From the HIV/AIDS scourge in the 1980s to the COVID-19 pandemic of 2020, Marion physician Dr. Paul Brown has experienced dramatic changes in medicine and society in his 35 years of practice.
Brown will entrust that knowledge and service to the next generation as he embarks upon retirement from Smyth County Family Physicians at the end of May. Although, his service is not over yet.
The longtime family physician came to Marion in 1985 to take over from the retiring Dr. Charles Thompson. He had been coming to the area for a decade and discovered a love for the Southwest Virginia mountains.
“I’ve loved the mountains since taking trips here with my family as a child and then, later, with … [a] biology teacher who conducted field trips to Shenandoah National Park yearly,” Brown said. “I loved those trips. I enjoy many outdoor activities as well and wanted to be close to those opportunities. A roommate in college was from Wytheville and visits with his family were when I first spent extended time in Southwest Virginia. During my residency years the trends in Family Medicine were towards less and less diversity in practice in cities – even some as small as Roanoke. I felt that I’d have the best opportunity to practice broadly in a rural area. I received excellent teaching and training in Roanoke and I was anxious to use that in the ‘real world.’ Dr. Charles G. Thompson was planning to retire in 1985 and the timing was perfect for me to assume his practice – so here I am. It was very appealing to step in where I knew a need existed – though I’m not sure I ever filled his very big shoes!”
Brown is a native of Richmond and his family moved to Mechanicsville when he was a child.
He attended Lee-Davis High School, Hampden-Sydney College, earning a B.S. in chemistry, and earned his M.D. at the Medical College of Virginia. He completed an internship and residency in family medicine at Roanoke Memorial Hospital - a program affiliated with the University of Virginia at that time.
Brown said he chose family medicine “because I enjoy the broad spectrum of practice that is unique to our specialty. I enjoyed every rotation in medical school so it seemed natural to choose a life’s work that incorporated them all. I also wanted to practice in a rural area and have the opportunity to build long term relationships with multiple generations of families.”
It is typical for family physicians to have long-term relationships with patients as they may treat a person for many years, often from birth to adulthood and then their children. Changes in the healthcare industry; however, have transformed that relationship.
“The increasing growth of subspecialization and hospitalists contributes to the fragmentation of care,” Brown said. “This robs primary care physicians of one of the major incentives for that career – the continuity of care that patients and families need and desire. With increasingly complex treatments available, much of this is simply unavoidable yet frustrating nevertheless.”
“I’d say the most pernicious change that I’ve witnessed has been the increasing corporatization of medicine and the attendant growth of a massive, useless bureaucracy. That bureaucracy rarely delivers on its promises yet consumes huge resources (money) that would help defray costs to patients. Sadly, the footprint of the innumerable contractors and consultants and academics and ‘experts’ as well as officials at the local, state and federal level is becoming way too big in the lives of those physicians on the front lines who are actually caring for patients day by day.”
The frustrations physicians experience dealing with healthcare bureaucracy can sometimes be offset by the advancements in treatment not even imagined decades ago.
“In general, the last 40 years have seen amazing growth in our diagnostic capabilities – especially non-invasive ones – and our therapeutic options,” Brown said. “Most of the ‘first line’ treatments for more serious diseases when I started are not even considered today. With the rise of Genomics, it will be amazing to see just how sophisticated care will become, if we can control the costs. CT scans were just coming on line and MRI didn’t exist. Many ‘routine’ treatments today simply were not available and many of the ‘cutting edge’ new treatments – like using ‘clot busters’ for initial treatments in heart attacks – were delivered here in Marion. These changes have been amazing and exciting to witness.”
Brown said that the rise of midlevel practitioners is certainly a major change affecting the delivery of care.
“To the best of my recollection there were very few, if any, midlevels present during my medical school days or residency,” he said. “Today, they are on the front lines and there is a better than average chance that they will be the primary provider of your care – a trend that will surely continue to grow. They routinely see patients in subspecialists’ offices. In fact, many of my patients express frustration at rarely seeing their physician during those visits.”
The current COVID-19 pandemic has come with its own alterations to health care and how it is administered.
“There have certainly been challenges to all of us with the COVID-19 pandemic,” said Brown. “Most patients are deferring their follow-up visits for chronic disease management so our office is ironically slow. With hospitals likewise slowing down on all elective procedures they are underutilized as well. I understand the concerns. Still, chronic diseases like diabetes and high blood pressure, to name a few, need regular care. I hope that patients will not delay those visits for too long and that we don't see a bump in disabilities or deaths from other diseases as a result of neglect. When I began in training, the HIV/AIDS epidemic was beginning to emerge as a terrible threat. I can bookend my career between the HIV/AIDS and COVID-19, which is certainly memorable.”
Speaking of memories, Brown has collected a lifetime through his career and the lives of his patients.
“My best memories revolve around the care of multiple generations of patients in the same families,” he said. “Especially fun was the opportunity to care for the babies of patients that I had cared for when they were infants and to be the doctor for both at the same time. Obviously it took a few years for that to occur!”
“I have wonderful memories of working with amazing colleagues/consultants,” Brown said. “Most mornings at the hospital (in the days of yore!) were filled with interactions with the other physicians in the community. The esprit-de-corps was amazing and a cherished memory. Every partner and consultant, from my first day, has been gracious and helpful – I think we all felt, and feel, a collective desire to give great care to our patients and to help each other along the way.”
A few easily recalled memories of specific patients:
“I was once berated by a delightful elderly lady for taking my Scout troop on a winter camping trip to Mount Rogers. She was just incredulous that I’d consider such a thing and was totally unreceptive to my explanations. When I told her that there was no one else there in winter, which made for wonderful solitude, she asked me with an unmistakable disgust, ‘And don’t that tell you something?’ I don’t think I ever laughed so hard – she had me there.”
“I once cared for a gentleman travelling back to his home in Maine when he was stricken with a stroke in our local motel. He did well and we made arrangements to fly him home once he was stable. The family was hopeful that I could accompany them but that just wasn’t possible. I mentioned how I wish I could as well – and maybe have a fine New England lobster dinner before I returned. Several days after they were safely in Maine, they shipped me a complete whole live lobster dinner which I enjoyed that night.”
Brown may be retiring from his general practice, but he plans to continue his service to patients in the area in other ways.
“I hope to continue working at the Urgent Care clinic once it reopens,” he said. “I believe that has been a good service to the community and I enjoy it very much.
As he reflects on his career, Brown admires the tenacity of his patients.
“I’ve never gotten over the amazement of how well many of my patients have coped with tremendous adversity,” he said. “I wonder to this day if I can have the grace and forbearance to endure such challenges if they come my way.”
Brown is looking forward to more time in retirement to pursue special interests.
“I have a lot of home improvement projects to tackle and will continue my outdoor adventures,” he said. “I love spending time in my woodshop - especially building Queen Anne and Chippendale furniture reproductions for my family. I hope to travel – mostly to be with my children and grandchildren.”
Brown has two sons, a granddaughter, and a grandson set to make his appearance in July. One son lives in Colorado and the other, with his family, in Oregon.
So far, none of his family members are following in his footsteps, but who knows what the future may hold.
“My tenth-grade biology teacher inculcated a deep love of science/biology,” Brown said. “My own two family physicians (they were “just G.P.s” in those days) inspired me towards medicine. They were wonderful gentlemen who were widely admired and respected in the community, and the relationships that they built with whole families (including mine) were very special.”
“I worked for many years, first as a junior member and later as an adult, on our local volunteer rescue squad – that too was immensely satisfying and fostered the desire for a career in medicine. From my earliest days I never recall thinking of anything but ‘becoming a doctor.’”