This interview originally aired on In the Moment on SDPB Radio.
Tom Dean, M.D., will be inducted into the South Dakota Hall of Fame next month.
He's being recognized for the years of dedicated care he brought to thousands of rural patients. And he'll be honored for his work as a leading advocate and policymaker for small-town doctors and patients across the state.
Learn more about Dr. Dean and the South Dakota Hall of Fame.
Lori Walsh:
You're listening to In the Moment on South Dakota Public Broadcasting. I'm Lori Walsh. This summer we have been getting to know the newest inductees into the South Dakota Hall of Fame. There are people like Dr. Tom Dean. Dean grew up on a farm in Wessington Springs. When he graduated from medical school in 1972, family medicine had only recently been approved as a specialty. He spent his career not only caring for thousands of patients, but by serving as a leading advocate and policymaker for sustainable rural healthcare. I had the pleasure of sitting down with Dr. Tom Dean in the studio yesterday. Take a listen.
So much of the Hall of Fame is about excellence and not only finding and acknowledging and celebrating the people who have changed our lives in obvious and sometimes not so obvious ways, but it's also about celebrating leadership and excellence. And I'm just kind of curious to know, are those things that you thought about as a rural physician or were you really just focused on the practice, focused on the patients, focused on the people?
Dr. Tom Dean:
Well, I guess it was all of those things. I've always had an interest in health policy, and so the politics and the policy issues have always been an interest, even going back to medical school or before. But certainly the things that I've responded to are where I ran into or knew about clinical issues where things were not working for one reason or another, and that's oftentimes where the policy activities evolved from, that there were things about the structure of medicine and the way it was paid and all of those things, which were not helping my patients, and so that led me to get more involved with the overall policy discussions.
Lori Walsh:
And rural practice, rural healthcare was incredibly important to you for some obvious reasons, but let's talk about that first. Why was rural healthcare the area of focus for you?
Dr. Tom Dean:
Well, because I'm a rural guy. I grew up in Wessington Springs or on a farm actually west of Wessington Springs. My uncle was a rural physician in Wessington Springs for many years, and he was a role model and actually he's in the Hall of Fame as well, because he was quite involved in discussions about how we can make healthcare more effective and more relevant and more meaningful for rural patients, do a better job of meeting the rural needs.
Lori Walsh:
That's about more than geography.
Dr. Tom Dean:
Some of it has to do with just numbers. The fact that we're dealing with much smaller numbers of patients and delivering services is more of a challenge when you have a broader range of responsibility and a smaller number of providers to cover that responsibility.
Lori Walsh:
Tell me what your practice was like.
Dr. Tom Dean:
Well, it was a small town primary care practice. The way it may have been different is right from the very start, I got involved with what was initially Tri-County Healthcare, and that evolved into Horizon Health Care, which is part of the Community Health Center movement, which means that we were a clinic system that accepted we had a certain amount of federal support because many of the places where now Horizon has clinics are simply places where a typical conventional practice would not survive financially.
And so there's the Community Health Center authorization, which is an old, old piece of legislation, provides federal support through the US Public Health Service for communities that couldn't support services on their own. Now, a portion of those are rural and another portion are in inner city because of working in areas where poverty is a huge issue. I felt fortunate because I could see and deal with the whole spectrum of people. I mean, I had some patients that were millionaires and I had some that really didn't know where their next meal was coming from. And so that I appreciated because it was a range of different types of people and different interests and different behaviors and all of those things.
Lori Walsh:
So when you went to medical school, family practice, was that just coming up to be a thing? Tell me a little bit about some of the changes in the late '60s, early '70s where medicine was changing.
Dr. Tom Dean:
Yes, family practice was a brand new idea. When I was in college, I read some stuff in the media that the American Medical Association had commissioned a study because old time general practice was declining, and they felt there was a need for not just narrow-focused specialists, but for providers that could know the person in a broad way and deal with a whole range of problems and try and both be a first contact person, but also be a person that would coordinate the care and work with the various specialists to try and be sure that the care that was being provided was coordinated. Where I went to medical school in Rochester, New York, they had one of the first departments of family medicine, and then when I graduated, was fortunate enough to get involved with the Family Medicine Department at the University of Washington, which was the very first family medicine residency in a major academic medical center. There were other residencies, but none in the big academic centers.
Lori Walsh:
Yeah. Back to rural South Dakota, you saw patients for their first breath to their last.
Dr. Tom Dean:
Yeah, yeah, yeah.
Lori Walsh:
What was your role then in the community? Because you know an awful lot about these families, you know when they're not eating like they should after the heart attack, you know when someone has an addiction problem, you know-
Dr. Tom Dean:
Sometimes we know that.
Lori Walsh:
Sometimes you know that. What's the role of a rural doctor in a community? Why does that have value?
Dr. Tom Dean:
Well, I'm obviously not very objective, but I think it has huge value because especially in today's medical environment, things are so fragmented because people that have multiple different problems are oftentimes being seen by multiple different specialists, and too often things aren't well coordinated and they certainly benefit if there's somebody that knows them and knows their situation, knows what things that they are likely to accept and what things they might not accept. Good physicians will always know those things.
Lori Walsh:
How did it change you?
Dr. Tom Dean:
Well, that's a tough question. I was not very aggressive about any of these things when I first started out and gradually through the years, I got more interested in how the policy development works and I got more comfortable speaking out about places where I thought it didn't work. And so I got involved with an organization called the National Rural Health Association and about, I don't know, 12, 15 years after we moved to Wessington Springs, I became president of that organization. And with that we spent more time in Washington and promoting lobbying, but I was still a full-time small town family doc, and that was my primary role, but I got more and more interested and really felt stronger that the system as it was structured really wasn't serving my patients as good as it should.
Lori Walsh:
That's Tom Dean, one of the 2023 inductees into the South Dakota Hall of Fame. The Honors Ceremony for this year's class is September 8th and 9th in Chamberlain/Oacoma.
