Life lessons

TAFP’s Physician of the Year teaches from experience

Story and photos by Kate McCann

Meet Larry Karrh, M.D., the 2009-2010 Texas Family Physician of the Year. A gentleman who opens doors for others and addresses everyone as ‘ma’am’ or ‘sir’ regardless of age, the West Texas native has maintained his manners and unassuming approach to medicine even when transplanted from the land of wide prairie sky to the heart of the third largest metropolitan area in the state. Karrh currently serves as faculty at the Christus Santa Rosa Family Medicine Residency Program in San Antonio, but telling his story means summarizing the life of the consummate physician, family man, patient and professional advocate, role model, and community leader.

On a Friday morning during the residency program’s procedures clinic, Karrh plays two roles. To the young girl sitting nervously on the exam table, he is the caring professional reassuring her that her ingrown toenail extraction will not hurt. To the young resident by his side, he is a teacher showing by example how to interact with a patient’s family and explain the treatment step by step in a calm, warm manner.

“I’m not in the business of hurting people,” Karrh tells the girl, speaking sincerely and looking her straight in the eye. “I’ll tell you everything I’m going to do; I’m not going to lie to you.” She nods and steals a glance toward her mother standing nearby who speaks up with a few questions and an account of a previous treatment that left the girl in pain. With hesitation, the girl agrees to the procedure and Karrh and Tyson Purdy, M.D., a second-year resident, step outside the exam room to prepare.

“You only need to touch two tools on that tray,” Karrh explains to Purdy. “Other physicians may do this differently, but you only need two today.”

Ask around the program and the first word used to describe Karrh is “experience.” With nearly three decades of private practice under his belt and six years with Christus, Karrh has seen and done pretty much everything. The way he puts it, he’s “not good at the formal way” and won’t frequently quote literature and the latest articles, but he knows medicine and has a knack for bridging the old style of family medicine with the educational needs of the next generation of physicians.

As far back as he can remember, Karrh never wanted to do anything other than family medicine. His career began after graduating from the University of Texas Medical Branch at Galveston and completing residency training at John Peter Smith Hospital Family Medicine Residency Program in Fort Worth. He and his wife, Patricia, a nurse, spent two years in Tyler before hearing the call back to Karrh’s childhood home, Plainview.

The young physician stepped right into a busy practice. Two JPS graduates were leaving as he was coming in, so he took over as a solo practitioner at Medical Center Clinic in 1976. It was a busy time, Karrh says. “I didn’t have the usual buildup. I had ladies due weeks after I started.” He maintained a full practice including hospital rounds during his tenure at the clinic, treating everyone from “babies to old folks,” and delivered more than 1,200 babies over the 13 years that he practiced obstetrics.

With his wife Pat’s help, with whom he said he had a “perfect partnership,” Karrh balanced his family and his career. Together with their three children, Kristen, Kevin, and Kara, they were active in the community and worked on the family farm where they raised registered horned Hereford cows and performance-bred foundation quarter horses—a hobby Karrh maintains to the present.

“She understood the demands of medicine so we didn’t have the conflict of other physician marriages,” Karrh says of his late wife, who passed away in 2007. “Because we lived in a small town, we were able to make all of our kids’ events.” What he couldn’t do, she did. Pat was president of the Chamber of Commerce, and served multiple years on the Plainview ISD Board of Trustees, activities she could pursue without putting strains on a practice, he says.

Karrh stayed at Medical Center Clinic until 1995 when he was recruited to a practice affiliated with what would later be Covenant Hospital Plainview. Though Covenant Family Healthcare Center started out with just him and a pediatrician, the clinic at its height employed eight physicians—three family physicians, two pediatricians, an internist, an allergist and a surgeon—to provide full-spectrum care to their patients.

In 2003, the health system faced a large deficit and administrators questioned where to make cuts. “The answer was to shut down all the rural clinics and keep the high-dollar subspecialist clinics open,” a point Karrh raises with a furrowed brow. The system converted several clinics in the area into rural health clinics affiliated with the local hospitals.

The closings uprooted not only the five physicians still in Karrh’s practice, but also much of the primary care base in the surrounding areas. “When they closed the clinic in Hereford, they took out all the family physicians but one, in Tulia they took all, in Abernathy they took the only doctor in town.” An article by the Plainview newspaper at the time also reported closings in Crosbyton, Littlefield, Snyder, Brownfield, Artesia, N.M., and Clovis, N.M.

Karrh considered several options, including moving 45 minutes down the road to Lubbock to start a new practice, or to an area closer to his children and grandchildren. The search continued. Because of his years working on numerous TAFP committees and representing the South Plains Chapter as director or alternate director to the TAFP Board, he was well known among family physicians around the state. Fellow TAFP member and then-Associate Program Director Leah Raye Mabry, M.D., heard of his availability and approached then-Program Director Jim Martin, M.D., about recruiting him to Christus Santa Rosa.

Mabry respected Karrh’s dedication to family medicine and real-life medical experience treating patients in a small town, something they had in common. Adding to the team, Martin, Mabry, and Karrh had nearly 90 years of experience among them. “You can’t be effective at teaching residents without having experience,” Mabry says. “You want to treat patients with the medical knowledge you have, but sometimes you need the experience. Larry brought in his knowledge of procedures that some have never seen.”

Through his years with the program, he has become a favorite among residents for his extensive knowledge and practical teaching style. The residents cite him as a mentor and role model on both a professional and personal level, but also approachable and grounded. “He is the true embodiment of what a family physician is,” says Jesus “Chuy” Rodriguez, M.D., one of Karrh’s former residents. “As a teacher not only is he well versed in up-to-date medicine, but he is also well versed in rural medicine. He is extremely patient with residents and is a great father figure. He’s someone every family medicine doctor strives to be.”

Tyson Purdy says “all the residents want to be like Dr. Karrh.” He describes a video produced for last year’s “roast” of graduating residents and faculty. In it, residents impersonated faculty members and viewers guessed who they were. Purdy reenacts Karrh’s representation. The actor walks down the hall, pauses for a moment to place his ear on an exam room door and pronounces with gusto, “appendectomy!” He continues down the hall, sniffs the air outside another door and says, “C-section!” With a smile, Purdy explains Karrh’s uncanny instinct to give an accurate diagnosis. “He walks in and knows what is going on. He has the experience we all wish we had.”

Benjamin Stahl, M.D., also a former resident, describes Karrh’s quest for excellence in all areas, in his residents and himself. “He wanted the ‘operation’ to run right—the clinic, the hospital. He has a keen eye for what can run better in order to provide better patient care. He continually educated the nursing staff about how they can be more efficient and knowledgeable in a way only Dr. Karrh can do. Familial.”

Keith Patteson, M.D., now a fellow faculty member, first met Karrh as a medical student and continued to work with him as a Christus resident. He wrote in a nomination letter that he was instantly drawn to him because of his broad skills as a physician and sincere interest in developing medical students and residents into well-rounded, caring family physicians. “I learned that Dr. Karrh’s ability to practice the broad scope of family medicine with skill, confidence, and wisdom is a result of who he is and not what he does,” Patteson wrote. “His skills as a physician are a reflection of his work ethic, character, and compassion for his fellow man.”

Karrh’s dedication to the residents extends beyond the 8-to-5 workday. Patteson continued: “The residents often make guesses as to whether their 2 a.m. phone call to Dr. Karrh will be answered on the first or second ring. His willingness to always be available is well known throughout our residency program.”

In the same way he makes himself available to the residents, Karrh teaches them to be available to their patients and act as their advocate as if they were family. While he was in private practice he never had an unlisted phone number and didn’t mind taking care of patients any time day or night, he says.

With patients, Karrh is completely at ease “like he is one of their best friends,” Stahl says, and they respond to him in the same way. “He is firm, honest, blunt at times, but always in a jovial manner. He treated each patient as if they were family—sometimes your family is the only place you get the ‘tough love’ you need.”

Barbara Wright has been Karrh’s patient for the past six years. He treats her husband, too. “I like the fact that you can talk to him in a comfortable way,” she says. “I love his bedside manner. He is just a down-to-earth, nice, nice person.”

Within the larger community, Karrh gives his time freely: as a medical volunteer at the annual San Antonio Rock ‘n’ Roll Marathon, on the planning committee and medical team for the San Antonio Stock Show and Rodeo, and on the board for the Hale County Stock Show and Rodeo. Along with his son-in-law, Marc Powell, head athletic trainer for Trinity University, Karrh volunteers as one of three primary care physicians for Trinity, spending many evenings and weekends on the sidelines of the soccer or football field as well as providing sports physicals and clinic care to athletes in baseball, soccer, football, tennis, and other sports.

Still, he wants to do more. “Because I sleep in Boerne and work in San Antonio, I don’t get to be as involved in either community as I would like. For retirement, I want to get involved. That’s who we are.”

Retirement means something different to Karrh than most. To him, medicine is an obligation, a calling. That’s why a lot of family docs don’t retire, he says, because they enjoy that calling and what they do every day. “I definitely want to slow down—no 12-hour days—but I can’t imagine not going to the office and seeing patients.”

That’s good news, especially to Todd Thames, M.D., current program director at Christus, who jokes that he won’t let Karrh retire. “I don’t think we could ever replace him. I don’t know that we’ll find his combination of experience, skill, and temperament. He can’t retire.”

Thames recalls searching for a new faculty member with the same private practice experience and aptitude for teaching, with no success. “There’s not a day that goes by that he’s not looking at ways to be more effective, to get more involved,” Thames says of Karrh. “Not many doctors would leave private practice to come into teaching because of the strenuous schedule. It’s unfortunate that it’s unusual because it brings a richness to the program.”

Back in the procedures clinic, doctor and resident begin the ingrown toenail extraction. Karrh preps the needle he will use to numb the area, explaining to the girl that it will burn just a bit, but that this will be the worst part. She reaches for her parents who stand by her side squeezing her hands. Karrh places a hand gingerly on her foot and she flinches as he begins numbing the toe. He pauses to utter an encouraging word and give instruction to Purdy. With each movement she squeezes her parents’ hands tighter and her eyes shut.

Karrh is focused on the task he’s done hundreds of times before, speaking slowly and deliberately to explain the procedure to everyone in the room. After a minute, he’s finished numbing the area. “The mistake some doctors make is to not let the anesthetic fully take effect. We’ll be back in 10 minutes. You won’t feel a thing,” Karrh says to Purdy and the patient, patting her foot gingerly. They leave the patient and her parents in the room, the girl’s eyes open now and her breath calming. She believes him.

Once the procedure is complete, Karrh and Purdy dress the area and give care instructions. The door opens. Shoe already back on her foot, the girl walks slowly out of the exam room. With a half-smile she looks up shyly and says, “that’s a good doctor right there. That’s a good doctor.”