Man about town
Meet Lloyd Van Winkle, M.D., 2010-2011 Texas Family Physician of the Year
By Jonathan Nelson
Twenty-five miles west of San Antonio alongside the Medina River is the quaint village of Castroville, population of about 3,000, home to TAFP’s 2010-2011 Family Physician of the Year, Lloyd Van Winkle, M.D. For more than 25 years he’s practiced family medicine here, just off the old town square in a clinic he designed and built, Medina Valley Family Practice. He keeps the original floor plan, splattered with little spots of spackle and mounted on a plywood plank, leaned against the wall behind his office door.
The clinic is surrounded by the whitewashed adobe facades of provincial buildings new and old—several dating back to the mid-to-late 1800s—characterizing the community, which began as an empressario settlement in 1842, when Henri Castro brought a group of settlers from the Alsace-Lorraine region of France to populate the Medina River valley. From his clinic, Van Winkle can see the spire of the rustic and beautiful St. Louis Catholic Church, completed in 1870, dominating the great town square, enhancing “the Little Alsace of Texas,” as Castroville is called, with its old-world rural European charm.
Through his dedication and determination, Van Winkle has written himself into the distinguished history of this place. His is a household name here. Feats of selfless kindness, considerate leadership, and his continuous availability are recounted time and again by grateful patients and friends. In a letter recommending Van Winkle for the Family Physician of the Year Award, one patient wrote:
“Having four very active children and living on a ranch, we have had many occasions to call his after-hours answering service. Without fail, in a matter of 10 or 15 minutes, we’ll receive a call back (even on Saturday nights), ‘Well, I am dining in San Antonio with my family. We are almost through. Can you meet me at the clinic in 25 minutes?’ To the parent of an injured child in a rural area, those are the sweetest-sounding words in the world.”
Perhaps his most conspicuous characteristic is his consistency of behavior and appearance. His partner in practice for more than 10 years, Mary Nguyen-Poole, M.D., swears he sleeps in a suit. “Maybe if it’s a casual event, he may go without a tie, but I have never seen him disheveled,” she says. “He always looks like Dr. Van Winkle.” Whether you call him at 2 p.m. or 2 a.m., “the way he answers the phone and talks to you is exactly the same.”
In another letter of recommendation for the award, a patient commented on this same quality:
“His patients can always depend on his being there for them, no matter the date or time of day or night. I do not pretend to know how he manages to be all places at all times, unless he has a closet full of clones, but he does it. Even more amazing to me is the fact that, even in the wee hours of the morning and after countless hours without sleep, hours filled with one dire emergency after the other, he will appear at the bedside of a newly admitted patient meticulously groomed, incredibly alert, and disgustingly energetic. As a matter of fact, in all the years I have known him, I have yet to see him otherwise.”
The head nurse at Medina Valley Family Practice finds his unflappable nature among his finest qualities. Donna Winters has practiced alongside Van Winkle since he came to town, and she remembers clearly her employment interview with him. After answering several of his questions, she was surprised when he asked if she had anything she’d like to ask of him.
“I said, ‘Do you curse?’
“He said, ‘Never.’
“I said, ‘Do you throw things?’
“He kind of sits back in his chair and gives me this look and says, ‘No.’
“So I said, ‘If we have a really stressful day and something really bad happens in the office, you’re not going to yell at me, and cuss at me, and throw things across the room at me?’
“He goes, ‘You have to be kidding me, right?’
“I says, ‘No. I’ve had all those things done to me. Are you going to do those things?’
“And he says, ‘Never.’ And I can tell you, 25 years and he’s never cursed, he’s never thrown anything, and he’s never yelled at me. He’s a man of his word.”
There have been plenty of stressful days, rest assured, as one would expect in a practice as busy as Van Winkle’s. He regularly sees 40 or more patients a day, admits patients to three hospitals, serves as the medical director for a nursing home and for the Medina County Emergency Management Service, and is the supervising physician for a rural health clinic in Utopia, about 60 miles west of Castroville. Between Nguyen-Poole and himself, they share about 7,500 patients.
They offer full-spectrum family medicine at the clinic, complete with X-ray imaging, casting, suturing, and removal of foreign objects. (Over a quarter of a century, they’ve racked up a long list of painfully funny tales of foreign-object removal, none of which can be safely recounted here.) They even have a crash cart, which they’ve had to use from time to time.
He sponsors little league sports teams for boys and girls, and has for years. Hanging all along the clinic walls are team pictures—girls’ softball, boys’ baseball, soccer teams, and basketball teams—all with jerseys that read “Lloyd Van Winkle, M.D.”
He’s a clinical associate professor in the Department of Family Medicine at the University of Texas Health Science Center in San Antonio. He’s the health officer for Castroville and its neighboring community, La Coste. He’s the Medina County Aviation Medical Examiner, the chair of the Department of Family Practice at San Antonio’s Methodist Hospital, and a quality reviewer for TMF Health Quality Institute.
He has served on too many committees and commissions with TAFP, the Alamo Chapter of TAFP, and the American Academy of Family Physicians to list, and he’s held every office of TAFP, serving as president in 2000 and 2001. He has just completed a 10-year commitment representing TAFP as alternate delegate and then delegate to the AAFP Congress of Delegates, an honor he holds most dear.
At age 56, with a wife of more than 30 years and four successful children, Van Winkle has accomplished a tremendous amount. But don’t think he’s about to coast into the golden years. He’s planning a major remodeling project for the practice, and he and his staff are currently in the thick of implementing an electronic health record system. “My goal is to practice into my 80s,” he says.
Van Winkle grew up quite close to where he practices today. His great-grandparents settled in the area in the late 1800s, and his parents met in high school in a nearby town. His family moved to San Antonio in search of better schools for Van Winkle and his younger brother and sister, and his father went to work for IBM. Van Winkle remembers being surrounded by early computers, learning the theory behind them, their presence fueling a keen interest in science. His parents subscribed to the Time-Life Science Library, offering a new book every two months for three years, which he read from cover to cover.
In September of his freshman year in high school, 1969, his biology teacher pulled him aside. “You really have a gift for this; you ought to be a doctor,” Van Winkle remembers him saying. “He was the first person to suggest that.”
“When I went off to college, the politics of the late ’60s, early ’70s were in gear, and I decided as much as I enjoyed science, politics and changing the world was important, so I became a political science major.” After a year, he had changed his mind, switched his major to biology, and entered the pre-med program. He would change the world another way.
After graduating from St. Mary’s University in San Antonio, he began medical school at the University of Texas Health Science Center at Houston. The first two years were tough. School had always come easy to him, but now he had to learn to study. Then came the clinical rotations.
“Every single course I took during my clinical rotations, whether it was psychiatry, or dermatology, or general surgery, or ER, everything I did, when I finished it, I said, ‘That’s what I’m going to do.’”
There wasn’t a true department of family medicine at the school back then, so he didn’t have any exposure to the specialty until his mandatory primary care rotation with a family doctor in north Houston.
“I watched him making hospital rounds and seeing his patients, and I said, ‘This is the missing link.’ I saw how his patients talked with him and the relationship he had with them, and I said, ‘This is the thing I need. This is what will pull it all together and make it work for me.’”
Back at school, he got a cold reception from friends and faculty. He says not one faculty advisor, attending, or professor supported his decision. “They all said, ‘You can’t do that. You’re too smart for that.’”
Undeterred, Van Winkle became an intern at the UT Health Science Center at San Antonio Family Medicine Residency. “It was a whipping of a residency,” he says. “It was in the days when there were no hour limits on call, but man, I learned a lot. You would admit someone at 3 a.m., and you’d have an option of going to sleep until 5 or going to the library and preparing for rounds to know that patient’s disease. You’d better go to the library, because that attending in the morning is expecting you to present that case.”
Entering the internship in the same class as Van Winkle was a tall, strong-willed physician who had already had a brief career as a pharmacist and who would go on to become TAFP president, TAFP Family Physician of the Year, and Speaker of the AAFP Congress of Delegates, Leah Raye Mabry, M.D.
“Of course we were all young and innocent,” she says, “but one thing we immediately noticed about Dr. Van Winkle is that he was very professional.” She says the interns and residents would go on call, working extremely hard each night with multiple admissions, then come in the next morning hoping not to look “half dead.” Then they would see the young Van Winkle. “He never had a hair out of place. He always had on his suit and his tie, and you know, he was always well-shaven and taken care of. So quickly we nicknamed him Mr. Clean.”
She says he would say he wanted to look like the doctor that his patients expected him to be, and to this day, he abides by the same code. He runs six days a week, and pays close attention to his caloric intake. He reads voraciously from a wide variety of genres, the clinical literature for certain, but also fiction—from science fiction and mysteries to the classics—and histories, biographies, and other non-fiction.
He cultivates a grand appreciation for music of all sorts. Yes, he loves The Beatles, but his ear wanders far, and his music collection would rival that of many 20-something hipsters, including the likes of Death Cab for Cutie, Wilco, Sufjan Stevens, and Radiohead. He has attended multiple concerts by progressive metal rockers Tool, probably clad in coat and tie.
“When I have [medical] students here, I always ask them about music, and some of them have some music knowledge and some really don’t, but I tell them you know, medicine is important, but you can’t limit yourself. If you broaden your horizons, you’ll have a better ability to interact with patients.”
Van Winkle is usually in the process of tutoring medical students, and he enjoys doing it. During his residency training, one of his clinical professors taught him that to be a physician, you must do three things. First, you must take care of patients. Next, you have to teach, to pass on the knowledge you’ve been given, and lastly, you have to study.
“I thought it was a great philosophy, and so it’s what I’ve done from the beginning.”
Teaching is one of the many ways Van Winkle extends his benevolent influence beyond the exam room. Another is his community leadership. After completing his residency training and setting up shop in Castroville, he was asked to serve as medical director for the Medina County EMS. At that time, the unit consisted of a few volunteers and a single ambulance parked under a carport behind the volunteer fire department building. Today, the department has three stations, five ambulances, and a paid staff on duty around the clock. It is a model department, conducting training sessions for EMS units in rural communities across the country. Medina County EMS was named Texas State EMS Provider of the Year in 2009.
This transformation didn’t take place overnight, and it was successful because of the concerted effort of many members of the community. They had to establish an emergency services district that could impose a quarter-cent sales tax to pay for the service. Van Winkle says it took several months of persuasive phone calls. “There’s a lot of folks out here who don’t want to pay any taxes for anything, and you kind of had to get them to come around to the fact that when your mom has an MI [myocardial infarction, or heart attack] in the middle of the night, if you had to pay an extra $100 a year in tax, would you be willing trade your mother for that? They came around.
In a letter of recommendation from the Medina County EMS, business manager Sherry Trouten wrote: “Dr. Van Winkle has definitely been a very valuable key to the success of this organization and we could not recommend him higher for any recognition for his service to this community.”
It was this leadership quality that led Leah Raye Mabry to recruit Van Winkle into service for the Academy, first at the local chapter level, then at the state and national levels. “I like to think I talked him into it,” she says.
According to Van Winkle, she wouldn’t take “no” for an answer. When Mabry had begun moving through the officer ranks at TAFP, she called Van Winkle again, saying that when she became TAFP president, she needed him to be the parliamentarian. “I told her thanks, but I really couldn’t. I was just too busy,” he says. “She goes, ‘Lloyd, I didn’t call to ask you, I called to tell you you’re going to be the parliamentarian.’” A few years later, Van Winkle was sworn in as TAFP president. For years, he’s served as the chair of the TAFP Political Action Committee, and he has become a respected voice for family medicine on various AAFP committees and in the Congress of Delegates. He sees his participation in organized medicine as an extension of the care he provides in his community
“In my office, I see patients every day and I impact health care in Texas by doing that. But medicine is practiced in an environment and it became clear to me that the medical environment as the world became a bigger and bigger place was going to be regulated. It also became clear to me that there were people with different motives for that environment that I might not agree with and that might be detrimental to my patients.”
He says when he saw his colleagues serving as leaders in the state and national levels, making policy and working to improve the state of family medicine, he had to be a part of that process. “That’s really what you’re doing,” he says. “You’re giving to your patients through your involvement in organized medicine.”
After all the excitement, though, it’s good to get back to Castroville, back to the practice, back to his patients. “All the other things I do are interesting, but the thing I do where I really feel like I’m where I’m supposed to be is when I’m here, seeing patients in the office.”
When he accepted the 2010-2011 Texas Family Physician of the Year Award at TAFP’s 61st Annual Session and Scientific Assembly in San Antonio last summer, he told his assembled colleagues and friends that family medicine is really about relationships. He showed a video montage of images of family medicine’s leaders in Texas over the decades set to the old Louis Armstrong standard, “What a Wonderful World.” Then he looked out over the crowd and thanked them for the honor.
“You know, a popular show on television right now is called ‘House,’ but none of my patients is looking for a house. They’re looking for a home, and that’s what we are. Friends and colleagues, I thank you all for being here. I love you all. We’re all Family Physicians of the Year every year.