Chicago native Dr. Paul Fletcher arrived in Selby Flats, California, in 1956 to work in Cedars Hospital. Described by Bert Bauer as a "sour apple", Paul even admitted himself that he didn't like people much. Though many were put off by blunt style, some people appreciated his directness and he made a name for himself at Cedars in 1957.

His honest treatment of teenaged Robin Lang and Bert's terminally ill stepfather, Albert Franklin, won him the friendship and respect of many, especially the Bauers. He also developed a rivalry and friendship with Dr. Dick Grant, whom he shared a practice with. By 1958, with Dick absent so often working, Paul formed a close, platonic friendship with Dick's wife, Marie, and began to open up to her about his past. He told Marie that his father had died before he was born (or so he thought), and he'd spent his entire life looking for a father figure. Soon, Dick and Paul were at odds over Dick's ongoing neglect of Marie. They were also at odds over the treatment of Dick's ex-wife, Kathy Roberts. Though Dick recommended that Kathy undergo surgery on her legs, Paul knew that Kathy had only one chance in a thousand of walking again and accused Dick of offering her false hope. Kathy and Robin (her daughter) were more comfortable with Paul's direct approach than Robin's husband, Mark Holden, was. Mark was also not happy that Robin had latched on to Paul as a father figure, and he blamed Paul for widening the gap between him and Robin. Soon after Kathy's tragic death, Paul found himself being contacted by a woman he wanted nothing to do with--Marian Winters. Disgusted, Paul wrote back forbidding her from ever contacting her again. Undaunted, Marian came to Selby Flats, got a job at Cedars and finally confronted Paul--her son! That's when the truth about Paul was revealed. Born Paul Winters, Paul was told his entire life that his father was dead, Paul became suspicious, though, when he found Marian's love letters to a man named Fred Fletcher. He confronted Marian who was forced to admit that he was indeed the illegitimate son of her and Fred Fletcher. Disgusted, Paul lashed out at his mother and changed his name to Paul Fletcher. Now in the present, Paul's anger still hadn't diminished and he told his mother that he wished he'd been put up for adoption because now he considered himself a nobody. Filled with hatred for his mother, Paul prepared to move to New York to get away from her.

Before departing for New York, Paul was sidestepped by his patient Anne Benedict. Anne, who was wealthy and spoiled, but incredibly charming, had been raised in San Francisco where her parents, Henry and Helene, were country club cronies of Richard and Laura Grant's. When Anne took a turn for the worse and was diagnosed with endocarditis, Paul saved her life and then decided to stay to oversee her recovery. Reluctantly, Paul allowed Marian to be Anne's private nurse because of her past experience (of being a nurse in Chicago), but he was not pleased to see nurse and patient become friendly -- after all, Marian and Paul had not told anyone at Cedars that they were mother and son. Soon after, Anne's parents arrived in town along with Anne's fiancé, Tom Sloane. Paul instantly became antagonistic toward Tom, who was to the manner born. Indeed, Paul and Anne were finding themselves very attracted to each other. To the horror of Henry, a nouveau riche snob, Anne broke her engagement to Tom and agreed to marry Paul. News of Paul and Anne's engagement reached San Francisco and caught the eye of Fred in Santa Clara. Fred was a widower with a daughter, Jane, and he thought Paul bore an uncanny resemblance to the son he had lost in the Korean War.

Suspecting that they were related, Fred wrote Paul a letter, which Paul promptly tore up. Anne innocently mentioned this to Marian as well as to her parents. On the sly, Henry went to Chicago to investigate Paul's past, then visited Fred in Santa Clara but was cagey about his purpose. Ashamed to tell Anne he was illegitimate, and feeling his past was closing in on him, Paul asked her to elope. At the same time, suspicious of Henry, Fred came to town, looked up Marian and told her about Henry's visit. She admitted to Fred that Paul was his son. Marian explained that by the time she found out she was pregnant, Fred had already decided to go back to his wife and children, and she felt she had no right to break up his family. In time, Paul established a relationship with Fred and apologized to Marian for being ashamed of both her and himself. Henry also apologized to Paul and went back to San Francisco with Helene, while Marian married Paul's friend, a pharmacist named John Lipsey. At last, Paul was able to accept who he was and he and Anne married in 1959. Not long after, Paul was again thrown into the life of his teenaged patient Robin after she suffered pneumonia after standing out in a rainstorm. Paul placed the blame squarely on Meta Bauer for having fed Robin's fantasies about a reconciliation between Meta and Mark. For once, both Bert and Mark agreed with Paul, and the three angrily told Meta to get on with her life. In 1960, Paul rejoiced when Anne bore him a son, John.

In 1961, Dick swore Paul to secrecy when he separated from Marie. Dick was angling to replace the retiring Dr. Ainsley as chief of staff and knew that a failing marriage would make him vulnerable to public attack. Paul urged Dick to come clean; instead, Dick asked Marie to return. Knowing Dick wanted her back only to keep up appearances, Marie refused. When Ainsley found out the truth, he offered Paul the position instead. Paul made no secret of his disinterest in the job but accepted it under pressure from the status-conscious Anne. In 1962, Doris Crandall, arrived from San Francisco with her young son with Alex, Carter, in hopes of winning her ex-husband, Alex Bowden back. Alex asked his cynical lawyer pal, George Hayes, to pay her to get rid of her, but Doris wouldn't accept the money. While renewing a prescription for her medication, Doris consulted Paul and the two formed an instant rapport. Paul hired Doris to be his receptionist, much to the consternation of Anne, who considered Doris a deadbeat drunk. Anne was horrified further when Paul resigned his chief of staff post at Cedars to open a clinic in an impoverished, often violent, neighborhood. Even worse, Paul insisted they move into a house next door to the clinic.

In the meantime, Paul's friend, Bert, consulted Paul about a virus. Appalled that she hadn't had an exam for 14 years, Paul ran a full examination, including a pap smear and learned that Bert was in the early stages of uterine cancer. Happily, her surgery was successful. Meanwhile, months later, Alex recognized that his loveless marriage to Robin was on the rocks, so he started looking in the direction of Doris, who, much to the pleasant surprise of everyone around her, was showing signs of becoming a strong and independent woman. Bert admired Doris's character and became a close friend. Even Anne discovered that they had a great deal in common. Like Anne, Doris came from a finishing school background and had the same understated "old money" tastes. Unfortunately, a friendship between the two was not to be, much to the dismay of Paul. The pressure on Paul was becoming unbearable since because of his poor patients' inability to pay their medical bills, his clinic was failing. To maximize his chances of getting at least a few solvent patients, Paul worked virtually around the clock. During his few off-hours, Anne bombarded him with complaints that she was unable to afford new clothes, and she hounded him to give up the clinic in favor of a lucrative job

back at Cedars. Anne had a potent ally in her father Henry who was spending more time in town due to various business commitments. Henry was horrified by the gang violence that was erupting in the clinic's neighborhood and convinced his darling girl to get a gun for her own protection. Unfortunately Joe Turino overheard the discussion between Henry and his daughter, secretly stole the Anne's gun and gave it to Doris for protection in the hopes that Doris would use it to kill Joe's rivals, Alex and George Hayes. At the same time, Paul had to contend with the arrival of his half-sister, Jane. Meanwhile, in her determination to save Paul's clinic, Doris convinced Alex to invest heavily in the facility. Anne was livid at this development and served Paul with an ultimatum: the clinic or their marriage. She prevailed upon Robin to change Alex's mind about the loan, insidiously implying that the business deal was evidence of a renewed bond between Alex and Doris. Anne and Robin lashed into Doris so brutally that Doris went on a bender. When Doris finally resurfaced back at the clinic, she got a hold of Anne's gun and threatened suicide. In an effort to retrieve the gun, Paul grappled with Doris. The gun went off and the bullet hit Anne who died on the operating table. Full of self-recrimination, Paul impulsively confessed to killing his wife. His chances of acquittal looked dismal because Doris had blocked out the tragic event, and Henry was snidely feeding the prosecution's case against his son-in-law. Luckily, George Hayes mounted a brilliant criminal defense. Later, Doris's memory finally returned, and she testified that Anne's shooting was accidental. Soon after, Doris left town to raise Carter on her own and moved back to San Francisco.

In 1963, a grieving Paul was glad when his clinic was expanded with the money from Alex who felt partly responsible for Anne's death. About this time, Jane, who was without a roommate, moved in with Paul to take care of Johnny. Meanwhile, Paul was beginning to look at Robin, who had become Paul's secretary after Anne's death, for the first time as a woman. Jane was quick to pick up on the growing attraction between Paul and Robin, and she didn't like it one bit. Jane sought refuge with Paul and Johnny to the point where she was beginning to look at her brother and nephew more as a husband and son. With uncanny precision, this would-be spinster infected little Johnny with her twisted mind. By 1964, Paul and Robin announced plans to marry. Johnny was convinced that he was losing his father to an evil woman who had set out to take his mother's place -- all thanks to Auntie Dearest, Jane. Henry, too, started feeding his preteen grandson ideas that he should be in protest of his father's relationship with Robin. Johnny became quite the little tyrant. Helene tried to convince Johnny to accept Paul and Robin's engagement, but Henry and Jane kept indulging the boy. Buckling under the child's pressure, Robin called off her engagement to Paul and went to New York. George eventually tracked her down and innocently left her address with Jane while Paul went to fetch his lady love. Salivating at this golden opportunity to wreak more havoc, Jane called Robin and tipped her off that Paul was on his way, adding that she thought she did the right thing by leaving him. Robin eluded Paul, but he caught up with her and they married secretly in New York. The newlyweds led separated lives, for a while, until Robin accompanied Paul to a medical convention.

In 1965, when Jane called Paul's hotel to tell him that Johnny was having problems at school, the desk clerk told her that Paul was with "Mrs. Fletcher." Devastated, Jane told Johnny that his daddy had lied to them and Johnny ran away. When he turned up later at the Children's Zoo, the boy not only rejected Paul and Robin, but added his aunt Jane to his list. Johnny stayed briefly with his grandparents in San Francisco and returned home to Paul at Helen's firm insistence. Determined to salvage both his marriage and his relationship with his son, Paul angrily ordered Jane out of his home and his life! Later however, Paul and Robin forgave Jane after she married George and gave birth to Amy. Meanwhile, Johnny was so insolent to Robin that Paul reluctantly allowed him to go back to his grandparents for an extended stay. In 1966, after Paul learned that Helene had been killed in a car accident, he and Robin moved to the Midwestern town of Springfield, so that Paul could accept the position of chief-of-staff at the Cedars' branch hospital in that town. Johnny came to Springfield when he turned seventeen; Paul felt that Johnny was an anomaly to him. Johnny was now an insufferably snobbish, preppy golf maven in the mold of Henry and Paul had trouble getting Johnny to see the wiseness of attending the public school, Springfield High, in his senior year. Afterwards, tragedy struck when Robin miscarried her child while cleaning Johnny's room. Distressed at the loss of their child, Paul was further distressed to ldiscover that Robin blamed Johnny for it. Knowing that Johnny was trying to be nice to Robin, Paul found her attitude very immature and selfish. Soon the couple began arguing constantly and, in 1967, Paul kept spending more and more time at Cedars in the company of his old friend, Sara McIntyre. Though he tried to convince a continually depressed Robin that his relationship with Sara was platonic, the jealousy got the best of her and she committed suicide by throwing herself in front of an incoming car.

After Robin's death, a grieving Paul led a secluded life, but still continued to support the people who needed him. When Johnny turned 19-years-old, he wanted to marry Peggy Scott. Johnny knew that once he turned 25, he stood to inherit $3 million from Henry. Desperate to marry Peggy, Johnny asked his father and grandfather to advance him the money. Paul thought Johnny was much too young to marry and was relieved and pleasantly surprised when Henry said no to Johnny as well. Despite Henry's refusal, Johnny decided to run off with Peggy Peggy anyway. When Peggy's father, Ben Scott, learned of their plans in early 1968, he got into an argument with Johnny that resulted in his having a massive heart attack and dying. Not long after, Peggy's mother died while being operated on by Ed Bauer. Deeply disturbed by the death of her parents, Peggy broke up with Johnny and embarked on a nursing career. When Peggy married Marty Dillman, an upset Johnny married Tracey Delmar, until he learned that Tracey was actually a con woman named Charlotte Waring. Finally, in 1969, Johnny and Peggy were able to marry, this time with Paul's blessing. In 1970, Paul left Springfield to take a job in Washington DC. Though Johnny tried to become a well-respected doctor like his father, the pressure became too much and he had a nervous breakdown in 1971. Johnny was hospitalized and later left Springfield to "find himself" and that was the last anyone heard about the Fletchers.