We supported the candidates the best we could. It was a very interesting experience to be involved in “political medicine” at that particular time. I remained on the Board for a good number of years in California. I was on the Board until the time that I left California. I saw a growth of that board; saw a change in the demographics of that board, in the human demographics, from some of the older physicians who did not take the MD degree at the time of the merger. The Board became increasingly seeded with contemporary DOs which changed the nature and complexion and the thrust of the organization. I was also active in the curriculum development at the College of Osteopathic Medicine of Pacific. One of the problems that we had early on was trying to have uniformity in the clinical experience of the students. Since the college did not have its own hospital, the students were farmed out all over the country. We at Pacific Hospital... were approved for, I believe 20 perhaps 30 students, but that left a short fall so students went to other various hospitals. There was a great deal of activity to try to establish some sort of standard for the clinical experience. I was involved in those meetings to try to determine a rotational experience that would be at least reproducible in some aspects.
Dr. Seffinger: Okay, excellent history that tells us where you’ve been and what you’ve done. If you don’t mind I’d like to go back in time and get some of your impressions at key points in this professional development, for instance, when you first applied for DO school, okay, think back at that time, what went through your mind and how did you determine whether to go to DO school versus MD school? How come you chose or selected to go to Chicago? How did that come about?
Dr. Chesky: Well, it was natural to stay in Chicago since I was a native Chicagoan. I always joked that I received my entire education without ever “crossing the street.” I had applied to the local allopathic medical schools and I also applied to Chicago Osteopathic. I was placed on an alternate list at one of the medical schools and I was accepted also as an alternate at Chicago College of Osteopathic Medicine. My position as an alternate at that school moved up rather quickly and I was acceptedat CCOM. ; I chose to attend that school. My experience with osteopathic physicians up until that time was rather limited. An interesting anecdote, the students needed a letter of recommendation from a DO, my father had a friend whose physician was a DO. This r individual said I should talk to Dr. Ward Perrin at the Chicago Osteopathic Hospital. I called Dr. Perrin and met with him and he was gracious enough to give me a letter of recommendation. Dr. Perrin was an internist, but at the time taking care of my father’s friend’s family, he also was doing obstetrics, which I thought was a very interesting situation. The letter obviously was effective as I was accepted. I became very excited about osteopathic medicine from the concept and philosophy of structural function and mechanics. I also felt that it was an added modality of taking care of the whole patient. I really thought that was interesting because it had one more area of options to give a patient than in traditional medicine. I thought osteopathic medicine had something more to offer. Remember now we are talking about 1964. The DOs in Illinois at that time only had full practice rights about ten years or less. I thought manipulation was a good thing. When I finally learned how to do it correctly, the people I used it on, primarily family and friends, felt better, so I said, there is something to this. As I got further into the educational experience, and further into my post-doctoral training in obstetrics, I felt there was a vast opportunity to utilize manipulation in the pregnant patient. I would manipulate my pregnant patients - the typical low backache of pregnancy that almost every pregnant woman has; was given relief, all be it temporary, they still had relief. An interesting story, one of my patients came into Long Beach Memorial Center and could not walk. Everybody was nervous and excited that she had some serious problem. I diagnosed a subluxated pubis. In the labor room, I put her on her side and manipulated her low back. She got out of bed and walked out . The nurses thought I walked on water at that time. I had all the nurses coming to me for manipulation after that. So I started to re-access osteopathic medicine and thought it was an incredible marketing tool in addition to the traditional tools of our trade. It was an added plus, a tremendous practice builder. I always felt that way. I always felt as a DO, I had as much to offer as my allopathic brethren and perhaps some more.
Dr. Seffinger: Okay. When you entered the osteopathic profession in Chicago, you said that the doctors had unlimited license, but then you went through training - third year, four year rotations - was this with DOs only or were you at that time able to study with MDs? And then when you went on to residencies, were you training under DOs and/or MDs?
Dr. Chesky: Interestingly enough, all of my educational experience that was credentialed were with DOs. In my third and four year, I did a rotation at Detroit Osteopathic Hospital all with DOs. That’s where I really got to see obstetrics in a large volume and really became very interested in pursuing it as a career choice. I also, as a second year student, worked at Grant Hospital in Chicago as a clerk in the emergency room and that was an MD institution, all MDs at that time. But they were very helpful in pointing things out. Being a clerk, I was responsible for filling out the paperwork, but then as the doctors became more comfortable with us, they’d let us take blood pressures and initial assessment of the patients. That was my first hands-on experience with MDs as the preceptor. Although that was not the certified educational experience, it’s certainly was an adjunct to it. It taught me a couple of things very quickly - that everybody does those things exactly the same way. So the distinction had to be something other than the mechanics of practicing medicine and I started looking at that even more in detail as far as the philosophy of the whole patient approach. One of the things I did notice, and of course, DOs fell into this category too, when the doctor came down into the emergency room and wanted an assessment of what was going on: staff would say, oh, the gallbladder in Room 2, or the hernia in Room 3, or the M.I. in Room one. I started thinking - that’s pretty impersonal – that’s a patient with a gallbladder or that’s a patient with a hernia, that’s a patient with an M.I. I thought the osteopathic philosophy was a little bit more humane. This is not to say that many physicians do not have this approach and then when I say physicians, I mean MDs and there are DOs that do not, but I think as a profession, it has that concept that this is a human being - a person that has a problem. It’s not a problem that walks into the emergency.
Dr. Seffinger: Okay. So your training was with the DOs in the state of Illinois. Then you came to California. It would be very interesting to know what your first impressions were with the California situation having been raised and trained with a well organized DO profession, and then to come to California where things were shambled with a lot of issues. I’m sure you could see the differences very well. I’d be interested to know what that impression was.
Dr. Chesky: Yes, it’s an excellent question and a very complicated question to answer. The question was my experience and perception of the osteopathic profession in California in 1977-78, which was only several years after the re-institution of the osteopathic licensing board. It was at that point, for all intents and purposes, a young profession. There were only a handful of traditional DOs that did not take the MD or if they did they didn’t utilize. So there was a lot of opportunity for growth, but there was also a lot of opportunity to give guidance and direction, if one had that interest skill and of course wanted to that. Some of the things were just totally mind-boggling. A former DO/MD said he couldn’t refer patients to me although he recognized my credentials and my skill as an OB-GYN surgeon; his reason was, it would be too difficult to explain to my patient what a DO is. I was so floored by this attitude. Then I said, “Well this is probably part and parcel of some of the attitudes why those former DOs took the MDs so they didn’t have to explain the difference.” There were other former DOs that didn’t have a clue of what my training consisted of and when they learned how much educational experience I had and what my skills were in the operating room. They became very good supporters in referring people, but they did not know that by natural knowledge. They had to be informed of that. When I was presenting the curriculum for the training program, many of the physicians were so surprised that we had such an in-depth sophisticated format to follow because things up until that time were running pretty loose. It was a wonderful experience for me because I had an opportunity not only to educate, but to educate some seasoned physicians in the osteopathic training program.
Dr. Seffinger: So then you became involved with OPSC and from that standpoint what did you see and what did you learn from that perspective as a member of a new revitalized osteopathic organization, political organization and educational organizational within the state?
Dr. Chesky: Yes, my perception of OPSC was, they were really the first line of public relations of the osteopathic profession in the state. We were well recognized in the legislature. That’s because we had a very good lobbyist that worked for us.
Dr. Seffinger: Do you remember who that was?
Dr. Chesky: That was Mr. Weyeuker.
Dr. Seffinger: Matt Weyeuker?
Dr. Chesky: Yes, Matt Weyeuker. He has an osteopathic background experience; was not a physician, but was very supportive of the osteopathic profession; new knew his way around the hill in Sacramento; and he had good rapport with the people that were supporting the California Medical Association. So we had a very good contact. He was well respected and well received. I believe that really helped us as a political-educational-social organization. We were small, and yet politicians came to us for support. So there was some recognition that we were a force to be acknowledged. We did represent a handful of voters in the state, osteopathic physicians. Politicians wanted all the support they could get and they acknowledged us as a political body that could shift elections one way or another. Of course, everybody wanted contributions. In any type of organization, politicians believe the coffers are unlimited. We had to very carefully decide whom we were going to support. We tried to support everybody as equably as possible. As I stated earlier, I did see a tremendous amount of growth in the OPSC over the early years as increasingly younger DOs came on to the Board. For a long time, it had the reputation of being a good old boys club. One of the things that physicians in my generation wanted to do was attempt to be gender equal. We really wanted to have female representation on the Board because we saw the handwriting on the wall and there was growth in the profession from the gender differentials. We thought we should have representation that would be sensitive to that. I saw that change. I cannot say that I was unilaterally responsible for that, but certainly involved in helping that decision to be made, to become more sensitive to those issues.
Dr. Seffinger: Okay. Were there laws beside the 1974 law that allowed for the return of the licensing board? The Supreme Court Decision in 1974 allowed the licensing board to be reinstated, but apparently there were still some laws that didn’t protect the profession. I understand that both OPSC had to work hard to try to deal with the discrimination that was still present in California. Can you talk a little bit about the discrimination that you found in California when you came there?
Dr. Chesky: When you say there were laws that needed to be overturned, I don’t believe there were statutes per se. What I do believe, there were areas of prejudice and animosity on a grass root level from various MD organizations and MD facilities that did not want DOs, although DOs were dully licensed and credited in the state of California. The DOs were still having trouble getting on the staffs of various hospitals. It was not primarily a state legal issue, it was a legal issue of discrimination - very much like the fact that DOs couldn’t get license in California before the Supreme Court reversed the original law. It really became a restriction of trade issue on a local level. The OPSC did what they could, as far as writing letters to administrators and chairman’s of boards, in trying to enlighten them in what the new law was and how they should look at that when a DO who was qualified would apply for privileges. Personally, my experience and I have to say happily, was not one of with any type of discrimination. One on one, I really had a very favorable experience. My credentials were all osteopathic; they were all looked at for what they were. As I said, I was the first DO on the staff of Memorial Medical Center. After I was given full privileges - an MD was not given privileges because his credentials were not impeccable. So I cannot say there was any favoritism played on my behalf. I think my credentials spoke for themselves. An interesting experience I had at Memorial Medical Center, there were twice weekly education meetings, and when I was new on staff, I was meeting various doctors and of course the first thing you do when you are in a medical meeting, you are asked what was your name and where did you train. I was very open about that and one MD says, “Oh, well you are in California now that makes you an MD.” Even the MDs did not understand that there was a reversal of the law. They still thought that if a DO came to California - you were an MD and that was not the forum to enlighten him. I did not acknowledge his statement. I shook hands with him very politely and we discussed other issues, but that came up more than once. So even the MDs were really not aware of the new law and the resurgence of the Osteopathic Licensing Board, which I thought was interesting because there were no DOs that came into the state for - what was it ten years, twelve years - from the time that the Board could not issue new licenses until it was re-instituted. So, I thought it was interesting that these MDs had not met any DOs until that time and they still had the concept that, well you must be an MD, if you are licensed in California, but even at that there was no acknowledgement that the MD wasn’t equivalent. It was just an unknowing situation on the part of individuals.
Dr. Seffinger: Were you aware that any of your graduates from the internship had difficulty applying for residencies because they had a DO internship and it wasn’t recognized or as a DO they were not allowed to apply to neighboring residency programs?
Dr. Chesky: I believe I remember one or two incidences where our graduates had to retake the internship or retake the PGY-one experience in an allopathic program to become eligible for a training program. If somebody wasn’t accepted at one place they probably would not want to challenge it and they went to another area where they were accepted. But yes, in the early days in 1978, 79, 80. ...Or at least when the first graduating class from COMP and the second graduating class from COMPcame into practice there was a discrimination on a post-doctoral level and that was another impetus for us at Pacific Hospital to create a program for those students that wanted to stay in the area.
Dr. Seffinger: Were you aware that in 1989, when I applied to UCLA for residency in family medicine and at Ventura also, I was told on the phone that they do not accept applications from DOs and I decided not to fight that, but I went to UC-Irvine and USC which did accept my application. I ended up getting accepted by both and took UC-Irvine route to (? 41:19) family medicine there?
Dr. Chesky: I find that very interesting because UCI and UCLA are still under the same UC auspices.
Dr. Seffinger: UCI was DO friendly...
Dr. Chesky: and UCLA was not.
Dr. Seffinger: was not.
Dr. Chesky: What I would question on that, of course you know my position these days as an attorney is a little bit different then when I was a physician and when I hear things like that...to answer your question, no I was not aware of that. Do you know who was giving you that information when you made the call? Was it a physician? Was it the Chair of the department? Or was it a secretary?
Dr. Seffinger: It was a secretary and I found out a year or so later that Matt Wiyuker and OPSC had worked to establish a law forbidding UCLA and other programs from discriminating against DOs.
Dr. Chesky: I do very vaguely remember something to that happening, but again that was on a grass root level. That was not widespread through the profession. I would be willing to make a statement that had you applied, your rejection would not have been - if you were rejected - it would not have been because of being a DO. They would have found some other area - if they did not want to accept you - that the program was full or something of that nature rather than being blatantly discriminatory. The fact that you heard it from a secretary, again you have to remember that a lot of the lay people were unknowing. She didn’t know what a DO was. She thought a DO might have been a chiropractor, not to demean chiropractic, but they just don’t know. So, I perhaps would have been a little bit more aggressive to get a formalized rejection. But, I think what you did was probably in your best interest and very smart - time and expense wise – you took the path of least resistance yet you got an excellent educational experience where you went; and not only that, it opened up doors to you to have your academic licenses where you are now. So things work out for reasons.
Dr. Seffinger: They do. I decided actually that I didn’t want to go into a culture that wasn’t initially accepting of DOs and try to break down those barriers. Where I felt totally accepted at one place, I felt more comfortable going there, actually there was less hassle, there was more acceptance at UCI or at USC, and I didn’t want to try to break through...I found out that they had never previously accepted any DOs and I would be trying to be the first one...
Dr. Chesky: You would be the ground breaker.
Dr. Seffinger: Yes and I thought, well instead of doing that right now with two kids at home and a family life, I didn’t want to spend extra time trying to do that...
Dr. Chesky: People make choices for very personal reasons, but in the long run it was a blow to your professional ego at the time, and yet it didn’t hurt you to the point where you didn’t achieve what you wanted to achieve. The credentials you have are very very impressive. Therefore, you know it was a choice you made not to pursue it and obviously, it worked well for you.
Dr. Seffinger: Now we have to examine the insurance and residency going through UCLA so...
Dr. Chesky: I remember some of the letters that were composed, now that my memory was jogged, that we did write to the various powers that this is not a constitutional position for you to take - to reject people based on there degree and then inform them. As far as laws that were passed, I cannot say there were laws per se other than laws that were already on the books as far as discrimination. Perhaps just identified the ones that already existed in...
Dr. Seffinger: No, there was some that Matt had put through. We will be interviewing Matt Weyeuker as well, but we have an OPSC on the website now that has all these different laws where legislation has been put through...
Dr. Chesky: They have, well...
Dr. Seffinger: They actually passed that one in 1909, so...
Dr. Chesky: If for whatever reason they did, I don’t have the absolute recall on that other than the fact that something was going on with it...
Dr. Seffinger: Okay. That’s fine. Are there times...we’ve talked about your accomplishments, we’ve talked about what you’ve been able to do in your career, are there things that you were not able do or things that fell short or things that you didn’t succeed at that were...you know frustrations or you know?
Dr. Chesky: I remember one experience I had when I was a resident, I believe I was a second year resident at Chicago Osteopathic Hospital, I was interested in endocrinology, at that particular time and I wanted to take an endocrine rotation at Michael Reese Hospital. I wrote to the Chairman of the Department at that time and told him, who I was - what my background was and I wanted to spend some time. My letter was never acknowledged or if it was, it was a very polite refusal that they did not have any openings. Was I devastated with it, no, but I thought it was interesting that even then, that must have been 1970, that there was still that level of discrimination.
Dr. Seffinger: And now there is DOs in Michael Reese...
Dr. Chesky: Michael...
Dr. Seffinger: Very much so.
Dr. Chesky: Another interesting thing as far as discrimination, when I finished my residency, which was in ’73, we on staff at the Chicago osteopathic Hospital still had to call a Board of Health approved OB-GYN consultant on every C-section that we performed. I found that was a demeaning that here we were acknowledged specialists and we still had to call the Board of Health. In my time when I finished, I was one of the first DO OB-GYNs that received Board of Health acknowledgment to be a consultant - that we did not have to call on anyone else - we could make our own decisions. This was a tremendous breakthrough because, not only was there a time factor to be considered, there were some expenses involved to pay this consultant.
Dr. Seffinger: Were you involved with military at all? Did you have any experience with that?
Dr. Chesky: I was in the second class of graduates that were eligible for the draft. I believe that 1967 was the first year that DOs were eligible to be drafted. It was during the Vietnam War.
Dr. Seffinger: As physicians?
Dr. Chesky: As physicians - drafted as physicians with full acknowledgement, credentials, and privileges, as physicians in the military. Not only that, a DO residency deferment program was instituted either 67’, 68, where DOs could make a commitment to go to the military and they would get a deferment for whatever the amount of the time was for the residency and it would be a DO residency. They would not be drafted during that period of time, they were allowed to finish their residency, but then they were obligated to go into the military. In addition, that happened during my experience in Chicago. One of the things I was concerned about was being drafted. I wanted to do a residency program and OB-GYN was not one of the residencies that was eligible for deferment. So I tried to find out...and this was the lottery at the time where you were drafted on a lottery number, I wanted to find what my number was; it was difficult to determine that. Then I found out that physicians were not in the lottery. Physicians were drafted as a need, so I was not drafted and that was just a lucky opportunity on my part not being drafted, but I had friends that were.
Dr. Seffinger: Who were your mentors through your professional career in osteopathic medicine?
Dr. Chesky: Are you talking from the student level on up or as...?
Dr. Seffinger: Yes, student level on up and people you thought were role models, your confidants, people that would guide you along the way.
Dr. Chesky: Well, I mentioned Dr. WardPerrin. I thought he probably was the “physician’s physician.” I mean, he was a statesman and he really represented the osteopathic profession with skill and grace. He was also very active in continuing medical education. I believe he had some position on the Board of CME and I am not talking about osteopathically, I’m talking about nationally. He was a role model. As far as other instructors, there was a pathologist I had a great deal of respect for - Leo Stein, a wonderful pathologist and a very nice gentleman. Another pathologist that I liked and thought he was a great personality was Lou Grieki. He was on the staff, I believe of COMP , if I’m not mistaken. My professors in OB-GYN, Dr. Seaver Tarulis, was the Chairman of the department. He was my Chief. Another DO that I had a great deal of respect for was Fairman Denlinger. Dr. Tarulis was an interesting personality. He would tell stories of the osteopathic professional. Sometimes when we were setting in the OB lounge waiting for a delivery, he would tell stories of when he had to take money out of his own pocket to give to the hospital to buy food for the patients in the early days, the ‘50s. Dr. Don Craske, Sr., general surgeon was an MD/DO. He actually ran the hospital on his license, when it was a limited license, to allow surgery and obstetrics.
Dr. Seffinger: What was his name?
Dr. Chesky: Don Craske, Sr. general surgeon. He was a colorful personality. And the Dean of the school at the time and I don’t remember is first name, but his last name was Kestner. He was a DO/MD. He got his MD after he got his DO degree. And he was the Dean for many years when I was there. Dr. Denlinger was a very nice gentleman. I mean he was just a very soft spoken. He gave me the best advice of my entire career and I remembered it all the time, when things are going bad in the operating room - if you lose your cool, everybody loses their cool. You have to stay calm because that calmness will go over everybody in the room. So when everything is falling apart, you have to stay calm and that was a lesson easy to learn, but harder to institute. Dr. Tarulis was OB-GYN and he actually, while he was head of the department took his surgical residency to become OB-GYN surgery. Dr. Denlinger wasn’t OB-GYN surgery, he was just OB-GYN. The only surgery he could do was C-Sections, D&Cs and tubal ligations, but he couldn’t do hysterectomies and other more advanced procedures. So I really saw a transition in the educational experience from my mentors. When I learned how to do laparoscopy, Dr. Tarulis asked me to do one of his private patient’s cases because that way he wanted me to teach him how to do it and I was a resident at that time. So as a resident your experience started to pass your mentors. Moreover, isn’t that the definition of a good teacher - one who teaches the student to be better than they are.
Dr. Seffinger: Good. Good. Good. Then speaking about your students, who did you mentor?
Dr. Chesky: You know some years ago...if you are going to ask me for a list of names it’s difficult to remember individuals, but some years ago I received the Physician of the yYear award in California from OPSC and it was a total surprise to me. During the luncheon, I was setting at a table and all of a sudden there were all these people that were my students and we were just chatting and they were all OB-GYNs. They all came to honor me, but I didn’t know that at the time. I thought it was curious that all these people that I had...you know...that paths had crossed, lives had been touched were practicing OB-GYN. Then I got the award and it was one of the few times in my entire career that I was speechless. I realized why these students came back to acknowledge me. Another interesting experience as far as never knowing whose life you are going to touch, a new member of the Certifying Board of the American College of Osteopathic OB-GYNs came up to me after he was on the Board and said I showed him how to do his first laparoscopy. Now, not only is he practicing OB-GYN, he is also on the Certifying Board. When you go through your career - you never know when you are going to touch somebody in a very positive way. And it always gives me a great sense of personal pride and fulfillment because you look at your students almost like you look at your children and you want the best accomplishments for your children and when you see a student who arises and becomes successful you feel like a proud parent.
Dr. Seffinger: Yes. Wonderful! Okay...
Dr. Chesky: And by the way you are in that category too.
Dr. Seffinger: Ha-ha-ha, okay. What advice do you have for future osteopathic physicians in training?
Dr. Chesky: Be the best that you can be. I mean its sort of a cliché taken from the government, the Army. I will get back to that, but one of the things I noticed, I was president of the Alumni Board of Governors from Chicago College of Osteopathic Medicine for two terms and I was on that Board for a period of time and part of our responsibility as board members were to honor the graduating students. We would have round table discussions for students that would ask questions about practice opportunities, and post-doctoral trainings. I saw a transition from when I first started - students wouldn’t think about taking a program outside of the osteopathic profession to almost 50% or more in some instances going to allopathic training. When I questioned these students, “Why are you doing that, why are you going?” and it also exists today - there is a perception that the allopathic educational experience is better than the osteopathic. There is a degree of prestige for some one who trains, say they trained at UCI versus trained at Chicago Osteopathic Medical Center; and whether that’s real or not, just the sound of that gives these students the incentive they want to leave the osteopathic profession for whatever the reason; maybe its demographics and geography; some students can’t get on an osteopathic program in the area they want to be - but there is an allopathic program. I think we are going to see that change. I know on the Board level in Ohio there’s been some talk that the AMA wants to increase the number of medical schools; which will in turn increase the number of MD graduates; which will increase the number of post-doctoral training applicants; which will take up more slots; and it may close out the DOs that are going to the allopathic programs. But still, the best advice I can give the student, “Get the best education you can, be the best physician, but never forget your roots even if you go outside the profession. If it were not for the osteopathic profession you, the student, would not have the opportunity to go outside the profession. So remember that and how do you remember that, you return to the profession either your educational experiences or you do that financially, but you want to remember where you came from.” Just the reverse side of that, I told you a couple of the experiences with physicians that I had met when I went to California that did not want to acknowledge their DO Degree. I also saw that on some professional organization level - the founder and organizer of the American College of Gynecological Laproscopists, a former DO, would not acknowledge his DO background. I met him personally at a meeting and gave him a regards from one of my trainers that knew him when they were students and he said, “Oh yes, he and I go way back” and that was the end of the conversation. Therefore, people did achieve some degree of status not being a DO, but they did not acknowledge the background and that is wrong. I think what you are experiencing at UCI, with people that started as DOs became MDs and are now attempting to give credibility and acknowledgement to the DO profession is really the right thing to do.
Dr. Seffinger: Okay. Thank you very much. We are going to pause now and change tapes...
Tape #2
Dr. Seffinger: Tape two - back with Dr. Chesky. We are going to clarify some points as well as finish up some of the questions for the interview. First of all, Dr. Chesky, could you elaborate on your tenure at OPSC in the 1980s and 1990s, some of the things that occurred during the time you were on the board and when you were president?
Dr. Chesky: Yes, there were some bills introduced to change language from osteopathic physician to...for having either (a) membership or (b) leadership responsibilities to languages that say either MD or DO to modernize the language. In addition, there was, and I do not remember the exact bill number, but it was to state that osteopathic physicians did not have to be a member of any particular organization to have staff privileges or membership on an insurance panel. That happened during that period. There was also some language that was introduced to avoid discrimination of clinical trainees on the student level at the California University systems in their training program, to not discriminate against externs or clinical clerks that also occurred during that period. Another interesting bit of historical background regarding earle days California,: after I was on the staff of Pacific Hospital for a couple of years, I was elected to be the Chairman of the Department of Surgery, and a former DO stated that I was not eligible to be the Chair because I wasn’t certified by the American College of Surgeons, I was certified by the American Osteopathic College and I checked the Business and Professional Act. It stated, “to be a Chair of a Department you had to be boarded by the American College of, and whatever the specialty was, or the equivalent”. The language “or the equivalent” was there and that clearly allowed someone who was osteopathically certified to have that position, that quickly caused this one individual to not say any more and I became Chair of the Department of Surgery based on my research of the Business and Practice Act.
Dr. Seffinger: Okay and you were also accepted into clinical appointment at UC-Irvine?
Dr. Chesky: I was an assistant professor in OB-GYN at UCI and I had residents from that university at Memorial Medical Center work with me in my OB/Gyn service.
Dr. Seffinger: About what year was that?
Dr. Chesky: I believe that was the late 80s or the early ‘90s.
Dr. Seffinger: Okay. Do you have other people that you know that we should be contacting that may have had an important impact on osteopathic history in California?
Dr. Chesky: Many of the people you have already spoken with would have been people I would have suggested particularly Ethan Allen who is still active clinically. I see him once or twice a year at various meetings. He was at the cutting edge of the profession at the time of the merger. A couple of other people that I would recommend - they are not very politically active, but they were there - they were young at the time of the merger and they took their residencies after the merger. They are two psychiatrist in the Long Beach area, I haven’t seen or heard from them in many many years, but it was Dr. Jim Jenkin and Dr. Michael DeLuca - both psychiatrists. When I came to California, I spent a lot of time talking to them about their perceptions of the merger since I was interest in that particular aspect. Some of the other people that I could think of probably are deceased. I testified for the Osteopathic Board as an expert witness in a case of moral turpitude against a DO. Alex Tobin was the attorney representing the osteopathic board. I worked with him very closely on that. I know he was instrumental in some of the early legislation regarding the merger. I do not know whether any of his documents are available, but that certainly would be something to look at. There was another gentleman before Matt Weyeucker was the Executive Director of Osteopathic Physicians in California. His first name was James. I can’t remember his last name, and I don’t know if he’s still living. However, he might be someone of interest that you might want to speak with. The name Duffy comes to mind. I do not know if that is correct or not.
Dr. Seffinger: Do you have any knowledge of documents or things that we should be looking up or searching for that would be important in this project?
Dr. Chesky: Obviously, the archives at the Department of Medical Education at Pacific Hospital would be a rich resource of material, particularly the applications for the internship and the application for residency. Several grants were written that and were approved during my tenure as Director of Medical Education. Some of those were minority grants to train osteopathic physicians that were Afro-American, American Indian or Eskimo or Pacific Islanders. We were able to take advantage of some of that grant funding because we were able to fulfill the requirements. Those grant applications may be interesting to review. They too would be at the Department of Education at Pacific Hospital. Perhaps reviewing the minutes from the Executive Committee might be something you would want to look at to help identify the thoughts of some of the members as far as this program was concerned. I do not know how far they go back, but I would certainly see if we could find the minutes from the late 1970s. I do not believe the minutes would be confidential or restricted as far as the discussion regarding the early development of the educational program. There is another document that, I believe, I have somewhere in my own files. I have yet to locate it, so it’s probably in storage. Perhaps either later this year or next year I will get to that. When I was in clinical practice in California, a young man, I believe he was a graduate student either at UCA or UCLA, came into my office with a manuscript that was relating the history of osteopathic medicine in the state of California. He asked me if I would review it and critique it, which I did and I kept a copy of it. I cannot remember his name now, but I am sure I still have the paperwork. It will be something that I will send to you when I locate it.
Dr. Seffinger: Okay. Now you were Director of Medical Education at Pacific Hospital of Long Beach from when to when, do you remember the years?
Dr. Chesky: I started as Acting Director. I believe I have it in my Curriculum Vitae or resume. If I could review that, I can tell you the dates.
Dr. Seffinger: It says here 1983 to 1993?
Dr. Chesky: That correct and I was Acting Director I believe before that...
Dr. Seffinger: 1979...
Dr. Chesky: ...to 1982 and then I was given the position of Director when the powers to be saw that the educational program was vital and doing well. They decided to create an actual position and not make it an Acting Director, but a real position.
Dr. Seffinger: So when you left that Director of Medical Education position, did you continue practicing in Long Beach or you didn’t have much involvement with the medical education system there after that, is that...?
Dr. Chesky: I left California in 1993, so I was the Director of Medical Education until the day that I left.
Dr. Seffinger: I get it. Okay. And that’s when you also left your responsibilities with OPSC and this school’s...
Dr. Chesky: I also left my positions with the school. I remember it was very difficult to write my letter of resignation. I left my staff positions at the hospitals. Interestingly enough, when I talked to the secretary of the medical staff at Memorial Medical Center, she asked, “Why don’t you just ask for a leave of absence rather than offer a resignation.” She said, “If it doesn’t work out for you in Ohio then you could come back as it was a leave of absence. All you have to do is say that you are back. If you turn in a resignation you come you have to reapply.” I thought that was very courteous and a very good idea, but obviously it was a resignation and not a leave.
Dr. Seffinger: Okay. Do you have any advice for future allopathic physicians in training in regards to osteopathic medicine or interaction with DOs?
Dr. Chesky: I do. My partners in clinical practice since my early periods have been MDs. I have always had wonderful relationships with MDs as physicians. What I have found interesting, and I’m not avoiding your questions specifically and I’ll get to the answer, but as Dos, we always want to take advantage of allopathic experiences in educational programs. As osteopathic physicians, we only recently open our doors to the MDs and I have seen that a few times in the specialty area, our college the American College of the Osteopathic Obstetricians and Gynecologists, has invited foreign physicians. There was a contingency of Italian physicians that came to our convention for two years in a row and I thought that was very interesting. They were able to spend time with us and exchange some cultural ideas and differences. But, if we as DOs are going to allow MDs to become educated by us, we are going to have to teach them some of our modalities and techniques, such as manipulation. We cannot keep that in the closet as a private treatment. By modality, I mean Osteopathic Manipulation and if we are going to open our doors and convince people that it is real science ..and it has real scientific value, we are going to have to teach them. There is an old story that in the history of obstetrics, when the obstetrical forceps were invented by a Dr. Chamberlain in England. When Dr. Chambelain was forced to present his secret instrument that he used to deliver any patient in a short time to the medical community, he only introduced one pair of forceps keeping his turf protected by keeping the other forceps secret. We have to take a look at that. As much as we want to share the wealth of knowledge on both sides of the political area osteopathic or allopathic, we are going to have to share our techniques and modalities. If it is accepted, is that going to be the beginning of the end of the osteopathic profession? If allopathic physicians start to follow the osteopathic philosophy and principals, is there going to be no more osteopathic profession per se because everybody does the same thing. Then, in fact, what is our difference? I mean, we are unique and we are special in our approach to the patient. I had an experience when I was in California with one of the trainers, I believe the Director of Medical Education or Family Practice Residency from U.C. Davis who came down to Long Beach to visit with us. One of our teaching faculty in the administrative level was formerly from U.C. Davis, I believe it was Dr. Brown, and he invited this Director of Medical Education.. He stated thathe liked to have DOs in his program because they brought another dimension into the medical education arena. They had a cultural and philosophical difference that enhanced his program. Now if a medical educator understands that and if allopathic medicine as a whole begins to appreciate and want to glean upon that, wherein lays our difference? So, my advice to MD trainees is to learn as much as you can. If that means including learning manipulation and osteopathic philosophy, do so. Again, what is our position in medical education and what is our position in the delivery of medical healthcare to the public in general. We have two schools of medicine right now. The whole concept of the merger in 1962 was to avoid confusion of the public by having two schools of medicine that were doing the same thing. The bottom line is to get patients better, whether you use treatment x, y, or z or treatment a, b, or c. Evidence based medicine looks at results. So, if we get good results that are better than the other people’s results, do we have to share that? Absolutely! Somewhere along the line, I think we have to be realistic that what we have is something unique and special. But once we start to share it, is it going to continue to be unique and special?
Dr. Seffinger: Okay. Have you had experiences in your career where osteopathic care demonstrated a difference, had better outcomes you think, even with manipulation or without or other things?
Dr. Chesky: I will reiterate some of the things that have already been published. But in my own personal experience, and again of course this is anecdotal, post-operative ileus tends to respond very nicely to osteopathic manipulation. The low back discomfort of the pregnant patient responds well to osteopathic medicine. The case of the subluxated public bone responded well to osteopathic manipulation. In my clinical practice, I utilized osteopathic manipulation which I believe is the physical manifestation of the difference between a DO and an MD. Clearly the philosophy that the body in proper alignment, and the whole patient concept, is unique to osteopathic physicians, but not entirely, because other physicians will share that that is allopathic. Nevertheless, the physical manifestation of the difference in my opinion is that of manipulative medicine. I utilized that as an adjunct to what I did as a specialist, as an OB-GYN specialist, so I have seen it work. I have seen it work as a therapy, in and of itself, without other medication and I can wholeheartedly speak that it does have a place in healthcare delivery system.
Dr. Seffinger: Can you give me a couple of examples in your career where you felt it helped the patient. Do you remember some patients that had a problem that you applied your osteopathic manipulative skills to make a difference in the care of that person?
Dr. Chesky: Well as I stated the example of the patient that could not walk when she came to the hospital. She walked out of the hospital. I mean that sounds like osteopathic magic, but clearly it did have a place and it was a valuable therapy.
Dr. Seffinger: Was that the problem that she had from delivering the baby?
Dr. Chesky: This was before delivery because of the change in the curvature and the carrying angle of the lumbar spine and the tilt of the pelvis. It caused pressure and which caused her symphysis to shift. She had subluxation and terrible pain when she walked, and yes, it was immediate relief.
Dr. Seffinger: So she was in her second or third stage?
Dr. Chesky: She was in her third trimester, and advanced pregnancy, yes. Again, the patients with low back ache will feel immediately better when they leave the office.
Dr. Seffinger: Do you remember the type of treatment that you gave?
Dr. Chesky: Usually the lumbar roll technique. You know that a pregnant patient is difficult to do some of the aggressive techniques on. I am a high velocity, high thrust proponent that was the way I was educated. However, fascial release mechanisms work well too. The techniques I used were very effective and I would work around the patients’, I hate to use the word infirmity, but during their pregnancy and post-operatively manipulation worked well with patients that had an ileus. Of course, you could not be very aggressive because they had abdominal pain from their incision. I have had patients that had spinal headaches after surgery. A cervical manipulation clearly gave them relief, although it did not cure them, it made them feel better. Their headache was less intense, so there is value to manipulative technique. One of things that I always taught my students, ‘learn how to do it. You never know when you are going to need it.’
Dr. Seffinger: Okay. Excellent! Is there anything else you feel that you would like to talk about or add to the history of osteopathy in California?
Dr. Chesky: Well, I never really thought about it at the time when the post-doctoral program was starting. Only after you approached me, asking for my recollections and memories of it, and said from your own perception, how instrumental I was in developing the program. I never really thought about it until you approached me, which was relatively recent. As I spent time reflecting upon that - it was very interesting and I cannot tell you some of the things I did, and why I did them, other than I thought they were appropriate at the time. For example – we were financially approved for eight in the post-doctoral training program, but we applied for 25 for future use. I think that was an ingenious thought at that particular moment which tended to be true. I attempted to develop a program that would give dual accreditation to DOs in the residency program. However, to have enough MDs to get approval by the GME Boards - t was never able to happen. We did not have enough people, MDs, to do that, but I thought about that long before it was reality in various areas that it is now. I am talking about this in the early ‘80s which was a concept that was very foreign at the time. Again, my feeling was not that we would be more accepted, but it would open up doors so our graduates can get on staffs of hospitals that they may not have been eligible to get on because of their osteopathic background. Of course, time took care of that. The government took care of that. There are very few places where DOs cannot get privileges today. The other thing I’m finding very unusual is a lot of our students are going out - for whatever reason - and I don’t want to get into a discussion on that again (which would take another two or three hour interview on ‘why our DO graduates go allopathic’), but what’s happening is, we are creating a very good product. Our graduates are very smart. Our graduates are very good physicians. The allopathic physicians are seeing that. Many of these students are getting job offers from MDs. They are getting faculty positions at allopathic institutions. Are these people going to come back to us or are we losing that resource? Well hopefully, they will come back. I think a student has to be out a number of years before he or she realizes (when the maturity factor clicks in) that they wouldn’t be where they are today if it wasn’t for the osteopathic training they received as students. Hopefully they will realize that. I feel very strongly and passionately about that. The osteopathic profession has been very good to me personally and I share that with other students. One of the things I was very, very disappointed about, when I came to Ohio and affiliated myself with the institutions, there was no formal educational program. I really felt something was lacking in my professional career. And for that reason, I really felt bad about leaving California. I loved being with the students. I thought it was invigorating, inspiring and it challenged me on a daily basis. I think it forces you to be a better physician when you interact with the students.
Dr. Seffinger: So, it wasn’t because of Ohio itself, but it was because you changed careers? No? Or that you weren’t involved with the educating system within Ohio?
Dr. Chesky: Within Ohio.
Dr. Seffinger: They did have educational systems?
Dr. Chesky: They did, but...
Dr. Seffinger: Columbus and...
Dr. Chesky: Where I was practicing, they didn’t have those. I did become a professor, an associate professor of OB-GYN on the staff of Ohio University, College of Osteopathic Medicine. I did lecture to the students there from time to time upon invitation, so I did have some interaction, but not like I did in California. Then I started having residents in family practice programs that wanted some GYN experience rotate through my office. My partner who was an MD was very excited to have the DO graduates come into the office too. They spent much time with him educating him and he spent time educating them. We really enjoyed that. However, it was not on a regular basis and that is why I am saying I felt something was lacking.
Dr. Seffinger: Right. Now you have educated and trained MD and DO students?
Dr. Chesky: Over the years, absolutely!
Dr. Seffinger: Did you notice a difference between the two groups of students?
Dr. Chesky: You know that is an individually determined observation. I have seen MD students that were incredibly enthusiastic (MD residents) and I have seen MD residents that were indifferent. But I’ve also seen DOs the same way. However, as a group, I think the DO post-doctoral trainees have a little bit more enthusiasm. But if you look at them individually, no, there’s not a whole lot of difference. Yet, as a group, I think there was something to be said about that. I had another anecdotal experience with a resident, OB-GYN from UC-Irvine. I had a very rare case when I opened this patient up. We were suspicious she had malignancy. She had seeding (thought to be cancer) all over her uterus, fallopian tubes, ovaries, the peritoneum, the intestine, and the omentum. It looked like metastatic carcinoma, but it was not typical. I said, “I don’t think this is a malignancy” and the resident said to me, “If it looks like cancer and feels like cancer and smells like cancer, its cancer.” I said, “Let’s keep an open mind,” as I took a biopsy and sent it down for frozen section. The biopsy indicated a benign process called disseminated leiomyotosis, a very rare condition, and definitely not malignant. This resident learned a huge lesson. He really became less dogmatic after that. It was a humbling experience for him. So, I think about that case often because I hope it enhanced this individual’s willingness to be a little less narrow minded in his approach to the patient. And I’ve seen many cases like that over the years. But that one case, because of the unusual circumstances and because of the pathology, makes me recall that on a regular basis.
Dr. Seffinger: Interesting. Thank you very much for your time. You certainly were a trail blazer in many ways. And I appreciate your sharing with us this history and your role in historical development of osteopathy in California.
Dr. Chesky: Mickey, I certainly hope it helped and I hope it helps you in developing your historical recall of all of the events. I really want to look at your produced book.
Dr. Seffinger: Sure. We will share it with all those that were involved, certainly, and more, gather around libraries and various places...
Dr. Chesky: But I want mine hand inscribed by the author.
Dr. Seffinger: Ha, ha, ha, thank you very much.