Chapter 03: A Switch from Internal Medicine to Diagnostic Imaging (Never Losing the Internist’s Perspective)
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Description
Dr. Podoloff talks about how he switched from his original focus on being an internist, with an interest in psychiatry. Dr. Podoloff tells the story of joining the Air Force after his residency, an experience that tracked him into radiology. He was stationed at the Clinton-Sherman Air Force Base in Clinton, Oklahoma. Though interested in psychiatry, he explains, he changed specialties because radiology services were contracted to external providers. Dr. Podoloff then explains how he got into a residency program in diagnostic imaging at the Wilford Hall Medical Center at the Lackland Air Force Base in San Antonio,TX (’70-’73). There he became interested in nuclear medicine.
Next, as part of a discussion of the kind of cognitive work that characterizes nuclear medicine, Dr. Podoloff explains why the field is jokingly referred to as “unclear medicine.” He refers to an image (provided below) to illustrate the fuzzy images he had to interpret.
Identifier
PodoloffD_01_20150402_C03
Publication Date
4-2-2015
City
Houston, Texas
Interview Session
Tacey A. Rosolowski, PhD, Oral History Interview, April 02, 2015
Topics Covered
The Interview Subject's Story - Professional Path; Military Experience; Influences from People and Life Experiences; Personal Background; Overview; Evolution of Career; The Professional at Work; Professional Practice
Transcript
Donald A. Podoloff, MD:
I actually started out being an internist, not a radiologist.
Tacey A. Rosolowski, PhD:
Really? Wow.
Donald A. Podoloff, MD:
Yeah. And I—let’s see. What changed my mind was an experience that I had in the military. I graduated and finished my residency in internal medicine at the time of the Vietnam War. It was 1968 when I finished. And I was exempted from service because I qualified for something called the Fisk Plan, which was they’ll defer you until you finish your training, and then they’ll take you as a trained physician rather than a general medical officer. Sometime in the course of my medical residency I got very interested in psychiatry. And I did very well in psychiatry in school. I took it as an elective. I was very Freudian in my orientation about things. And once I got into the air force, I was in a very small base. You probably don’t remember the Vietnam War.
Tacey A. Rosolowski, PhD:
I do, actually.
Donald A. Podoloff, MD:
OK. This was a SAC base.
Tacey A. Rosolowski, PhD:
Just for the record, this was Lackland Air Force Base in San Antonio?
Donald A. Podoloff, MD:
No. It was actually Clinton-Sherman Air Force Base in Oklahoma.
Tacey A. Rosolowski, PhD:
Oh, OK. So I didn’t know. So what were the dates when you were there?
Donald A. Podoloff, MD:
From 1968 till 1969.
Tacey A. Rosolowski, PhD:
To ’69, OK, and the name of that base again?
Donald A. Podoloff, MD:
Clinton-Sherman.
Tacey A. Rosolowski, PhD:
Clinton-Sherman.
Donald A. Podoloff, MD:
In Clinton, Oklahoma, which is 147 miles due west of Oklahoma City.
Tacey A. Rosolowski, PhD:
Wow.
Donald A. Podoloff, MD:
It’s the cultural and artistic armpit of the United States. It was described that way to me by one of the guys that preceded me there, and it lived up to those expectations.
Tacey A. Rosolowski, PhD:
I think my dad would say that about Troy, New York. (laughter) I think there are many of those places.
Donald A. Podoloff, MD:
The first encounter we had at the base going in, they stopped you, you have to produce credentials, why you’re here. And the guard says to me, “Do you have children?” I said, “No.” He said, “You will before you leave here, there’s nothing else to do.”
Tacey A. Rosolowski, PhD:
(laughter) That’s quite the welcome.
Donald A. Podoloff, MD:
And he was right.
Tacey A. Rosolowski, PhD:
So you were married at the time.
Donald A. Podoloff, MD:
Yeah.
Tacey A. Rosolowski, PhD:
And when did you get married, just to put that into the record?
Donald A. Podoloff, MD:
Let’s see. We’ll be married fifty years this coming January, so 1966 I guess.
Tacey A. Rosolowski, PhD:
Wow. All right. And your wife’s name?
Donald A. Podoloff, MD:
Mary Ellen, two words.
Tacey A. Rosolowski, PhD:
All right, great. So you were telling me about this mind-changing experience that you had there.
Donald A. Podoloff, MD:
Yeah. So while I was at this small base in Oklahoma, the way the war was arranged, as you know it was politically unpopular. Well, one of the ways that the government kept the troop count down is they sent people on TDYs, temporary duty assignments. If you were gone from your base overseas for 179 days, it didn’t count as an overseas assignment.
Tacey A. Rosolowski, PhD:
Oh my God.
Donald A. Podoloff, MD:
So the wing would go away for six months, all the men. It left all the women on the base. And they came in with their various internal medicine complaints which were all psychiatric pretty much. And I started to—I was very good at that. And so I got more and more patients. And I hated it. I was sitting there listening to people—I guess my grandmother would say kvetching, although—and about the same time the base was being serviced by some radiologists from Oklahoma University. So once a week they would come out and they would read the X-rays. And it was costing the government and the base about $50,000, $60,000 a year to pay for this. And they decided they wanted to go to $80,000. One of the sergeants, a master sergeant—who actually run the air force as you know probably—
Tacey A. Rosolowski, PhD:
I didn’t know that.
Donald A. Podoloff, MD:
Yeah, they run the—those top sergeants run everything. So he looked the regulation up. And it said an isolated base that has a board-certified radiologist can make that person the temporary base radiologist with six weeks of training. So my commanding officer armed with that knowledge calls me in. He said, “Don, how would you like to do the radiology out here for the rest of your tenure?” And I said, “Well, not really. I’m going to be a cardiologist when I get back, and I’m not going to stay in the service.” He said, “OK, well, how would you like to go to Vietnam?” I said, “Radiology looks very good.” So that’s how I became the base radiologist.
Tacey A. Rosolowski, PhD:
(laughter) Interesting.
Donald A. Podoloff, MD:
And when I was mentored—this is the time when we wore fluoroscopic glasses and all the things that—the residents if I tell them the story now laugh at me like I was from the twelfth century. The people who were at the University of Oklahoma were very very good teachers. And they taught me. And I liked. And one of the particular people was a board-certified internist, a gastroenterologist, who was also a radiologist. Bingo, that’s what I want to do. So there were six slots available for the entire residency program the year I applied. And I guess because I had internal medicine background they chose me. And so I became a radiologist at Wilford Hall and that’s where I trained. And as things happen in the service, I got interested in nuclear medicine, again something I was very good at during my residency, I think because it was quite cognitive, not necessarily as visual.
Tacey A. Rosolowski, PhD:
How would you describe that difference? What do you mean it’s very cognitive?
Donald A. Podoloff, MD:
Well, nuclear medicine is called by many people unclear medicine, because the information content of the scans, because you’re using radiation, can’t give too much. So it’s not like a full developed X-ray. It looks like a blob. So that’s what I was going to do. I was going to do nuclear medicine. And that required a fellowship.
Tacey A. Rosolowski, PhD:
I’m sorry. Can I just stop you? Because I’m really interested in this. You said the information comes in and it looks like a blob. So the cognitive part is that you have to know how to sort that out and make a mental picture of it?
Donald A. Podoloff, MD:
Yeah. Exactly.
Tacey A. Rosolowski, PhD:
OK.
Donald A. Podoloff, MD:
I think I can probably demonstrate it for you better than I can explain it. So let me find a scan.
Tacey A. Rosolowski, PhD:
And actually it’d be really cool if I can put images into your transcript. And so if you want to provide me with a copy of whatever you’re talking about, then whoever’s listening to your interview, reading your transcript, can follow along. That would be neat.
Donald A. Podoloff, MD:
OK. So here’s a good example. That’s what a PET scan looks like.
Tacey A. Rosolowski, PhD:
OK, yeah, it does look like a blob with a little bright spot of light in it. Dr. Podoloff’s Caption for the image to the left: Whole body PET, 2 PET, 3 CT and 4 PET/CT fusion images of a patient with mediastinal lymphoma. This scan is in Dr. Podoloff’s materials as Podoloff Scan 1.
Donald A. Podoloff, MD:
It actually happens to be a big tumor.
Tacey A. Rosolowski, PhD:
OK.
Donald A. Podoloff, MD:
When you put it together with the CT scan now you’ve got some anatomic landmarks and you can see what—but that’s what I meant.
Tacey A. Rosolowski, PhD:
I see. I got it.
Donald A. Podoloff, MD:
So anyhow, and because of my internal medicine background, nuclear medicine, that was one of the pathways into nuclear medicine back then. You could either do it as a pathologist, a radiologist, or an internist. So I took another residency. And because the service is the service and things get strange, I ended up the day after I finished my residency being the head of nuclear medicine at Wilford Hall.
Tacey A. Rosolowski, PhD:
Wow.
Recommended Citation
Podoloff, Donald A. PhD and Rosolowski, Tacey A. PhD, "Chapter 03: A Switch from Internal Medicine to Diagnostic Imaging (Never Losing the Internist’s Perspective)" (2015). Interview Chapters. 731.
https://openworks.mdanderson.org/mchv_interviewchapters/731
Conditions Governing Access
Open
