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Editor's note: This is the third in a series of stories called "Profiles in Health" - a look at how health care leaders experience the American health care system as consumers and patients. The series is part of the 

 project, American Public Media's focus on information, insight and experiences in health.


Thinking back to when his daughter, Betsy, was hospitalized for the leukemia that would quickly steal her life, two people stand out in Dr. Alan Johns' memory. One is the third-year medical student who talked to Betsy a lot, explaining things in a way she could understand, and the other is the janitor who mopped her floor every day. "He always had a really positive attitude," Johns said. "He always had a smile on his face and was always visiting with her. You could depend on him."

"Of all the people who saw her," said Johns, an internist with Essentia Health and the incoming interim dean of the University of Minnesota Medical School's Duluth campus, "all the high-powered researchers and physicians and oncologists and hematologists, those two come to mind." Each gave Betsy, just 19 at the time, someone to trust and even laugh with. "Some people would say he's not doing anything," Johns said of the student, ignoring a large latte in a noisy campus coffee shop. "He's just talking to her. But I would submit that he was doing really a lot for her care just by being human."

It's that personal connection -- between doctor and patient, student and teacher, even janitor and patient -- that Johns considers essential to good health care. And he worries that as family medicine takes a backseat to specialties like cardiology and orthopedics, which are more lucrative, patients lose out. "It's the human aspect of medicine I try to relay to my students," said Johns, one of the first Native American students to attend medical school in Duluth, where he now teaches and oversees curriculum. On July 1 Johns becomes interim dean of the medical campus, after the current dean steps down.

The school makes a mission of training primary care doctors, many of whom go on to practice in rural areas, and Native physicians. Approximately 40 percent of the 60 or so medical students starting in Duluth each year enter family medicine, Johns said, compared to the national average of 8 percent. The school, combined with the Twin Cities campus, turns out the second-highest number of Native American medical graduates of any school in the country.

Both as instructor and administrator, Johns, 62, pushes students to take a long-term interest in patients' lives, something primary care doctors are well suited to do. "Once you've seen a thousand cases of diabetes, the next diabetes case isn't that interesting," he said. "But the people are all interesting." When presenting medical cases in class, he goes beyond the details of the illness to describe the patient. One person he talks about, whom he calls "Richard," died of multiple myeloma. But he was also a hardworking carpenter and roofer who never saw doctors. So when Richard reported his symptoms, Johns knew it was meaningful. "He came in and said, 'I'm feeling kind of tired.' Well, a lot of people are tired. I'm tired. For somebody like him, that is really significant."

"Richard was a real person, and I guess..." Johns paused to compose himself. "Betsy, she was a real person, too."

His daughter, who died almost exactly ten years ago while a sophomore at the U of M in Minneapolis, was a gifted flutist and member of the U's symphonic and marching bands. "She was, and I'm not just saying this as a parent, she was very beautiful," said Johns. "She had the artistic temperament. She was a little fragile and dramatic. That was Betsy." She went to student services one day after noticing that she was bruising. "I knew it wasn't anything good," Johns remembers. "I was hoping it was some drug reaction. She was on some medication. But then they did a bone marrow and found out she had acute myelogenous leukemia. Oh, it was terrible, a terrible part of my life. Of our lives."

Getting to know a patient can help a doctor understand the larger context of an ailment, while also building confidence and good will. Sometimes people just need to be listened to, like an elderly patient Johns calls "Mildred." When she would come to an appointment, he asked how she was doing and she would say, "I'm too darned old." And then she would laugh. The fact was, he said, "Mildred was too darned old. I mean, what am I going to do? She's older than the hills, you know. I'm not going to make her young again. But I can listen to her and kid with her and talk to her."

Johns tells students about Mildred and also about Betsy and the janitor and third-year medical student who meant so much. "I tell them, don't think that you are ever not doing something," he said. "You can help someone without writing a bunch of orders or ordering a bunch of tests."

Dr. Gene Karwoski, a friend and fellow internist in Duluth, describes Johns as a smart doctor with a mild manner and strong sense of compassion, "the kind of doctor you would want if you were looking for a physician yourself." He shares Johns' belief that you can better help patients by knowing them a little. "So much of people's medical problems are connected to everything about them," he said.

Karwoski remembers a doctor who inspired him when he went to school in St. Louis. The doctor, a pulmonary physician, told him, "Listen to the patient. They will tell you what they have. You just have to put the name on it." He thinks Johns is that same kind of doctor, one who inspires students in the same way. "Role models are important to younger doctors," he said. "They think they would like to be a doctor like him."

Born in Stanley, Wisconsin, near Eau Claire, Johns was the only child of a librarian mother and a father who served in the army during WWII and the Korean War. His dad was raised on the Oneida reservation near Green Bay, but when there was no work, joined the Civilian Conservation Corps and then the military. "He was gone for a year after I was born," recalls Johns. "He saw me being born and then he left for Korea for a year. It was a pretty horrible experience for him." The family traveled a lot and Johns, as a child, lived in Chicago and spent three years in Germany.

He was a young teen in 1964 when his father, having been discharged from the military with severe rheumatoid arthritis, took a civilian job on the air force base in Duluth. His mother worked as the Proctor high school librarian, but suffered from her own illness, multiple sclerosis. "Let's put it this way, both of my parents had terrible chronic illnesses," Johns said. "My father got rheumatoid arthritis when he was fairly young and kept working through all of that. He got so ill at the start of his disease, he was sent away for eight months to an army hospital. So both of them were disabled but kept on going. And how they did it I will never know. They were in poor health for many, many years."

Johns said his parents were treated well by doctors, but there was only so much they could do for either illness at the time. "I saw that go on for years and years," he said. "It was so difficult."

So, when Johns went to college at the U of M in the Twin Cities, he didn't take up medicine, but rather chemical engineering. "I had had enough about medicine and doctors and illness," he said. Yet, in the middle of his studies, he got a call from a professor in Duluth recruiting him. "He said, 'Did you ever think about going to medical school?' I said, 'Ah, no.' I still never figured out how he got my name," Johns said. "There must have been a list somewhere."

The more Johns considered it, the more he realized he wasn't ready to settle into a corporate chemical engineering job, a field he didn't have passion for. So, he headed to Duluth for medical training and wound up finding his calling.  After completing his residency, he and his wife, Dorothy, moved to San Diego with dreams of living in a warm climate. But a few years later, in 1981, they moved back to Duluth and Johns went to work at the Duluth Clinic, now part of Essentia. He was drawn by family, ready access to fishing and snowshoeing, affordable housing, and the city's strong and collegial medical community.
He and Dorothy, an English teacher, live on Island Lake north of Duluth, not far from her brother and his wife, Michelle Juntunen, who used to be communications director for the medical campus. "I love that medical school and everything about it," she said, citing the passion behind its mission to train primary care and Native doctors. She has known Johns since the 1970s and describes him as a champion of that mission. "He is confident but empathetic, somebody who is very approachable," she said. "He is a great part of our family." As a Native American doctor, he serves as a role model for prospective Native students too, she said.

Johns recruits Native medical students from all over the country. And he mentors them through the school's Center of American Indian and Minority Health and at a yearly conference held by the Association of American Indian Physicians. "They bring in Native students who are interested in applying to medical school for two or three days and several of us work with them (on) the technical aspects of applying," from conducting mock interviews to writing personal statements. "It's trying to get them on the level playing field with a lot of students who have come from more advantage."

American Indian students are often poor, he noted, with little family college experience--the on-time high school graduation rate for Native Americans in Minnesota is under 50 percent. "I think, having a Native person here makes a real difference in connecting with Native students. It's not that I can share a lot of common experiences, because I can't say I grew up in poverty or desperate situations like a lot of Native people do. I didn't grow up with privilege, that's for darn sure. We were of modest means. Neither of my parents went to college. But I think I bring some credibility and some knowledge of what it means to be Native. How, going to school as a Native person, you are just a little different. You are looked on a little differently. You are not part of the majority culture. I have certainly felt that at times."

"So, I've always been interested in helping out the Native students because I see some of myself in them," Johns said.

It was just three months after her leukemia diagnosis, on the week of Duluth's annual Grandma's Marathon, when Johns' daughter, Betsy, came home for a family gathering for what would turn out to be the last time. "Betsy got really ill and I brought her to the emergency room," said Johns. "And she had this overwhelming infection and died three days later. So she died up here in Duluth."

"I'm a different person now than I was then," he said. "Not better or worse, but just different. I have more patience with people, not that I was impatient before. I think I am more understanding, not that I wasn't understanding before. But I look at life's ups and downs a little differently. I put things in perspective. People ask me, 'Isn't your job stressful?' And I say, 'No.'"
Johns tries to impart this generous outlook to his students. "I try to teach them patience," he said, "and getting to know people and appreciating the whole spectrum of humanity."

Jennifer Vogel is a freelance journalist living in Minneapolis and a contributor to MPR News.

Health

To Dr. Alan Johns, a personal connection -- between doctor and patient, student and teacher, even janitor and patient -- is essential to good health care. The incoming interim dean of the University of Minnesota Medical School's Duluth campus worries that as family medicine takes a backseat to specialties like cardiology and orthopedics, which are more lucrative, patients lose out.

Profiles in Health: Dr. Alan Johns

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