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December 19, 2019
Daniel M. Fox
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Fitzhugh Mullan, who died in November, will be mourned by many admirers of his brilliance and warmth, his capacity for friendship, and his achievements as a primary care physician, author, editor, advocate, teacher, and manager. For more than half a century, Fitz worked, creatively, at the intersection of American medicine and society. During these years he contributed to the work of the Milbank Memorial Fund, mainly as the author of a significant book and of articles for The Milbank Quarterly.
In that 2002 book, Big Doctoring in America: Profiles in Primary Care, he described me as “an important friend and colleague … a commentator, critic, and editor of my writings [and a source of] vision, advice and support.” I quote these words because they also describe my opinion of Fitz’s work and of our relationship. We met in the mid-1970s, when each of us was a senior federal official; Fitz at the National Health Service Corps, me at the National Center for Health Services Research (now the Agency for Healthcare Research and Quality).
The title of Fitz’s first book, White Coat, Clenched Fist: The Political Education of an American Physician (published 1976 and reprinted 2006) was, as the titles of his books and articles always were, an insightful summary of its contents and its purpose. He describes and assesses his “political education” as a student, resident, and member of the National Health Service Corps (which he subsequently directed). During these years he was a civil rights worker in Mississippi, lived and marched in a poor Chicago neighborhood, became a national leader among activist medical students, helped to organize and lead an unconventional residency program in pediatrics at Lincoln Hospital in the South Bronx, and provided primary care to people with low incomes in New Mexico. “I think that there remains alive within me,” he wrote, “a spirit of objection and resistance that is the essence of radicalism … that regularly and religiously points to a job unfinished … reminding me constantly that systems, institutions, and people are often not what they appear to be.…”
Fitz applied the results of this political education throughout his long career in government, universities, pediatric practice, and as a prolific author. As a result, he made significant contributions to health policy and public health practice. Fitz’s publications, moreover, increased the prestige of narrative as a method of analysis and communication within the health sector. He also set an example of dedication to his profession by retraining in pediatrics after retiring at the highest rank (admiral/assistant surgeon general) from the Commissioned Corps of the US Public Health Service; he also published a compelling memoir about this experience and his return to practice. In his final years, he organized the Beyond Flexner Alliance, a project to build a constituency for substantial change in the purposes and processes of medical education in the context of furthering equity and justice.
In 1991, a year after I became president of the Milbank Fund, Fitz spoke at a program honoring Leroy Burney, one of my predecessors, who was retiring from the board of directors. In the 1950s, Burney, like Fitz, a long-time member of the Commissioned Corps, was the first US Surgeon General to describe risks and harms of smoking tobacco. Fitz, who had recently published Plagues and Politics, a scholarly history of the Corps commissioned by then Surgeon General C. Everett Koop, presented an insightful survey of Burney’s career and its significance.
Soon after the Fund and the University of California Press decided to commission and co-publish a series of books titled Health and the Public, I invited Fitz to contribute. He had recently begun interviewing practitioners of primary care about their history, with support from the Pew Charitable Trust and the Robert Wood Johnson Foundation. Over several years Fitz interviewed 75 physicians, nurse practitioners, and physician assistants. Then he wrote about 15 of them in Big Doctoring in America. The Fund commissioned John Moses, a primary care physician as well as a professional photographer, to photograph them in their clinical settings.
When the authors of each book in the series completed next-to-final drafts of them, the Fund and the Press convened 15 to 20 experts to spend a day discussing the book; first in general, then chapter by chapter. The intense discussion of Big Doctoring contributed especially to the final chapter of the book, “Building a Better Future.”
The Fund also advised Fitz and John Igelhart, founding editor of Health Affairs, as they developed a new section of that journal, “Narrative Matters.” The articles in the section applied and expanded the methods Fitz had used, and described in detail, in Big Doctoring.
Fitz and I had our last conversation at a memorial for Lambert (Bert) King, a physician and medical administrator who had been a medical school classmate of his and with whom I had worked early in the AIDS/HIV epidemic and then on the governing board of a provider organization. David Kindig, a close friend of Fitz and Bert in medical school at the University of Chicago, has also had a distinguished career of leadership in medicine and health policy. For several years, Dave led the Milbank Memorial Fund’s program in population health. Fitz, Bert, and Dave developed their profound commitment to improving social justice through health policy and practice in the 1960s, as students and young clinicians. The Fund has relied on people with similar commitments and values throughout the 114 years of its history.
Daniel M. Fox is President Emeritus of the Milbank Memorial Fund.
 Mullan F. Big Doctoring in America: Profiles in Primary Care. Berkeley, CA: University of California Press; 2002: 239.
 Mullan F. White Coat, Clenched Fist: The Political Education of an American Physician. Second Edition. Ann Arbor, MI: University of Michigan Press; 2006: 221.
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