Chapter 05: A Fellowship in Cardiology at Baylor University Medical Center, Dallas
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Description
In this chapter, Dr. Ewer discusses his fellowship in Cardiology at the Baylor University Medical Center (Dallas, Texas, 1975-1977).
He notes that he was very intrigued by the new cardiac ultrasound capabilities being developed (and set up the first echocardiogram progam? At MD Anderson). He explains that during his fellowship period, he was very focused on assessing the value of cardiac interventions, given that there was no data about how various interventions effected outcomes.
Identifier
EwerMS_01_20180524_C05
Publication Date
5-24-2018
City
Houston, Texas
Topics Covered
Professional Path; The Researcher; Professional Practice; The Professional at Work; Professional Path; Personal Background; The History of Health Care, Patient Care; Technology and R&D
Transcript
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
It certainly has not, no. So that was Pawtucket. And then there was an ad for the Baylor University Medical Center Cardiology Fellowship. And I looked at the ad, and I was so angry about it that I applied.
Tacey A. Rosolowski, PhD:
Why were you angry?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
It said, “Foreign graduates need not apply.” (laughter)
Tacey A. Rosolowski, PhD:
Okay... Contrarian again!
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
So I looked at that, and I wrote a very arrogant letter of inquiry, and said that if you are looking for somebody with an inquisitive mind who will move this field forward, then I suggest you take a closer look. And if you are so tunnel-visioned as to restrict capable candidates on the basis of their initial training, then perhaps it would clearly not be the right place for me to continue my education, and I look forward to hearing from you. And I got a call, “Come on down, we’d like to talk to you.” So I got hired, and I did my fellowship there.
Tacey A. Rosolowski, PhD:
That’s cool. Now, you hadn’t mentioned a growing interest in cardiology before this. How did that come about?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
In Rhode Island... (break in audio)
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Okay.
Tacey A. Rosolowski, PhD:
Okay, I just quickly paused.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Yeah. The new technology of cardiac ultrasound was just coming into play, and I found that fascinating. And so I got involved in that. (phone rings)
Tacey A. Rosolowski, PhD:
I’ll pause again.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
It’s all right. We will not be disturbed again.
Tacey A. Rosolowski, PhD:
Okay. So you were talking about the new cardiac ultrasound.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Yes, and this was able to see things that we couldn’t see before, and I had had an interest in electronics, and had an interest in this type of thing, and so I really got involved. I had translated a paper on very early ultrasound from one of my Swiss colleagues while I was there. We didn’t get to it, and it doesn’t matter, that some 60 years ago I became an amateur radio operator, and I still do that. But I was interested in electronics, and so here we had a new electronic technique, and how does that fit, and how does that merge with medicine. And so I became interested. I set up the first echo lab here.
Tacey A. Rosolowski, PhD:
Oh, really? I didn’t know that. Wow. So tell me about the training at Baylor. How did that work out?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
This was highly invasive, and I got to incorporate some of the techniques that I had learned as a medical student in surgery, and I was quite talented at it, and so we did lots of procedures, and the education was good, and I did the two-year fellowship.
Tacey A. Rosolowski, PhD:
Any high points for you, or kind of big learning moments that were key?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
It was very, very much focused on intervention. And I wondered whether intervention really was necessary to that extent. Again, it was how much of what we do is good. And it troubled me that we were doing so much, and was that really...? I mean, outcomes research hadn’t been invented yet, but this is just the way we deal now with coronary disease. If you have any irregularities, we bypass you. We do catheterizations. We quantitate it. We send you to the surgeons. And this was what was happening in ’75 to ’77.
Tacey A. Rosolowski, PhD:
Which were the years you were at Baylor.
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
Yeah.
Tacey A. Rosolowski, PhD:
Now, of course, what’s remained unspoken with you bringing up this idea of questioning the normal way of doing things, is this really the best way, is what is the impact this has on patients. And were you seeing certain results in patients who had gone through interventions that maybe you questioned whether they were necessary? What was happening on that human side?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
I’m not sure that I could see it. It wasn’t until years, or maybe decades, later that some of these things then got rethought, but much was happening. For instance, the deaths from stroke had shrunk tremendously. Were we actually doing the same thing with heart attacks, with all of these masses? We didn’t have the answers yet. But we certainly weren’t prospectively studying them. And so I wondered what are we really—do we know what we’re doing? Or are we simply poisoning the mosquitos in Africa with no other result as we create a better mosquito that’s resistant to DDT? What are we doing? And the answer was, “Well, you don’t like what we’re doing, go somewhere else.” But I finished the program there, and having all of that critical experience turned out to be extremely useful in my early years here.
Tacey A. Rosolowski, PhD:
Mm-hmm. Because that was your next move, pretty much, was coming here?
Michael S. Ewer, MD, MPH, JD, LLM, MBA:
And that was my next move.
Recommended Citation
Ewer, Michael S. MD and Rosolowski, Tacey A. PhD, "Chapter 05: A Fellowship in Cardiology at Baylor University Medical Center, Dallas" (2018). Interview Chapters. 807.
https://openworks.mdanderson.org/mchv_interviewchapters/807
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