Chapter 03: Specializing in Diagnostic Imaging [Part 1]

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Chapter 03: Specializing in Diagnostic Imaging [Part 1]

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Dr. Hicks begins by noting that he realized that “the diagnostic dilemma would be solved by imaging” while he was interning in general surgery at Memorial University Medical Center in Savannah, Georgia (1982 – 1983). This prompted him to undertake his clinical residency in radiology at the Indiana University Medical Center (Indianapolis, 1983-1986). He describes how imaging was used to enhance the surgical perspective and also comments on how the entire practice of medicine was changing at that time.

Identifier

HicksM_01_20180417_C03

Publication Date

4-17-2018

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; Character, Values, Beliefs, Talents; Professional Path; Formative Experiences; Discovery, Creativity and Innovation; Professional Practice; The Professional at Work; Technology and R&D; The History of Health Care, Patient Care; Understanding Cancer, the History of Science, Cancer Research

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Marshall Hicks, MD:

Yeah. So that’s something that I began to understand how important that was. But yeah, that’s what I thought I was doing to do. I was going to go away for five years and come back to some small town in Kentucky.

T. A. Rosolowski, PhD:

So what happened?

Marshall Hicks, MD:

Imaging. I got into the surgery and realized that the diagnostic dilemma was being solved by imaging. And more and more it was going to be solved by imaging. At that point, a lot of the surgery was, I don’t want to say a technical exercise, but it was something where the challenge was certainly in doing the surgery well but also in the diagnosis, and that that’s really where it triaged where the patient—what happened after that. It was a critical point, just like the lineups in pathology, so I got very interested. It was also, personally, it was not a very good experience there. At the time it was a very—Savannah was a very closed society, let’s just say it that way. If you’re not from there it was a challenge. Even though I always thought I was a southerner from Kentucky, not in the Deep South, you’re a Yankee.

T. A. Rosolowski, PhD:

Oh really, you were considered a Yankee?

Marshall Hicks, MD:

Oh yeah, yeah.

T. A. Rosolowski, PhD:

Oh that’s amazing. I actually spent some time at the Medical College of Georgia and I’m from New York State, and that was the first time I ever realized that there was a difference between North and South, and people mapped the world in that way, and it was very culturally, a real eye-opener for me.

Marshall Hicks, MD:

Yeah, it was amazing. It was good training, I liked that aspect of it, but I just, I didn’t feel comfortable there and I just also was getting attracted to the imaging side, where it’s like I need to switch, and I was fortunate to be able to get into Indiana University, which had a very good radiology program and it was a four-year program. Most of the programs at that time were three years after your internship. Indiana was unique but I thought it was a good enough program. Your last year there you—it was sort of like a fellowship, they didn’t really have a lot of fellowships then, so it was sort of like a fellowship, you could do one thing the whole year, so you could get really good at one thing before you left Indiana.

T. A. Rosolowski, PhD:

And let me just say for the record, because I don’t think we mentioned, the clinical internship you did in general surgery was 1982 to ’83.

Marshall Hicks, MD:

Eighty-three, correct.

T. A. Rosolowski, PhD:

Memorial University Medical Center in Savannah, Georgia. Just so we got that on the recorder.

Marshall Hicks, MD:

I loved living there, it’s a beautiful area of the country, took one of my board exams over at—where is MCG, is it—it’s Augusta, right?

T. A. Rosolowski, PhD:

Augusta, Georgia, yeah.

Marshall Hicks, MD:

I went over there with some friends. It was a good year of experience. I couldn’t see myself—the reality was, everything was becoming so specialized, and I tried to think about orthopedics or cardiovascular. It was a combination of those things. I just couldn’t really get excited about any of the surgical subspecialties, and yet it was pretty clear that that’s the way things were going, general surgery was going to be very few things. And then I got my eyes opened to sort of the imaging aspects. I had a patient come in in the middle of the night, had a bowel obstruction and we thought he had a twisted bowel, volvulus. It turns out he had a cancer and it was diagnosed, so it’s a very different approach to how you’re going to treat it. Knowing that going in was incredibly helpful because it’s a different operation. So that’s when I realized this is really important and this is really a field that’s opening up.

T. A. Rosolowski, PhD:

Was that a new thought for you, to think of yourself as a diagnostician in that way? Was that kind of a new oh, I didn’t know my brain worked that way?

Marshall Hicks, MD:

Yeah, yeah I think so. I think the whole medicine was changing because up until then, it was plain films and ultrasound was crude, CT was just starting to be widely used clinically. There was barium studies or GI studies and things, so still a lot of information you got indirectly from the imaging. When CT started to come out, you could actually see the structures and define it and figure out what really was going wrong, as opposed to like with a—you do an upper GI, where you put barium in and you see the stomach is pushed by something, and so you know there’s something there but you don’t know what it is or where it’s coming from. With CT you can actually define it and see where it is, so some of these indirect findings, which were a challenge, became much more clear with the cross-sectional imaging.

Chapter 03: Specializing in Diagnostic Imaging [Part 1]

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