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The cover article in our Fall issue—about a family physician who struggled for years with the increasing burden of regulatory and payment-related paperwork before finally giving up solo practice—struck a chord with readers. We heard from a former coworker of Tim Shafer's, a former patient, a couple of other private practitioners, and even an English professor, who found the story "heart-wrenching." And that wasn't the only feature in the last issue that moved readers to write in. We also got letters about alumnus Bob Rufsvold's experiences in Ethiopia with Médecins Sans Frontières and about DHMC's first-in-the-nation Center for Shared Decision Making.

Kindness and compassion
I was very surprised to see Dr. Tim Shafer on the cover of the Fall issue of Dartmouth Medicine. I used to work with him at Grace Cottage Hospital in Townshend, Vt., so of course that was the first story I turned to.

The article was written superbly and enlightened me about rural private medical practice. I really had no grasp of the complexities and struggles that are involved in meeting the needs of the patients, the practice, and the government.

Yet despite all of these headaches and tribulations, I recall many good times working with Tim. I owe him thanks from the bottom of my heart for the help and support he gave me during my nursing career at Grace Cottage Hospital. I think back with to all the knowledge I gleaned from him.

One of the best things I worked on with Tim was the creation of an ACS [acute

We're always glad to hear from readers about matters pertaining to medicine at Dartmouth or to the contents of past issues of Dartmouth Medicine. Letters to the editor may be sent to DartMed@Dartmouth.edu. Letters may be edited for clarity, length, or the appropriateness of the subject matter.

coronary syndrome] policy and procedure protocol, which we drafted with the assistance of DHMC. Because of that effort, the second night the protocol was in effect we saved a life. This is something that I will always cherish.

Because of Tim Shafer and all the other dedicated doctors, nurses, and staff members who work there, Grace Cottage is an outstanding little hospital.

My mother also had a very special place in her heart for Tim. He was always her Tim and no one else's. She talked often of his kindness and compassion to her, and of the wonderful care he provided her as a patient and as a friend.

Many thanks for the enlightening article.

Margo Boyd
Jamaica, Vt.

Not a clock-watcher
When I saw the cover of the Fall issue of Dartmouth Medicine, I said to myself, with a great sense of bittersweetness, "That's my doctor!" Though Tim Shafer has actually not been my primary-care practitioner for several years now, due to distance, he was my doctor and my friend for almost 18 years. I still think of him as my doctor and suppose I always will.

So of course I read the article with great interest, and I must say that in all the years I was his patient I had no idea that any of this financial struggle to create a "Care Package" was going on—because, as Tim's wife, Deb Luskin, writes in the article, his patients were never treated any differently than they had been. If it is possible for me to have gainedmore respect for thisman, this father, this husband, and this doctor, I have.

I remember going to his office feeling that I needed to see him urgently, and he always made time for me. Having to sit for 45 minutes to an hour past my appointment time never bothered me because I knew he was giving someone else his precious time, listening intently to that patient. No matter how long it took, I knew when it was my turn to see him that he would give me as much time as I needed, too. He never looked at his watch and he never sat in front of a laptop typing while patients were talking with him. He always looked at his patients as they were speaking, which gave him so much insight into what was really going on in their lives. This is something that is sorely lacking in today's doctors, in my opinion.

Tim often had medical students working with him. I always felt hopeful that somewhere in this world would be a few new doctors who understand that laptops

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