Chapter 14: Final Comments

Chapter 14: Final Comments

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Description

Dr. Ewer begins this chapter by looking back at the impact he feels he has had on the institution. He notes that he wishes he could have had more of an impact on young faculty in cardiology, helping them to think outside of the box in the ways that are essential to address cardiac issues in cancer patients. He notes that he is currently working on a case study of basal cell carcinoma. At the end of the session, he comments on the profession of oncology.

Identifier

EwerMS_02_20180725_C14

Publication Date

7-25-2018

City

Houston, Texas

Topics Covered

Overview; The Researcher; Contributions

Transcript

Tacey A. Rosolowski, PhD:

Do you have retirement plans?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I did.

Tacey A. Rosolowski, PhD:

You did, or you do?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I did.

Tacey A. Rosolowski, PhD:

You did. And you’ve forgotten all about them, or...? (laughs)

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I had some issues, and Dr. Burke suggested that this might be a time to lock in my pension, so I went to 20%.

Tacey A. Rosolowski, PhD:

Okay. And when did you go to 20%?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

That’s five years ago. And then last year I said, “You know, I’m reading all these cardiograms. I’m here every day. And you need to up me to 40%.” So they upped me to 40%, so I’m now 40%. Looking back, it was probably one of the worst decisions I ever made, because the problems that I had resolved—and I’m fine, and I’m fit, and I still fly my airplane, and I still gallivant all over the world—August may be the first month in the last six months that I haven’t made a trip to Europe, giving a lecture. I do a lot of lectures.

Tacey A. Rosolowski, PhD:

Yeah, it sounds like it.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Yeah, and I can still stand up in front of a thousand people and give a talk, and have it well received.

Tacey A. Rosolowski, PhD:

It seems like you really enjoy teaching.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Oh, I enjoy... I enjoy my various roles in healthcare. Always have.

Tacey A. Rosolowski, PhD:

Is there one you enjoy more than others, or is it really renaissance, I like it all?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I’ve had to reinvent myself so many times. I think it’s all.

Tacey A. Rosolowski, PhD:

You’ve used that phrase a number of times today, “reinventing yourself,” and is that—

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Well, I started out—I came here as a cardiologist. Nobody was doing critical care. Nobody wanted to. So I became the critical care person. Did that for 15 years. Then I was the ethics person. Then I was the conflict of interest person. Then I was the special assistant person. Then I was the advocate. And now I’m being turned down. They turned me down for the ombudsman recently.

Tacey A. Rosolowski, PhD:

Really?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I don’t know why they turned me down for that. That would’ve been a perfect fit. The institution does what they want.

Tacey A. Rosolowski, PhD:

It does. So do you have a plan for how you’re going to reinvent yourself next?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I have to see what happens down in those [offices?]. Maybe I don’t need to. And if I do, I will. If they’ll let me stay, I’ll find something to do that will be worthwhile.

Tacey A. Rosolowski, PhD:

Interesting. If not?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Then I will find something to do that is not worthwhile. (laughter)

Tacey A. Rosolowski, PhD:

So tell me: as you kind of look back, what’s kind of, “Yeah, I did that, and I’m really glad,” in the institution?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I’m really glad I influenced ethics. I’m really glad I influenced critical care. I wish I could’ve influenced cardiology more, but never had the chance to be the department chair there, although I think I could’ve done that very, very well, and given it direction.

Tacey A. Rosolowski, PhD:

What would you have done?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I would have stimulated our junior faculty to think outside of the box, because our cancer patients exist outside of the box. Cardiologists are trained in cardiology centers, and for them, chest pain is ischemic heart disease, and it needs to be dealt with quickly, and it needs to be revascularized, and it needs to be supported. Here, the chest pain may well be a complication of chemotherapy. It may be other things. To think that our population is the same as Saint Luke’s population is a misconception. So I would have encouraged them earlier—I mean, eventually they get it, but it takes them too long to get it. And there’s no push and drive to get it, that you have to think in broader terms. And even things like criteria may need to be rethought in the context of the Cancer Center. Would you like an example?

Tacey A. Rosolowski, PhD:

Sure.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

If you have a cardiogram, and at Saint Luke’s that cardiogram has a 90% chance of being a heart attack, and you look at our population and you see similar changes on the cardiogram, and there’s only a 10% chance that it’s a heart attack, the criteria for defining a heart attack is based on what Saint Luke’s sees, and not what we see. Should we be using the same criteria if our likelihood of having a heart attack is much smaller? We don’t have answers. We don’t want to miss the occasional heart attack, but we also don’t want to give blood thinners into somebody who has cancer and has brain metastases that can bleed if we’re dealing with something that maybe a little bit of prudence will sort out, but that prudence may conflict against guidelines in other centers. It is not just the seed; it’s the soil. And that balance does not come intuitively to some of our new faculty.

Tacey A. Rosolowski, PhD:

Interesting. Do you feel that you were able to successfully bring that thinking out of the box perspective to your other work, in ethics and advocacy and conflict of interest?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Absolutely, but whether it’s appreciated or not is totally another question, (laughter) and in some instances it is, but in many instances it is perceived as querulence, arrogance, and other things. It takes a while before somebody says, “Yeah, he was really right.” (laughter)

Tacey A. Rosolowski, PhD:

Yeah. Well, a new perspective often takes a while to absorb and digest.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Yeah. I mean, I’m not Semmelweis.

Tacey A. Rosolowski, PhD:

You’re not...?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Semmelweis. You know about Semmelweis.

Tacey A. Rosolowski, PhD:

Well, explain for that... Because I’m sure...

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Semmelweis was the person—I’m not sure exactly where he was, whether it was Prague—maybe Prague. To be looked up and corrected. (laughter) But new mommies were dying. They were dropping dead. And it wasn’t such a big problem when they were midwives, but when the doctors got involved these women just died of horrible infections. And he said, “Maybe if we wash our hands between the autopsy table and the delivery room this wouldn’t happen.” Wound up in an insane asylum, where they actually, I believe, beat him to death.

Tacey A. Rosolowski, PhD:

Believing in invisible things.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

I’m sorry?

Tacey A. Rosolowski, PhD:

Believing in the possibility of invisible things. (laughs)

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Anything that I brought wasn’t anywhere near that, but one thinks out of a box, and it has, in some instances, been stifled. I had a wonderful paper that looked at the possibility that basal cell carcinoma could be suppressed with an antibiotic. And the chairman of Medicine forbade me to publish that. It was accepted by a journal, and he made me pull it back. He said, “No, that’s too anecdotal.” Well, it was a case report; it’s supposed to be anecdotal. But it was very, very important. Now everybody knows that that’s a possibility, but this is 30 years ago, and I had the idea and couldn’t get it. So thinking out of the box was not universally always appreciated.

Tacey A. Rosolowski, PhD:

Well, I think I’m at the end of my questions. Is there anything else that you would like to add?

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Let’s see what tomorrow brings. (laughter) I may have to find a way to reinvent myself.

Tacey A. Rosolowski, PhD:

Reinvent yourself. Well, that’s exciting. Every day can be a new adventure when that’s your MO.

Michael S. Ewer, MD, MPH, JD, LLM, MBA:

Every day is a new adventure. Every patient is different. Every concept is different. I mean, it’s been a wonderful profession, and I’m still on the periphery, trying to help people see, help myself see. As all of our VPs that I have had the privilege of working under have said, you try to do the right thing. Sometimes trying to do the right thing is very difficult in a politically-charged, commerce-driven industry, instead of a philanthropic desire of helping the needy without considerations for other things. We can’t do it anymore. But we need to not give up hope.

Tacey A. Rosolowski, PhD:

And we want to thank you for a fascinating conversation. (laughter) And I’m turning off the recorder at 11:50.

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Chapter 14: Final Comments

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