Radiology and Pathology and Finland and Estonia

Sometimes insights, hitherto unperceived can be gleaned by finding points of connection between seemingly disparate pairs of organisations. The power of an apt metaphor can serve to transcend differences in focus and mission by bringing to the fore mutualities of concern and opportunity. In this regard, two small countries in Northeastern Europe—Finland and Estonia—have much in common with two relatively small medical specialties-Radiology and Pathology.

By many measures in the past 35 years Finland and Estonia have been very successful. Current economic underperformance notwithstanding, Finland has a higher per capita income than Estonia, but both are near or at the top in global rankings of political and press freedoms, a sense of contentment or happiness felt by their citizens and diversification of their economy despite each being relatively resource-limited. Their intellectual achievements are noteworthy. For instance, in music, both popular and classical, they each “punch above their weight”. Estonia has been called the most “wired” country in the world, while Finland has been heralded for having the best system for primary and secondary education.

Radiology particularly has grown in the same period, through the impress of technological advances in diagnosis and interventional procedures. Pathology perhaps to a lesser degree has nevertheless prospered technically, and is poised to pursue further initiatives through the advent of personalised medicine using genomic and cellular-based therapies.

Estonia and Finland have very similar languages and are situated near to each other with their capitals only 38 miles apart. Hospital-based Radiology and Pathology departments are also often positioned in close proximity. Both use visual representations as their “lingua franca” whereas other specialties can claim hegemony by the inherent advantage of the clinical “intimacy” of the doctor-patient relationship. Such a setting in the delivery of care is outside the domain of much of radiology and pathology practice, as each are largely confined to more remote sites within a hospital. Finland and Estonia are situated at a similar distance away from the geographic centre of Europe and hence at the margins of the world stage. By dint also of their small size and population they have limited power to direct global trends by themselves. The focus of both is on regional issues. They have each joined continent-wide organisations such as the EU and the euro zone to protect their interests and project some influence.

Technological process is the forte of each pair. For example Skype was developed in Estonia and electronic innovation is a hallmark of Finnish industry.

Today all four entities have to confront continuous challenges and expectations. Finland has successfully overcome the economic disruption caused by the recent difficulties of Nokia, a signature company identified with the country. Estonia now must protect itself from hostile murmurings from its neighbour Russia, which 75 years ago invaded and conquered it, forcing many of its citizens into forced labor imprisonment in the gulag.

Radiology, having passed beyond its 40-year golden age (1970-2010), must now face the need to be more judicious in its application of the technology within its purview. To make the necessary adjustments, outdated habits of utilisation must be discarded or modified to respond to imaging wisely initiatives. And at the same time it must confront the likelihood that some examinations will not just be computer-assisted but really computer-determined, thereby constricting the repertoire of tests it controls. Like many other forms of intellectual work, it must face the prospect of dislodgement by technologies, once its servant and soon to be its rival. Estonia and Finland have already shown the suppleness to reorient their economies away from a dependence on meeting Russian needs and wants in order to satisfy the demands of new trading partners, ie Sweden, Germany, and the rest of Europe. Can Radiology and Pathology reposition themselves so readily in light of new realities?

Patterns of convergence seem to be emerging between these two specialties. Joint projects in functioning imaging on a microscopic scale can be accommodated within the scope of expertise of both Radiology and Pathology, with them functioning as partners rather than as competitors. Some might claim that there are advantages in creating a so-called unified Department of Imaging services. In such a scenario the two specialties would have one leader to administer and strategise. Could this work? Perhaps? Despite their propinquity, similarities of language, commitment to the structure and function of democracy, the maintenance of social welfare programmes and education, there is no call at present for each of the two Nordic nations to forgo their independence to create a conjoined new country. Instead both have made a commitment to European integration rather than any other political arrangement.

Similarly, Radiology and Pathology could perhaps try to best meet the threats and challenges that technology will present by working toward shared investigational, educational, and clinical goals within the larger arena of Medicine in general.

Then how should such an anticipated conjunction of interests be accommodated? Finland and Estonia have needs in common to be sure, but they are still independent polities, each with a distinct history and a unique culture. On specific initiatives they are apt to be partners, but retaining always their de jure and de facto nationhood. Similarly Radiology and Pathology will do well to seek shared purposes and pursue opportunities for research, education, and political viability within Medicine. But for the near and medium terms, at least, be better realised by collaboration rather than confederation.

Note: Post-publication, "Current economic underperformance notwithstanding" was added to the sentence beginning  "Finland has a higher per capita income than Estonia..."  at the request of the author.