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Volume 38 , Issue 6
November/December 2018
Pages 780–781

Editorial: Simplicity

Sergio DePaoli, MD, DDS/Paul Fugazzotto, DDS

DOI: 10.11607/prd.2018.6.e

1905: Albert Einstein publishes groundbreaking papers discussing relativity, space time, and more. The publications are lucid and easily understood by anyone with a modicum of training in physics.

1983: We give our first joint periodontal restorative lectures in Vicenza, Italy. In preparation for these lectures, we create slides (yes, actual slides), one of which attempts to provide an overview of the immunology of periodontal diseases and contains information gleaned from lectures by Dr Sigmund Socransky and others. It also includes over a dozen arrows and subcategories, which, though multicolored and beautifully put together, are confusing and a poor teaching instrument. To paraphrase Russell Crowe as John Nash in A Beautiful Mind, the slide “does not contain a single original or seminal thought.”¹ We play the role of a regurgitating amanuensis.

With all due respect to our chosen profession, I believe Einstein’s work was inherently more complex than ours. Nevertheless, Einstein was able to formulate and present his thoughts more clearly and, dare we say it, simply than were we.

Simplicity. This word has come to signify simple-mindedness and a lack of depth. Such a characterization is grossly incorrect. Rather, simplicity should be viewed as the quintessence of sophistication.

The ability to distill a concept or challenge down to its essences, grasp their meanings, and clearly communicate both the appropriate ideas and solutions signifies true understanding and mastery of the situation.

Carlo Rovelli, in his book The Order of Time, clearly presents a highly readable recount of the current understanding of the concept of time as well as future avenues for potential research.² Even the most casual reader will come away with a greater appreciation of the matter at hand. In contrast, many a student (one of the present authors included) spent innumerable hours studying Martin Heidegger, the master of philosophical obfuscation, in order to understand his conceptual foundations of being and time.

As second-year periodontal graduate students, we were fortunate to experience Dr Jens Waerhaug giving one of his final lectures. In the face of verbose, often-overblown questions characterized by artificial complexities, Dr Waerhaug offered simple answers that beautifully cut to the core of each issue. The answers were not vapid, noncommittal responses. They were art.

Simplification is the art of making manageable and understandable that which is complicated and difficult. It is indispensable in establishing a diagnosis and formulating a treatment plan.

When treating patients, it is crucial to determine the correct diagnosis. Dr Jerome Groopman speaks of the tyranny of diagnosis.³ It is an unforgiving tyrant. The chances of optimizing patient care are small indeed when therapy is grounded in an incorrect or inadequate diagnosis.

When discussing patient treatment plans with Dr Gerald Kramer, he stated that the ideal plan must be simple, accurate, consistent, and predictable. When executed properly, such a treatment plan will generate equally consistent and predictable results.

Dr Morton Amsterdam expressed similar views, saying the best treatment was the one that most simply satisfied the needs of the case.

Upon graduating from our periodontal training program, we attended a meeting at which interdisciplinary treatment teams explained and demonstrated their approaches to treating “difficult cases.” While such team symposia are now fairly commonplace, this was not the case in 1982. After watching various teams present complex, multistep therapies that, in many cases, took up to 4 years, Drs Myron Nevins and Howard Skurow took the stage.

Drs Nevins and Skurow proceeded to show exquisitely documented cases with long-term follow-ups, demonstrating a “simplified” treatment approach that maximized treatment outcomes, minimized patient trauma, and drastically reduced overall treatment time. Such simplification was only possible because of their understanding and mastery of the intricacies of their field, thus resulting in understanding and mastery of the challenges they faced.

Twentieth-century architectural movements that stripped buildings of their ornate, often baroque, aspects were dismissed by many as “too simple” and the result of the architect’s inability to master the “more complex” aspects of architecture. Ayn Rand’s Howard Roark was labeled a simpleton and a failure. Such critics failed to understand that, by moving beyond distractions and mere ornamentation, one is able to access core principles and create beauty through simplicity.

Ralph Waldo Emerson said, “to be simple is to be great.”⁴ Such greatness is needed now more than ever, as we are constantly bombarded by new treatment options and avenues of information. We must rediscover our core principles and postulates, then integrate these new “magics” into an already-proven framework of patient care.

If Einstein could reconcile Newton’s theories and the concept of gravitational fields in what is his greatest work and the epitome of simplification, his general theory of relativity, we should be able to do the same in our chosen field.

Sergio DePaoli, MD, DDS

Ancona, Italy

Paul Fugazzotto, DDS

Milton, Massachussetts, USA

References

1. Ron Howard. A Beautiful Mind [DVD]. Universal Pictures; 2001.

2. Carlo Rovelli. The Order of Time. New York: Riverhead, 2018.

3. Groopman J. How Doctors Think. New York: Houghton Mifflin, 2007.

4. Emerson RW. Essays and Lectures. New York: Library of America, 1983:100.

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