"You've got to pick a pocket or two"
Thank you Alistair Devlin, President of the Dental Alumni, and your Committee for this honour as the inductee of the Campbell-Wilson Roll of Honour for 2012. When I received your letter, Alistair, some months ago, I was literally gobsmacked, because this has always been an occasion where many of my heroes in dentistry have been honoured. When you see names like John McGeachie, Ted Adler, Pat Henry, Bruce Barblett, David Booth, Rob Bower and many others; it would be an understatement to say that one would feel very pretentious to be included in that company. So it is with great humility that I accept this honour.
Then there is always a catch, because the next paragraph of Alistair's letter informed me that I had to deliver an oration, on any subject vaguely connected with dentistry. Well, I have delivered many lectures over the years, but an oration sounded very intimidating. It drove me straight to the Oxford Dictionary to define an oration - which horrified me even more. Definition 1: a formal public declaration or speech, and Definition 2: any rhetorical, lengthy or pompous speech. Then the next line defined an orator - a public speaker given to lengthy and pompous speeches. Therein lies the first contradiction of being humble and pompous at the same time. Lengthy isn't a problem as I could keep you here for as long as you want. It crossed my mind to call a great orator like Barack Obama for advice, but I suspect his minders would tell me he is busy with an election. So I am basically none the wiser, and you will just have to put up with the ramblings of a dental dinosaur.
Alistair's letter indicated that the Campbell-Wilson Roll of Honour was established in 1995 by the UWA Dental Alumni Society to recognise those who have contributed to the profession, especially for contributions to dental education. I find myself fortunate that very early in my dental education I met and befriended a legendary teacher who to this day continues weave his magic in imparting knowledge in a way that we have all admired and benefitted from. I speak of none other than John McGeachie, and he has been to me, and I am sure to many of you, one of the most inspiring teachers we have ever come across. I first met John in 1970 when I joined second year dentistry after completing a Science degree. Needless to say, I was seeking some exemptions in units that I had already completed in Science but I came across some bureaucratic obstacles. It so happened that John was the second year course controller and so I made an appointment to see him to plead my case. I was a resident at St George's College at the time and by chance had a talk with the Warden before seeing John. The Warden was none other than the eccentric Dr Josh Reynolds, who on hearing my predicament, and who I was seeing, immediately informed me that John was an old boy of the College, and I should pass on "his best regards". So when I met John for the first time, I quickly informed him, that "Josh sends his regards"; to which he responded, albeit affectionately, "How's the old bastard?" The appointment went all too quickly, as we chatted about Josh and College life; and it appeared that we belonged to a common experience, which had a very positive effect on our lives. I walked out of John's office with exemptions in Histology, Biochemistry and Physiology; but more importantly it gave me a sense of common belonging, and in many ways this has been the underlying joy in my career in that I have belonged to a wonderful profession, with so many wonderful colleagues and friends (and I thank many of you who are here this evening).
Some years ago, whilst indulging in one of my favourite pastimes of browsing through bookshops, I stumbled on a bestseller called "Eternal Echoes - Exploring Our Hunger To Belong" by an Irish author and philosopher, John O'Donohue. I am in awe of good literary expression, and I marvel on how this book is so exquisitely crafted to explore that most basic of human desires - the desire to belong. Allow me to quote a paragraph to illustrate my point: (unfortunately without the lovely Irish accent). "The hunger to belong is at the heart of our nature. Cut off from others, we atrophy and turn in on ourselves. Mostly, we do not need to make an issue of belonging; when we belong, we take it for granted. Merely to be excluded or to sense rejection hurts. When we become isolated, we are prone to be damaged; our minds lose their flexibility and natural kindness. We become vulnerable to fear and negativity. A sense of belonging, however, suggests warmth, understanding and embrace. The ancient and eternal values of human life - truth, unity, goodness, justice, beauty and love - are all statements of true belonging.
..... Something within each of us cries out for belonging. We can have all the world has to offer in terms of status, achievement and possessions, yet without a true sense of belonging, our lives feel empty and pointless."
So we are very fortunate as a profession that from the day I joined the Dental School, through to graduation and beyond, I was given the opportunity to belong, and with that opportunity I was also given the privilege to contribute to the profession. My greatest enjoyment, apart from clinical practice, has been that of teaching, of which I have been involved since my first year after graduation, when John Lewis asked me to demonstrate in Pros. Over the last four decades I have been involved with teaching at the undergraduate, postgraduate and also at the continuing education level, together with various research projects. I keep saying that this is the last year of teaching, and then you get another keen, smart postgrad student, and you postpone for another year or two. However, it is a very special privilege to be part of students' aspirations, and to help them achieve it.
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!
So over the years, with these snippets of philosophy and wisdom in mind, I have "picked a pocket or two" and tried to teach it as well. However, teaching a bunch of would-be pickpockets is sometimes very challenging, even though I would like to think that our motives are far more altruistic than those of Fagin in Oliver Twist! Technically, root planning/closed root debridement or "picking a pocket" is a difficult procedure to do well; because it is in most situations a "blind procedure". So when you depend on a favourable outcome dictated by tactile feedback (can you feel it?) as opposed to visual feedback (can you see it?), there is a very different learning curve. Dare I say some dentists never develop that tactile feel for subgingival calculus ever - a common situation, which has been described as "supervised neglect". However, healing will only occur if closed debridement is of a high standard and the root surface decontaminated, which in turn may obviate the need for open cleaning, which is surgery. In other words, surgery should be the last resort, not the first option. So therein lies another contradiction, how do you teach someone to do good surgery, if the objective of initial good closed debridement is not to have to do surgery at all?? Hence sometimes we have to "bend the rules" a little for the postgrads to teach them surgical techniques and skills, because it is still essential that they have to be able to do good surgery when the need arises; and they do arise from time to time. One of our nurses, who worked with a dentist from overseas, informed me that the dentist told her that Australian periodontics was very backward, because we only did root planing and did not do surgery. If that is the case, and we can still achieve comparable, or even better outcomes, then I will wear that "backwardness" as a badge of honour.
Thank you, ladies and gentleman, for your attendance, and for the honour of being the 2012 inductee in the Campbell-Wilson Roll of Honour. I bid you all a good night.
Clinical Assoc. Professor Albert Tan.
A/Prof Alistair Devlin (Dentistry, School of/Oral Health Centre of Western Australia (OHCWA)) (+61) 8 9346 7552.