Day in the Life… Daniel Maklansky, MD
Wednesday, March 30, 2011
Posted by: Kerri McCabe
Day in the Life… Daniel Maklansky, MD
by Dan Hurley
Daniel Maklansky, MD, wants to make one thing perfectly clear: he is not now—nor has he ever been—a gastroenterologist.
But 49 years ago, before joining the same practice on New York City's Park Avenue where Burrill B. Crohn, MD, once worked, and before building up what has since become the largest gastrointestinal radiology practice in the Northeast, Dr. Maklansky was a GI of sorts—in the U.S. Army.
"It was a time of patriotism, I was uncertain which field I wanted to go into, I would have made $25 per month as a resident and I was about to get married," Dr. Maklansky explained.
So, having just received a degree in medicine from the State University of New York, Downstate Medical Center, Brooklyn, he joined the U.S. Army Medical Corps and reported for training at Fort Sam Houston, Texas, in July 1957 with his bride, Elaine, in tow. To his dismay, he learned that he likely would be assigned to a battalion aid station as a general practitioner in a forward unit. But, he was told, the Army was short on a few specialties, including pathology, obstetrics and gynecology, and radiology.
"So I innocently checked off the space saying that I'd like to get on-the-job training in radiology," said Dr. Maklansky.
Thus his destiny was decided. Sent to Fort Dix, N.J., for training under Peter Zanca, MD, he spent a little more than six months learning what he could until being shipped off in March 1958 to serve as radiologist at the U.S. Army Hospital in Nuremberg/Furth, Germany.
"I kept learning as I went along," he said. "I spent so much time in radiology that when I rotated back to the States in mid-'59, I figured I might as well use it." After completing his residency in radiology at Mount Sinai School of Medicine, New York City, he was invited by Richard Marshak, MD, to join the practice originally begun by Dr. Crohn.
Dr. Marshak was one of two radiologists who joined Dr. Crohn's practice to help him evaluate the deluge of patients who sought him out after his first description of what he and his co-authors called "regional ileitis" (Crohn BB et al. JAMA 1932;99:1323-1329). Although Dr. Crohn had left the practice a year before Dr. Marshak joined it in 1962, Dr. Maklansky knew him well from Mount Sinai, and the practice continued to build on Dr. Crohn's referral base. Henry Janowitz, MD, who succeeded Dr. Crohn as Chief of GI at Mount Sinai, also took on Dr. Crohn's position in the office, and for nearly two decades the GI fellows in training rotated through their office for three months at a time.
One of the key lessons Dr. Maklansky learned from Dr. Marshak, he said, is that to be most effective, GI radiologists should not function as mere technicians.
"We are not picture takers; we are physicians practicing radiology," said Dr. Maklansky. "We're not just taking pictures every half hour or taking salami slices. We conduct examinations on each patient in such a manner as to yield the maximum amount of data. We try not to do more than five to seven small bowel follow-throughs per day."
In 1972 another radiologist joined the practice, Jerold Kurzban, MD. After Dr. Marshak's death in 1982, the practice grew to include seven radiologists in all, and in 2003 they added an eighth, who just happened to share the last name of Maklansky.
"Which one, Joe or Daniel?" the receptionist has to inquire when a caller asks to speak to Dr. Maklansky.
"If you'll forgive paternal pride, Joey is an extremely hardworking, assiduous and very bright individual," said the elder Dr. Maklansky, who recently celebrated his 74th birthday. "There's no rivalry, mostly because the amount of training these young people receive now far exceeds what I did. It adds luster to the practice and it's fun." But then, he added, "I'm very lucky to have three sons like that. One is the doctor, one is in books and one is a museum curator."
Just this past December, his group finally left the historic office at 1075 Park Avenue—where Dr. Crohn first practiced—before taking over 15,000 square feet on East 84th Street. Although still using barium X-rays, the office now boasts a PET/CT scanner, a General Electric 64-slice volumetric computed tomography (CT) scanner, a magnetic resonance imaging unit, two digital mammography units, a new General Electric gamma camera for nuclear medicine and four state-of-the-art Philips IU 22 ultrasounds with color and power Doppler imaging as well as 3-D sonography.
With all that technology, it's not surprising that Dr. Maklansky's practice is moving fast to make use of CT enterography.
"It's the next giant step," he said. "It's excellent for patients with recurrent Crohn's or for post-op Crohn's. It's faster, it's easier and it gives information not only about the wall of the bowel but its surrounding structures as well. We are doing two, three or four of them each week. So many gastroenterologists are used to looking at barium studies, it's difficult for them to adapt to cross-sectional radiology in conventional CT, but CT enterography permits the image to be manipulated so it looks like a regular small bowel study."
But in GI imaging, one of the most significant breakthroughs Dr. Maklansky has seen in his career is not performed by radiologists.
"The advent of capsule endoscopy has proven very valuable clinically when used properly," he said. "We regard it as a complement or additive to small bowel imaging."
Dr. Maklansky's wife Elaine passed away 19 years ago, and he is now married to Barbara McDonald. Together they enjoy pursuing the one subversive habit that he picked up as an undergraduate English major at New York University: reading.
"It continues to provide me with pleasure," he said. "I'm not a golfer or a hobbyist. Fortunately Barbara is a bibliophile, too. We're very big readers."
That doesn't mean he's sedentary. Almost every morning before work, he spends a half hour—twice that much on weekends—exercising at the gym in his building on the Upper East Side of Manhattan.
"I suffer from an ailment," he said by way of explanation. "I feel I have to accomplish something every day. It drives my wife crazy. But that's the nice thing about exercising in the morning. After 30 or 60 minutes, no matter how hard it was, you can say, 'Ha! I've done something already!' You get this feeling of satisfaction. Then you can approach the requirements of the day with a somewhat more gratified sense that you've already done something."
As if that were not enough, he then walks to work, arriving by 8 a.m. and rarely leaving before 6 p.m.
One of the nice things about radiology," he said, "is that at the end of the day, there's a feeling of accomplishment, because you've completed all your examinations and you've made all your reports. It's a satisfying and gratifying feeling."
And he has no intention of retiring.
"Many years ago, someone said to me, Find a job you love and you'll never work another day for the rest of your life. I've been very lucky."