I take my mind back over 35 years when I embarked on my postgraduate studies in London, and the encouragement I received from people like Rob Bower, Ian Davies, Greg Seymour, Bryan Wade and Bernie Keiser. It was an inspirational time at The Royal Dental Hospital with Periodontics still in its relative infancy, and that began my journey of "picking a pocket or two" (my apologies to Fagin in the famous novel, Oliver Twist, by Charles Dickens). It is not my intention to make this a clinical lecture, but it is amazing how the periodontal landscape has changed over the last few decades. The Scandinavians showed us the way to challenge every clinical dogma with rigid scientific evaluation, but in periodontics, we still have a certain dichotomy between those who advocate surgical management in most situations in spite of good evidence to the contrary, where more conservative management is equally effective in the long term. In the broader sense, think on how the clinical landscape has changed in the treatment of gastric ulcers - helicobacter is treatable non-surgically and I am sure for every patient a "medicinal scalpel" is preferable every time, as opposed to the traditional surgical scalpel. This revolutionary research won the first Nobel prize for UWA - and the names Barry Marshall and Robin Warren are now part of our folklore. So over the years, I too have been influenced by several pieces of advice and wisdom from my teachers and mentors:
From the late Bernie Kieser in London. Bernie originally hailed from South Africa, and with a name like Johannes Bernhard Kieser, it struck fear and trepidation to any postgrad student. But that was not the case, it was the total opposite. A razor sharp mind, keen wit and magnificent clinical skills which gave him the nickname of "Golden Hands Kieser". We all wanted to have Bernie's skills, but we also marvelled at his humanity. He would frequently pose the question: "Ask yourself if the patient is going to survive because of you, or in spite of you". I find myself asking this question daily in clinical decision making; will my patient be better off with what I am proposing? I am also reminded of the wise words of Ian Davies (Head of Department of The Royal at the time), that sometimes we have to "indulge in masterly inactivity" - in other words, not everything needs immediate remedy, Sadly, today, a lot of procedures may be recommended purely for good financial return, because we have bought a new gadget or new machine. Like in every facet of life, commercialism has crept into dentistry as well. It does sadden me to see "dental specials" advertised on the internet and health funds dictating to patients their preferred providers, eliminating the very essence of free choice in taking private health cover. These concepts are alien to a dental dinosaur like me, and in some ways I think we have allowed outside forces to cheapen our profession. I am thankful that I have never had to "sell" treatment to anyone, and I hope to retire before I feel that inclination.
From the late Professor Sture Nyman of Gothenburg, who collaborated in so many scientific studies with Jan Lindhe and others. Sture pioneered a lot of what we know in Guided Tissue Regeneration. He would frequently say, "You have to know biology, if you fail, it is because you did not understand the biology". To Sture, science was fundamental, you have to understand the science - if you do not understand basic science, your ability in apply it to a clinical setting will be sadly handicapped. Too often we are influenced by slick salesmanship, where scientific evidence is the first casualty. I cherish the times I spent with Sture, a wonderful teacher and human being.
And from Patrick Henry, who has told me many things over the years, but one statement that stands out is "Always tell the truth, then you will have nothing to remember". This reflects Pat's brutal honesty, and calling a "spade a spade". I learnt very early in the piece that you don't bullshit with Pat. At the end of the day, a true professional does not have to bullshit anyone, and to me Pat has personified this. However, with our mutual involvement in breeding Dexter cattle, Pat and I have been literally up to our ankles in bullshit on more than one occasion!
A/Prof Alistair Devlin (Dentistry, School of/Oral Health Centre of Western Australia (OHCWA)) (+61) 8 9346 7552.