Tiresias: Opening doors

“My job is making windows where there were once walls.”

Michel Foucault

My friends,

How are new technologies and new techniques introduced into the practice of medicine and surgery in Australia?

Traditionally, in Australia, the path has been that an upcoming specialist in medicine or surgery, who has just completed their specialty training, would go and get their BTA (“Been to America”) or BTE (“Been to England”) “degrees. This was almost a compulsory 1-to-2-year fellowship overseas acquiring a new skill. On return, with this final and essential qualification, and the new skill or as ironically referred to by the “stay-at-homes” - "trick". The returning “hero” would be accepted as a real specialist. In the first years of his return, he, and it was almost always he, would tout hisnew technique(trick), and the other older established specialists would then scramble to catch up with the new method, or risk, horror of horrors, being out of date. The new method will have been already known but the working physicians and surgeons were too busy plying their outdated craft to bother learning the new method. Many, of course, were past the time of learning anything new that required any training or time from their practices. A rare established and not too-set in their ways specialist, would take 6 to 12 months off from their lucrative practices, go overseas, and do a fellowship. Up until several years ago this was how most new techniques were introduced into medicine in Australia. There has however been a change in the last 5 to 10 years, not because the Australian medical system facilitates the introduction of new techniques but because it is simply become much harder for the young would be specialists to travel and obtain paid jobs as fellows, especially in America. Out of necessity, many post training sub-specialty fellowships have sprung up in Australia. Unfortunately, few of them are at the cutting edge.

What has this to do with Optiscan digital real-time confocal laser endomicroscopy (CLE)? Well, my friends, this is certainly a revolutionary new technology which requires some training. This would be perfect for an aspiring real-time digital histopathology super-specialty fellowship in Australia. The Australian government is in the season throwing huge funds at cancer to build new "cancer centres". Could there is an election coming my friends? The politicians want monuments and have earth turning ceremonies, wearing hard hats and hi-vis. If only Australia had wise governments and smart health bureaucracy, just a small fraction of these funds for fellowships in real-time digital confocal endomicroscopy would see a whole new field of medicine starting in Australia. It would have more effect than billions being spent on buildings and pointless and flawed investigations and treatments. Is Tiresias dreaming suggesting such a thing. Is Tiresias also dreaming in thinking that an enlightened, generous, real philanthropist, of the many and increasing Australian billionaires might fund a named fellowships for in vivo real-time histopathology? Perhaps, but dreams do have a way of becoming reality.