Year : 2020 | Volume
: 24 | Issue : 2 | Page : 193--194
Whither oral pathology?
Private Practitioner; Formerly Department of Oral Pathology and Microbiology, The Oxford Dental College, Bangaluru, Karnataka, India
T V Narayan
Private Practitioner; Formerly Department of Oral Pathology and Microbiology, The Oxford Dental College, Bangaluru, Karnataka
|How to cite this article:|
Narayan T V. Whither oral pathology?.J Oral Maxillofac Pathol 2020;24:193-194
|How to cite this URL:|
Narayan T V. Whither oral pathology?. J Oral Maxillofac Pathol [serial online] 2020 [cited 2020 Sep 24 ];24:193-194
Available from: http://www.jomfp.in/text.asp?2020/24/2/193/294633
I feel compelled to pick up on the vein struck by Dr. Yeshwant B Rawal in his succinct yet brutally honest editorial in the previous issue of this journal.
The identity crisis that Dr. Rawal referred to is real, and is a result of the structure of the curriculum and the mindset which believes the this is a “Non-clinical” branch of Dentistry (I'm a product of the same system, yet was reminded constantly by individuals like the late Dr. Ravi Shetty and Dr. Anita Borges, who I will label as early “Design thinkers,” about the innate clinical impact of Surgical Pathology). This leaves a set of individuals confused as to their very role in the grand scheme of things, and most end up as disgruntled “Academicians.” With the nature of Academia in India, where there was no emphasis on research and publication for the longest time, we ended up with an hierarchal structure which was happy in its time bound promotions and the entitlement that came with it, never feeling the need to develop or hone any diagnostic skills, and actually reveling in our “Non-clinical” status for a short period of time when we were a rare breed. Dental colleges mushroomed, Postgraduate seats in all branches were sanctioned indiscriminately and a whole generation of pathologists prospered in this new found gold rush. The consequence was a glut in the “market,” with hundreds of new “Oral Pathologists” -, not surgeons, not pathologists, not geneticists, not molecular biologists, not microbiologists, not clinicians, not researchers, with poor diagnostic skills, no experience and no jobs. A surefire recipe for the death of a specialty.
So is this an agony column, where I vent about a dysfunctional system, paint a bleak picture and offer no possible remedies? Far from it. I believe this is the time to act and infuse a fresh outlook toward the specialty, and this has to come bout as a top to bottom change, rather than the opposite. At the risk of bruising some egos, one may even consider the creation of a new specialty of oral diagnosis, amalgamating the existing branches of oral medicine, diagnosis and radiology with oral pathology, since despite the burden of oral disease, there does not seem to be enough work to go around. For this, we need get creative and apply some “Design thinking “concepts to the problem at hand, and the seniors in the field have to take the role of “Design thinkers.” This is a systemic change that will take years to implement, by when it may be too late for the specialty. So what is the unemployed youth to do in the meanwhile?
The identity crisis is not one of the oral pathologists alone-it exists in the specialty of oral medicine, diagnosis and radiology and community dentistry as well. While the OMDR graduates manage with opening cone-beam computed tomography facilities, many of the community dentists are employed by dental clinic chains as marketing executives/office managers etc.
The fundamental ideology in design thinking is a hands on, user-centric approach to problem solving, which leads to innovation and then to differentiation and competitive advantage. The process involves understanding the problem through empathy and definition, exploring solutions through ideation and prototype building and finally materialization through testing and implementation.
With this background in mind, it may be a good idea for young graduates to join forces with those of other specialties suffering similarly and provide comprehensive oral diagnostic services in a group practice format with pooled resources and shared revenues, to create an identity and competitive edge over the general pathology and diagnostic centres which cater to most of these needs for maxillofacial and head and neck surgeons in most parts of the country. After practicing surgical oral pathology privately for nearly 25 years, I can tell you that the need and demand exists and it can be financially viable in the long term, provided the service is competent and prompt.
Combine this with spreading awareness among general dentists, general physicians, ENT and other specialists, one can ensure a wide supply chain for a mutually productive relationship.
We are at the cusp of educational reforms in this country, largely focused on primary and secondary education and hopefully the powers that be will see the wisdom in bringing about some sweeping changes in profession education, particularly dentistry and oral pathology.