by Leif Kullman
Dear ODIS readers
Let me introduce to you my mate from the Southern part of our Globe:
Ross Macdonald. He has his own private practice in Maxillofacial Radiology in Adelaide, South Australia since 1978. He graduated to a specialty in MaxilloFacial Radiology at his alma mater in Adelaide during the 1970´s.
In 1988 new State Dental Legislation was enacted and he was acknowledged as a Specialist in Maxillofacial Radiology in South Australia, the very first one in Australia!. Today they have such Specialists in only three States in the country. During many years he was also Head of Radiology at the Dental Hospital and School in the
same city.
He is also one of the editorial board of the journal- ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY AND ENDODONTICS. Well, the list could be much longer, but above all he is my friend and he is a humanitarian. As much as you can be in our modern society. Here is Ross' very personal report of life from "downunder", in our southern hemisphere.
"A brief reflection on life in the Radiology fast-lane!" (You have to make your own Destiny because Destiny does not come to you.)
So you would like to be an Oral and Maxillofacial Radiologist? Why? ..says the interviewer, do you want to be a radiologist?...... and I am certain that many of you who are radiologists would not have a good or concise reply!. Even some of you in general dental practice might be hard pressed at answering why they did Dentistry!.
So let us look at this and other interesting points from my own personal Australian perspective. For brevity and self indulgence, may I call my country Oz and those who are citizens Ozzies?. I have had a number of very pleasant visits to Sweden and each time your hospitality and kindness increase my resolve to return. It is a long way from downunder in OZ and the intervals between visits are all too long. It will not surprise but still interest some people in Sweden that the Health Care systems of our two countries differ greatly. A mix of Socialistic government assistance and private health insurance systems in OZ provide a very confusing and at times unfair system of care. Dentistry is not really assisted by government apart from the indigent who are mainly treated at hospitals in the major cities .So probably 97% of dental care is either privately funded or done via a complex and competitive private insurance system to which only about 30% of the population belong and in which insurance rebate payments will only contribute about 50% of the total cost of treatment. Some contribute up to 80% of my radiology fees.
In answer to 'Why be a radiologist" I suppose from the first days early in my 4th. year at university and until the end of the undergraduate course in the 5th year I was fortunate to be invited to design x-ray cephalometric equipment to be taken into the central remote part of OZ some 250 km west of Alice Springs and reassemble it to do cephalometrics on indigenous aboriginal children and for continuing studies into young adulthood. That is, it was a group of anthropological/dental researchers who had embarked on a 20-year longitudinal growth study of a particular well defined aboriginal tribal group who had evolved as an homogenous semi-isolated nomad group but who returned to and stayed for periods of time at a tiny welfare community village. So this demountable equipment was reassembled by me for the 3 week trips which were done during those 2 years and the easy to reassemble system was redone each year by someone else from then on. My expertise came from being an aircraft electrical/instrument engineer before deciding to go the university to study dentistry.
Ten years later, with attending many short postgraduate courses of which the most were either in oral pathology or oral medicine, I decided that I had enough of private dental practice...it was time to get out!. My love and interest for radiology never faded. And thus with a return to hospital institutional life and teaching and study in January 1973 , the road to radiology started. Royal College Fellowship exams, radiology training (dental and medical), teaching and lecturing undergraduate students in the basic sciences of histology and anatomy and radiology along with a succession of various hospital appointments including Directorship of OMF Radiology and Senior Lecturer with the University set me on the way. But my love was to be a clinical radiologist rather than an academic. Many of us in OZ looked to Sweden as the "cradle of Oral Radiology"... We were aware of the developments in USA, Holland and other countries, and I also had a huge respect and interest for what I called the "Toronto School of Oral Radiology Philosophy" with the great Dr. Worth and the gentle brilliant mind of Guy Poyton. But somehow the real fascination was Sweden and earlier on all we frequently had to read were abstracts written in English. So the influences on me were a sort of bipartisan Trans-Atlantic dichotomy of the "Swedish school" on one side and of Toronto to the west.
It was Guy Poyton of Toronto, whom I briefly visited years before in 1976, whom upon my comment that I would like to return to Toronto to study told me to go home and set up a private radiology practice and show people in OZ it could be done. Yes , in effect, he gave me a proverbial "kick in the backside" and said "go and do it". By 1978 I had. By that time I was doing two jobs. Apart from teaching, I was doing Private OMFR in my very own practice, and Hospital as well as Private medical radiology, working from 6am to 6pm at least and soon had a marriage "on the rocks" so to speak. It is terrible that so often to achieve what we want for ourselves destroys those we love...almost as if love of ourselves and our aspirations are the destroyers of the very things for which we think we are working!. That is why I talk to any postgraduate student who will listen to me about the need for "balance' in one's life and the need to nourish those we love and respect and not to take love or friendship for granted. Postgraduate full-time study for newly or recently married people ( and in my case much longer married) is a recipe for disaster without a structured time set aside with each other which excludes work and studies and is just for themselves.
Well what really excites me in radiology?. Well, health professions have the characteristics of really truly being an art and a science. But it has the humanity aspect which always appeals to the "noble minded and sense of community" in so many of us. I have found radiology a very rewarding challenge and for me it has combined the excitement of making a business work and be successful and give way to creative and thinking skills which have not been limited or restricted. That is, not confined by the need to keep to a strict time schedule or the repetitive and relentless constraints frequently encountered in the treatment of one individual in a chair.
I like the challenges of diagnosis and on so many occasions being at the "end of the road" or the "too hard basket" of diagnosis and management. For me an exciting time is like an episode once in which I was at a session with Guy Poyton, Douglas Stoneman, Mike Pharoah and Axel Ruprecht in Toronto looking at some old films of Dr.
Worth's. It wasn't a matter of what the lesion was... but the arguments were more on the order of differential listing and justifying the presence of any item on that list.
Now, that is real radiology excitement for you. That is if you aspire tobe a clinical radiologist. Here in OZ at our Academy meetings we have a day of "Radiological Challenges" on the program. On this day we all bring along a "hard case" or something of particular interest. We in fact use an eminent pathologist as the Moderator and get really into the challenges full on. Again, for a radiologist or a pathologist that is real fun "Have you gone Digital mate" ? Almost as if have you caught a terrible disease. From my personal perspective it is too soon to go too far down the equipment road for this...especially CCD systems. I am convinced that more revolutionary changes are on the way, and that in my view a trend in this country and probably others of ignoring the
plate technology of Digora in favour of CCD and not heeding the prospect of newer and better systems are a real worry. We have to keep in mind the probable move to Amorphous Silicon Solidstate Detector technology. I believe that linear arrays etc., as we currently see for panoramic/cephalometric systems will eventually be replaced by better technology. The possibilities of the developing technological approach which includes cesium iodide scintillators in combination with sensors having an active amorphous silicon readout matrix (CsI:Tl / a-Si)is exciting, and really approaching economical commercial reality.
Whatever man can possibly dream about can eventually be achieved. I am reminded by the words of the famous Peter Drucker who is regarded as the "father of management thinking".......quote: "if you don't have a method of systematic abandonment, you will soon become committed to yesterday - in violation of one of the oldest medical proverbs (possibly from Hippocrates), 'There is nothing as difficult, as expensive, but also so futile as to keep a corpse from stinking' ".(unquote) From this far away on the other side of the world it seems to me that the great joy of practicing radiology like I can, does not exist in Sweden. I do what I want, when I want, employ whom I want, have holidays when I want, buy or throw out what equipment I want (depending upon what I can afford of course) and so on. The "penalty" for that is the daily grind of radiology reporting and general oversight of a small business. The rewards are that of a comfortable but not wealthy life style, and the joy of working with staff who respect each other and will work their hearts out for the success of the business. The joy of a happy workplace where there is never a word of anger , lots of laughter, and lots of praise for a good job done.
I remember once asking an eminent oral surgeon about the boring business of removal of so many third molars and I wanted to know what really kept him going....and he answered '" it's the interesting cases". And in some ways radiology is a bit like that although I have never been bored as a clinical radiologist. The only disturbing part of it all is that which is so interesting to us is on most occasions the misery for someone else. Most of us have had bad news to give patients from time to time and sometimes that news is catastrophic not only for the recipient but also the family involved. Unless one has developed humility and tact and a love of people and at the same time is a good communicator, then clinical radiology, even for the most talented diagnostician , is not for them. Why have I said all this ?..... what has happened to the study of the finer arts of philosophy, human psychology, human communication, and the training in the skills of decency and politeness and of forgiveness in the curriculum for postgraduate students ?. "Oh", you say..."it was never there"!. ...or perhaps it was in some way once, but in the catatonic and desperate bid the fill someone's mind with new technology and an amazing volume of irrelevant material these more recent years, the "balance of life" is being lost or ignored.
So... shall we all take a look at ourselves and think .."where am I and where have I really got to"?.....and perhaps turn and smile at some one and be pleasant to all who love us and work for us...and just now and again say to your secretary or radiographer..."gee, that is a nice job you did"... or "wow, what a fantastic group of examination films you have done for me". I always recall the message from the psychologist and social researcher H. Mackay.... "love does not reside in machines; nor do courage, integrity, fidelity or morality. Yet these are the very virtues upon which our personal and cultural survival will depend".
Ross Macdonald
