Giants Among Us

Gary Baldwin, for HealthLeaders News , June 26, 2007

From time to time, I'll dedicate a column to one or more of the people I have recently interviewed that made an indelible impression. The healthcare field is fortunate to have so many intelligent, dedicated people who have the ability to heal, lead and inspire. When I get off the phone with these people, I invariably feel uplifted, grateful for the opportunity to spend one-on-one time with them.

These encounters can transform what can become, for cynical reporters, the hum-drum experience of information gathering. For me, there is nothing more rewarding than being able to highlight the work--and ideas--of the true thought leaders. In reporting this month's HealthLeaders feature on intra-operative MRI technology, I encountered two such leaders. I call them "giants among us."

David Donahue, M.D., director of neurosurgery, Cook Children's Medical Center, Forth Worth, TX. Using marvelous metaphors, he described the difficulty of doing brain surgery on his young patients. "It's like using a 9-iron to drive a golf ball off your daughter's nose, and trying to hit it as far as you can," he told me. "You have misgivings about swinging too hard. That's what brain surgery is like. You want to know how to safely remove a tumor and you need to know the best trajectory."

Can you imagine it? Performing brain tumor resection on children? Their very lives are in your hands. It takes enormous skill to practice medicine in any specialty. I have observed, however, that surgeons are a different breed. Back in my days at the local medical society, the internal medicine docs liked to joke that surgeons were the "find it and fix it" physicians. But all the while you could hear the respect in their voice.

If anything, Donahue was modest in his accomplishments. He allowed how locating a tumor can vex even the most experienced neurosurgeon. It is why Cook Children's has deployed the iMRI--to give surgeons some real-time guidance during their difficult procedures. Using the iMRI gives patients a much better chance of not returning for additional surgery.

To be sure, Donahue is no Pollyanna about advanced technology. He cautioned how hospitals can get in over their heads if they delve into technology purely for the sake of technology, or because a wealthy donor sponsored a program. But the University of Tennessee-trained neurosurgeon also appreciates the tools at his disposal. "This is a phenomenal time to be practicing medicine," he said.

John Huston, III, M.D., professor of radiology, Mayo Clinic College of Medicine. Huston described how Mayo planned for its recent implementation of iMRI technology. Throughout the interview, he could express how complex technology works in a way understandable to the non-clinician. In his measured, professional cadence, Huston explained how Mayo waited on this technology (which has been available for over a decade) until it could be certain that patient safety issues were resolved. Huston went on to explain some of the complex procedures that the surgeons at Mayo perform using iMRI technology.

Mayo uses its iMRI unit during brain tumor procedures and during placement of deep brain stimulators, a technique used to treat Parkinson's disease. But the radiologist was quick to point out that it is the surgeons who are the experts here, not the radiologists. He was quick to deflect credit to others at Mayo, ticking off the names of his colleagues who brought the technology to life.

It is heartening to know that the educators of tomorrow's physicians impart such a collegial philosophy. We hear so much about healthcare's financial woes, it is easy to overlook the art and science of medicine that makes the entire industry possible.

Mayo's Web site has a nice graphic displaying its iMRI set-up. Huston patiently and calmly explained to me the intricacies of all this technology. Introducing magnetic resonance in the surgical suite requires teamwork, and figuring out the logistics of the room was not simple. Mayo's effort was two years in the planning, and its iMRI went into action early this year.

Like Donahue, Huston tempers his passion for technology with pragmatism. "Medical care cannot just be about adopting one new technical advance without proving it is improving care," he told me.

After the interviews, I envisioned my dream team if I ever need brain surgery (to insert a new one, maybe). I'd want Dr. Donahue doing the cutting and Dr. Huston reading the scans. We are indeed blessed to have such giants among us.P.S. Next week, we will not publish HealthLeaders IT. Have a glorious--and safe--Fourth of July!

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at

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