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Frances H. Stewart – Oral History Transcription (Cont.)

MASSA: Was there any opposition?

STEWART: There was a lot of opposition. One of the first things that happened: patients were allowed to get their supplies after they had been to the clinic, of course. If they were using a diaphragm they were allowed to get the jellies or creams they were using sent to them by mail. The Knights of Columbus or somebody tried to stop that delivery by mail. That wasn’t working out too well. Anyway, we finally got that straightened out and then there was a government post office regulation that they could be mailed.

One of the next things, the clinic had to get a city permit every year. This had always been automatic, and suddenly the clinic was informed by a newspaper reporter that they were not going to get the permit, that the Board of Aldermen was going to deny it. I think that was the work of the Knights of Columbus, too. They rallied their supporters, went down, had meetings and all kinds of things. A group of people decided they were going to go down and practically picket the place, but that got straightened out and the permit was given.

We had another thing one time that was rather amusing. After they were seen by the doctor, patients were given a written prescription which was taken to the front of the clinic and the prescribed material was given to them. Usually that was done by a volunteer worker. Suddenly a problem developed. I don’t remember who started it, but it was a problem. They wanted to know who was handing these materials to the patients, that according to Missouri law it must be given to the patient by a doctor or a pharmacist.

Somebody conceived the idea of getting a big market basket. They would fill the prescriptions and put them in the market basket. The patients stood in the waiting room in the front. When they had a basket full they would call one of the doctors. [The doctor] would go up and say, “Mrs. Jones . . . Mrs. Smith . . . ” and would hand them this and that. That lasted a little while and then it got straightened out. There haven’t been any real serious problems.

MASSA: Was there any opposition from the neighbors?

STEWART: No. Usually the clinic sites were not in residential areas. We are in a residential area right now – the clinic recently moved to an apartment building, I don’t know the address. It’s an apartment building on the corner of Newstead and West Pine. We were on Delmar, a block east of Kingshighway, and the neighborhood [there] got too bad. This [new site] is in a big apartment building where a doctor’s office had been on the first floor, on one end of it. There’s a drug store on the other side. A restaurant, a grocery store and a few things like that are close by. Outside of that it is a purely residential neighborhood and we have a clinic on the first floor where the doctor’s office was. There is no opposition there. The rest of [the sites] had been more commercial than anything else, so there wouldn’t have been any opposition.

MASSA: When you limited the clinic to just married women, did you ever attempt to bring in the husbands to counsel them also, or was it strictly female?

STEWART: Now there is some of it, but not too much. But at that time the husbands never came.

MASSA: Today, do the husbands come in of their own free will?

STEWART: Once in a while, we have a husband who comes in and wants to talk to the doctor, too. But more of that goes on with the social workers – and there’s not an awful lot of that. An interesting point, for the last couple of years now there is a vasectomy clinic in connection with it and they have that once a week, Thursday night. A couple of urologists take care of that, but that is run by the Planned Parenthood Association. We don’t get many husbands coming with their wives. They may bring them there but they sit in the waiting room and for most of them that is as far as they go.

MASSA: Right. I guess they feel that is their responsibility. Do you find that there is a trend that your clientele, your patients, are becoming younger all the time?

STEWART: Oh yes, there is no question about it. Definitely. An awful lot – I don’t mean just college, I mean high school now. We haven’t had any sixth graders yet. I shouldn’t really say that, because we do get them. Some of the mothers – most of them are colored women, I can’t get used to saying black – you would be surprised how many of them have one girl, one older girl, that has an illegitimate child and they [also] have some younger daughters. So they don’t trust [the younger girls] because of the older ones and they will bring them in.

MASSA: Is there anything else you would like to say about the work of the clinic; where you think it will be going, the future of it?

STEWART: It is changing all the time. There are more procedures that are being done at the clinic – what we used to call the old birth control clinic – much more is being done now. At first we did absolutely nothing except give the patient contraceptive advice and if we found any minor medical conditions we said, “We can’t treat you. You have to go to your doctor.” Now, for minor things we do have medication for them and we do give information about that. But anything of any serious nature, of course we don’t try to do anything about; we refer them. But we are doing more and more all the time.

Some years back we started doing Pap tests and gonorrhea cultures besides our regular examinations. We run a pregnancy-testing clinic and there’s a big educational department. We do a lot of work all over town, mostly on a solicited basis, if agencies or schools come. There has been a problem with that recently. A course was set up for teachers and guidance counselors, not students, in the Kirkwood Schools to give them an insight into what the sex education business would be. The pro-life people made such an awful fuss that Kirkwood dropped it. They are still doing a good bit.

We do not do abortions, but we do refer the patients who come to us who are pregnant and want an abortion. We refer them mostly to the Reproductive Health Service. We have a lot of those.

MASSA: Do you have any other community interests that you are involved with?

STEWART: Oh, not so much any more, no, because I am just getting lazy.

MASSA: How many hours are you at the clinic now?

STEWART: Right now, I have four clinics a week at Planned Parenthood, I have two clinics a week at the County Hospital and the City Prenatal Clinic down at 13th and Wyoming. I go there. But I don’t do deliveries anymore. I quit that five years ago. I’ve cut the private practice down. I have worked hard enough, but I keep busy.

MASSA: Are you active in any special societies?

STEWART: I am a member of County Medical Society, and the State Medical Society. I’m a founding fellow of the American College of Obstetrics and Gynecology. I did belong to the AMA, but I quit a few years back.

MASSA: I was wondering whether you would be willing to talk on any of the current problems of medical practice. Obviously there are many problems, but this could be narrowed to a few, such as malpractice insurance.

STEWART: That is a terrible problem. I don’t know what is going to happen about it. I don’t think anybody really does. It hasn’t been too long ago, a doctor sued a patient for suing him for malpractice and he won the case. I think that sort of thing, if it goes on very much, will make a difference in the number of malpractice suits that are brought. I think a lot of the malpractice suits are instigated by shyster lawyers. Maybe I shouldn’t say “shyster,” but some of them are. I don’t think anybody knows what is going to happen.

Then we have all this government stuff that I don’t care much for. Somebody asked me not very long ago if I would start medical school if I were a young person, with what is going on right now, and I said, “No, I wouldn’t.” I don’t want to work for Uncle Sam; of course in part I am doing it. The clinics I have out at County Hospital are funded by the government, but I think we are getting entirely too much poking into our medical business by people who don’t know anything about it and that is why I resent it.

MASSA: What about the cost of medical care? That is certainly a problem. Recently, President Carter suggested a 9% ceiling on increase of hospital costs. This goes beyond the hospital, and probably affects the operation of neighborhood clinics. Could you discuss that a little bit, please?

STEWART: I don’t see how he can say to the hospitals or any other group, “You have to cut this down, your fees have to be lowered.” Because what the hospitals are paying their employees, and for their supplies and everything, is not going to go down. That is going to go up all the time. One of the things that a lot of the people resent is that they say it costs too much to be sick. It does, it costs an awful lot. The doctors aren’t getting what the hospitals are getting in proportion. Doctors’ fees haven’t gone up that much [compared to what] the hospitals’ have. I don’t know how anybody who doesn’t have any insurance can be in the hospital. I don’t see how they can pay for it. Who knows what the answer is? I can’t see where Carter’s plan is going to help things any.

MASSA: Do you think this will have a negative effect on quality?

STEWART: It’s bound to, because the hospital’s expenses are not going to go down. Their income is going to go down but their expenses are going to keep going up, so what are they going to do?

MASSA: So it may eliminate medical care for the poverty level people?

STEWART: No, I wouldn’t say so. I don’t think they will be totally eliminated but I think the quality of care definitely will be damaged. It can’t help but be.

MASSA: Now that your class reunion is over, have you given any thought to the past 50 years: what you have done, changes that you would make if you were starting all over again?

STEWART: No, I would not start over again. Not the way the things are at the present time. I am sure I wouldn’t. If my daughter wanted to go to medical school right now, I would say, “No, don’t do it.”

MASSA: Do you have any other reflections on the past 50 years?

STEWART: It has been very worthwhile. I have enjoyed it. I have enjoyed every moment of it. I don’t know what I would have liked to have done if I hadn’t done that. I don’t regret it by any means, but the way things are now I am sure I wouldn’t start out if I were a young person now. Somebody’s got to do it though.

MASSA: Those are all the questions I have. Do you have anything else that you would like to add, in regard to your practice, your medical education, anything?

STEWART: I think I was given a very good education. The education present-day medical students are getting is different than we got because there is more to learn. There is more that we know about things now that we didn’t know years ago, but I still think we got a very good medical education and I am glad I got it.

MASSA: Anything else you would like to add?

STEWART: I don’t think so.

MASSA: Thank you very much.

STEWART: Thank you.

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