January 16, 2004

Meador’s Mission: A vision for health care, a legacy for the future

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Dr. Clifton K. Meador serves as the executive director of the Meharry-Vanderbilt Alliance. Photo by Dana Johnson

Meador’s Mission: A vision for health care, a legacy for the future

Meador, a staunch advocate for the uninsured, works to create a more equitable health care system. Photo by Dana Johnson

Meador, a staunch advocate for the uninsured, works to create a more equitable health care system. Photo by Dana Johnson

Meador presides over a meeting of the Nashville Consortium of Safety Net Providers. Photo by Dana Johnson

Meador presides over a meeting of the Nashville Consortium of Safety Net Providers. Photo by Dana Johnson

Not every day is a person asked what their tombstone will read. But leave it to Dr. Clifton K. Meador to rise to the challenge.

After a slight pause and a chuckle, he took a deep breath and confidently said: “It would read, ‘He tried to fix what was wrong with medicine.’”

For most of his 72 years, Meador’s medical degree has allowed him to help heal the sick but his passion for medicine goes far beyond the white coat, stethoscope and medical degree. Being ingrained in the medical profession has only fed his unquenchable desire to right what he sees is wrong with health care. It’s a gift he admits that frustrates him to no end.

It is how he began his practice and how, he believes, he will end it.

Born in Selma, Ala., in 1931, Meador spent much of his early life on a farm in the rural community of Cahaba, the first state capital of Alabama. At one time Cahaba, also spelled Cahawba, was a thriving town of nearly 6,000. During the time Meador lived there, many folks had moved after flood, fire and boll weevils destroyed the town. All that was left were his family and a couple of hundred blacks, most of whom were only two generations removed from slavery.

Meador’s family moved to Greeneville, Ala., just south of Montgomery soon after his fifth birthday. And that’s when his life changed. The path was laid.

“Right after we moved, I got pneumonia,” he said. “I remember getting a pain in my chest and they took me to the hospital and they couldn’t figure it out what it was for several days. This was before antibiotics too. There was no sulphur or penicillin.

“I had a chest tube, was in a coma for nearly two weeks and in the hospital for three months. I lost the use of my legs and had to learn to walk again. I was lucky. Literally, nine out of 10 died of this stuff.

“I had a doctor — Vastine Stabler. Dr. Tine, as we called him, was a great role model for me. He took care of me more than the pneumonia. Studies show that if you look at doctors and nurses, a high percent have had some serious illness themselves or in their family when they were under the age of 10. It sets you into this mode. My mother died from cancer when I was 13.”

Meador recalls living from house to house during that time. His father, a veterinarian working with the railroad company, was often gone. His older brother, Daniel, was off to college by then.

“Living in a little town of 4,000 people, the town kind of raised me. Despite all the changes, one thing was certain; I still wanted to be a doctor. Elementary and high school was purely pre-pre med for me. I skipped 11th grade in order to get on with it.”

Vanderbilt Days

He arrived at Vanderbilt University at the age of 16.

“No greener human being had ever hit Vanderbilt,” he roared with laughter. “It was a rude awakening. I was from a small town, first of all, and totally unsophisticated. I was not aware of very much except that I was going to study pre-med. I hated the first year and begged my family to let me go to Alabama.”

Meador was at Vanderbilt on a full, four-year, Walter O. Parmer Scholarship.

Thankfully, Meador’s older brother and only sibling, refused to allow him to leave. At the end of his first year, he began to enjoy his studies. After three years, Meador graduated with honors and enrolled in Vanderbilt Medical School. It had been nearly 15 years in the making.

“I loved every minute of it,” Meador happily remembers. “I remember saying to myself one day walking across the campus — “this is the best that you can get.’”

Once he was introduced to the sciences, there was no turning back. Academic medicine was his passion. He graduated in 1955 with the highest award — the Founder’s Medal for Scholastic Honors.

“He has always been a top performer in whatever he has done,” said his brother Daniel Meador. “He was the youngest Eagle Scout in town, he was Phi Beta Kappa at Vanderbilt. None of his accomplishments surprise me because I expected it.”

After graduation, he went to Columbia Presbyterian Hospital in New York for an internship and residency program. After he was drafted, he served two years in the U.S. Army Medical Corps in Fort Hood, Texas, where he ran the women’s ward of the hospital.

After completing his stint in the Army, he came to Vanderbilt to complete his residency and enroll as an endocrinology fellow, but soon had to go into private practice to take care of his young family. Back to Alabama he went.

It was a homecoming of sorts. He knew the people. He was familiar with the surroundings. He welcomed the challenges that Selma in 1962 brought. He ran a segregated clinic for black patients for a year.

He can’t really say why he chose that particular clinic or population, but acknowledges that he always liked working with black people. He felt at ease, secure.

It is here that his gift for seeing what was wrong with the system began rearing its head. While in Selma, he noticed that many patients were being treated for illnesses they did not have. At first he thought it was “sloppy medicine,” but much later realized it was a systematic error in the diagnosis process.

“If there is any overriding motivation for my work over the past 40 years, it comes from the experiences in private practice,” Meador wrote in the introduction to Symptoms of Unknown Origin: A Medical Odyssey, a chronicle of patients’ illnesses. This book is one of nine Meador has penned.

What he learned from that experience shaped the rest of his thought processes and approach to medicine.

In 1962, Meador was recruited to the faculty of the Medical College of Alabama, now known as the University of Alabama-Birmingham School of Medicine. From 1968 to 1973, he served as the dean of the School of Medicine. There is one night he will always remember.

“One night we decided to integrate the hospital,” he said. “We drew names out of a hat and between 6 p.m. and early the next morning it happened. It (integration) was planned at a high level. We had police on each floor. This was happening in Birmingham only a few years after the church bombings in 1963. The Medical School voluntarily integrated at the same time. That was my very small role in integration.”

Rocking the Boat

While in Birmingham, Meador discovered a glitch in the state’s health care delivery system. There was no timely system in place for physicians to communicate with each other with questions about patients and their diagnoses.

“While I was in practice, I noticed it was hard to get anyone on the phone in Birmingham to get a question answered,” he said. “You’d call up there and get the run around. So my goal was to create a phone system at the medical school in Birmingham where physicians’ questions would be answered.”

Meador describes how he used American Medical Association funds to hire a social worker and a telephone operator. He asked faculty to wear beepers. The social worker would gather necessary medical information, while the operator connected physicians in need of assistance to those in the know.

“Well that thing grew and grew and grew,” Meador said. “They now have about eight to 10 operators down there doing probably more than 100,000 phone calls a year and it’s still going. This is just doctor to doctor.”

The Medical Information System by Telephone or MIST recently celebrated its 25th anniversary.

The original MIST plan called for a four-county test to follow the infant death rate. It was discovered that the rate fell in the counties that implemented the system. Soon after, it spread throughout the state, allowing doctors to stay in contact with specialists while caring for the patient in their own community.

As with most things in his life, Meador enjoys staying busy and, most importantly, challenged. In 1973, it was time to move on. He came back to Vanderbilt to set up a teaching program at Saint Thomas Hospital for the residents at VUMC. He served in that role for 25 years.

During that time, he was asked by the Daughters of Charity at Saint Thomas to give a talk about the care for the poor. Meador focused on this topic, turning it into a project. He envisioned a restructured health care system that would be far less expensive to run and much more thorough. It would be organized by the clinical problems that the population experienced.

So why didn’t it work?

“The planned system would have dropped the admission rates to hospitals,” he said. “This is where my curse comes in of seeing things — seeing what is wrong with the system. I was focusing on decreasing the use of certain medical practices, not increasing them. I was interested in teaching mothers how to look at ears, how to examine throats. It was radical. It was done in Rhode Island. Mothers were licensed to treat ear infections early and the pediatric visits dropped by 20 percent.

“This was all pre-nurse practitioner. No one has ever created a medical system de novo, started all over again, run it and see what happens. Instead we continue on with this very complicated, elaborate, added onto, patched up thing that is driven by money and not by clinical need or patient need.

“It’s a disappointment that medicine has gotten so far off track,” he said. “And I must have some how been a part of that. I am not any better than anyone else. Somewhere medicine went from doctor to patient, to very high technology. Technology costs money and it went into a business. It will always be some sort of business, but you can make it more efficient.

“Someone needs to take the system and start over. We came close. The powers that were in charge were frightened by the radical nature of the new system so the project was scuttled.”

Secrets of the Gray Box

Meador’s ideas for health care are often exhausting for him. He admits that his love for medicine often gets in the way of the rest of his life. But those who know and love him say his legacy is strong and will be ever present.

Twice married, he has seven children ranging in ages from 12 years old to 46.

“When I think of my father, I think of someone who is wildly curious,” said Ann Shayne, his third child. “He has always been that way. He has had ‘enthusiasms,’ as we call them, for many and various things.

“A notoriously bad enthusiasm for camping left us with an attic full of sleeping bags and tents. We went camping exactly once, but we did have the legacy of a large gray box he built for the back of our station wagon. The Gray Box.”

Shayne recounts growing up and asking him what he did and how was his day during dinner table conversation. His usual reply, she said, was, “Saw sick folks.”

Now that her father, whose second love is writing, has published an armload of books, she is excited about reading what he’s written. A few titles: A Little Book of Doctors’ Rules, A Little Book of Nurses’ Rules, and with William Wadlington Pearls from a Pediatric Practice, How to Raise Healthy and Happy Children, and most recently, Med School: A Collection of Stories About Medical School 1951-1955.

“It is a gift to have my father’s writings, to be able to see back into his career, to discover that when he ‘saw sick folks,’ he was actually working hard to understand the very nature of illness,” she said. “After all these years as a physician, my father seems to have more questions now than answers. That may be the best lesson he ever taught me: a good goal in life is not necessarily to find an answer, but to understand and relish the possibility that there may not be one.”

Even so, Meador will keep at it — continue to beat the drum for the underserved, the forgotten, the poor, the voiceless until someone hears his call.

Dr. Roy Elam, an internal medicine physician at Saint Thomas and medical director of the YMCA of Middle Tennessee, has known Meador since 1975. He calls him a visionary, a leader and an explorer.

“He is always leading the profession in ventures,” Elam said. “He always is creative and follows his passion into new ideas. He has been very influential in helping medicine just to maintain its humanity.

“He obviously is someone who has been given extraordinary gifts. This is a guy who just fills a room when he walks in. He has been given much and feels he should give it back.”

Alliance is Newest Challenge

Elam said Meador’s stamp on the world would never be a building, an invention or an improvement in technology; rather it will be “the large number of people he has taught to care deeply about trying to improve the human condition.”

Which brings us to where Meador’s challenge, enthusiasm and interest lie today. As the executive director of the Meharry-Vanderbilt Alliance, his vision for addressing the need to create a new health care delivery environment is being realized. The Alliance was developed in 1999 between Meharry Medical College and Vanderbilt University Medical Center to enhance the educational, scientific and clinical programs at and between both institutions as well as assist with collaborative efforts in the areas of medical education.

Meador’s real passion through the alliance is the development of the Nashville Consortium of Safety Net Providers. The focus of this group, now under the direction of the Metro Health Department, is to create a registry of all the uninsured in Davidson County and work to bring these patients out of the local emergency rooms and into a designated primary care clinic for continued care.

“It’s kind of the residual of my original idea — building a system from the ground up. It was still percolating in my head,” Meador said. “What can we do to help the uninsured problem? Why can’t we get people out of the ER and into clinics where they can get decent primary care?”

But in order for this system to have a chance, more than two institutions needed to be involved. It had to be more accessible.

“It’s a simple rule — if you want to influence a big system, get control of a system, then give up control,” he said. “It’s a paradox. By giving up control of this project to the health department, it went community wide instantly. Instead of six clinics with Meharry and Vanderbilt, it became 23 clinics almost overnight.”

And that’s not all. Meador has studied the systems used in other states as well as incorporated the expertise of local companies to help create a systematic health care delivery system.

“We’ve got the clinics, the emergency rooms, a computerized system and we are about to get the specialists on board so that the uninsured and poor of Nashville will have a place to go for specialty care.

“They can get into the hospitals, we can track what happens to people through the claims data system and we can start to make real improvements.

“We will turn a chaotic system into a systematic one. That appeals to me. To systematize something that was not is aesthetically appealing. Bringing order to chaos.”

Those qualities are what the founders of the Alliance saw in Meador. According to Dr. John E. Maupin Jr., president of Meharry Medical College, it’s what most who meet Meador see in him.

“He exhibits uncommon leadership,” Maupin said. “He often takes positions based on the principles of the issues he believes in. He is candid, frank and very honest.

“Clifton Meador is a great advisor and listener. He is someone whose professional and personal friendship I cherish.”

The medical community has much praise for Meador’s determination and persistence. His commitment to serve is a mainstay of his medical career.

Although the challenges of righting the health care system have occupied Meador’s professional life and writing has given him an outlet to express humor as well as reflect on his life, there is one other hobby that allows him to see past the surface. But he does not label this gift as a curse. He knows he will see the finished product and relishes in it.

Since his early 30s, Meador has enjoyed wood. It’s during the times of woodworking that he is able to shut out the world. Self taught, he has made a dining table for his oldest son, two night stands for Ann Shayne, a bureau for himself, toys for all of his children and toy chests for the grandchildren.

“I like to make furniture and just look at it,” Meador said. “What I do in my job doesn’t show up for a long time. What you do for a patient is not immediate. This, this is immediate gratification. You see an actual product, an actual thing you make. You can look at it. You can touch it.

“When you’re finishing a piece of wood, you kind of get into the grain and it becomes three dimensional. There is a lot more depth.”

Meador recounts the story of traveling to New Hampshire to study under a well-known Japanese master. Although well into his 50s at the time, learning how to make the joints to the teacher’s satisfaction was dreadful, he said.

“It was the meanest I’ve ever been treated before in my life,” he said. “We were out in the woods and I found myself towards the middle of the week hiding from this guy. He didn’t speak English and all he said to me was —“No, No, No, No, No!”

Meador learned how to make the intricate joints and laughs about the adventure now, but said it is very telling of life.

“This may sound strange, but once I kind of figure out how to do something, I don’t want to do it anymore,” he said chuckling.

“I guess that’s kind of the story of my life. Once I get a job going and I learn how to do it, I don’t want to do it anymore. I get bored and I want to do something different. Something I don’t know how to do. I don’t know what that says about me.”

Will Meador ever retire?

Colleagues and family say never.

“No, No, No, No, No!” he said vehemently, much like the Japanese master.

“This is probably my last project — the Alliance,” he said. “I haven’t figured it all out yet. There is still work to do and the challenge is still here. But we’re close.”