Chapter 02: Appreciation for Surgeons and Surgery in Collaboration with Radiology

Chapter 02: Appreciation for Surgeons and Surgery in Collaboration with Radiology



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Dr. Cox talks about the people who were major influences on him, his reflections on leading physicians at MD Anderson, and how surgeons often interacted with radiation oncologists.



Publication Date



Houston, Texas

Topics Covered

The Interview Subject's Story - Overview; Portraits; Mentoring; On Mentoring; MD Anderson Culture; Influences from People and Life Experiences; The History of Health Care, Patient Care; The MD Anderson Brand, Reputation; Multi-disciplinary Approaches


Lesley W. Brunet, CA

Were there other people during your medical school and postgraduate work that were large influences the way he was?

James D. Cox, MD

I think Charles Sherman, a surgeon who kind of opened the door to these various cancer hospitals, also was a good example of a cancer surgeon. He was trained at Memorial Hospital in New York and was a really good cancer surgeon, gave me my first understanding of the difference between cancer surgery and general surgery as it was practiced around the world. The general surgeons learned an operation and applied it, and the people who were really trained in cancer surgery sort of understood the disease and went after it in whatever manifestation it had. So they were very skilled and very, very able to do things. To this day, I have such enormous respect for cancer surgery. One of my greatest, most delightful experiences in coming to MD Anderson was I had not appreciated how terrific the cancer surgery was. I should have known, but I just didn’t appreciate fully how good the surgery was here until I came in 1988. It’s fantastic.

Lesley W. Brunet, CA

It seemed unusual, when I started researching you, that you worked so closely with surgery. I was a little surprised by it, and among your accomplishments was the way surgery had been raised to a certain level. I’m looking for my quote. “Surgery has achieved academic stature without peer.” And you’d only been here for a couple years, and you had contributed to that.

James D. Cox, MD


Lesley W. Brunet, CA

I don’t remember seeing that about [Gilbert H.] Fletcher. Let’s put it that way.

James D. Cox, MD

Fletcher worked very closely and wonderfully with the surgeons. I mean, what he did, actually, he fought them, he and Bill [William S.] MacComb. MacComb was trained at Memorial also, in an era where there were phenomenal cancer surgeons that were trained in the late, late thirties, except possibly for the Mayo Clinic, but for cancer per se there was no training ground like the Memorial Hospital of New York. The surgeons, they didn’t know anything about radiation oncology, so they were really naïve and they were often super opinionated and they thought surgery was the only thing. But they were really skilled, and once they did learn about good practice of radiotherapy, they became real converts. So over time, Fletcher was ornery and MacComb was ornery, and they fought each other and gradually came to working together. Then when Dick [Richard H.] Jesse succeeded MacComb, he and Fletcher worked wonderfully together and set the example, in fact, for multidisciplinary collaboration that has been the example for the institution ever since. The other person, of course, was Felix [N.] Rutledge, who worked with Fletcher, and that combination was incredibly successful. So GYN and Head and Neck have always been the examples of multidisciplinary care in the institution. Then with Eleanor Montague and Norah [D.] Tapley and the people who interacted with especially the breast cancer team—and Fletcher was involved with that as well—there was the sort of general surgery or breast cancer surgery part of it as well.

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Chapter 02: Appreciation for Surgeons and Surgery in Collaboration with Radiology