Reflections of a fortunate fellow

  • G. L. Howe
Co. Durham: The Memoir Club, 2002 price: £ 17.95 ISBN 1841040231 | ISBN: 1-841-04023-1

Professor Geoffrey Howe describes himself as a 'fortunate fellow'; he is also a most distinguished fellow. He was the first to be appointed as Professor of Oral Surgery in the UK, at Newcastle at the tender age of 35. His subsequent career in academia included uniquely the deanship of three dental schools in three continents, his alma mater, the Royal, Hong Kong and Jordan.

Qualifying at the end of the war, he was drafted into the Royal Army Dental Corps, starting a life-long attachment to the Army, which continued into civilian life. He was the first RADC officer to command a TA general hospital and became an Honorary Colonel Commandant of the Corps. His life in the Army, both regular and territorial, is well chronicled in the book.

A career spanning over 50 years saw oral surgery (later oral and maxillo-facial surgery) recognised as a speciality, following the creation of the Faculty of Dental Surgery at the Royal College of Surgeons. He was there at the start of the NHS in 1948 and played a prominent part in the upgrading and refurbishment of the dental school after the Second World War.

He also had a distinguished 'career' in the BDA and a chapter on 'dental politics' details his rise to become the first and only academic to lead the Association as Chairman of Council. Tales of what went on in Wimpole Street and our first forays into the European Community will fascinate readers who remember those days. He was recommended for the Presidency in our Centenary Year, but gave it up to take up a new post in Hong Kong. He remains a Vice-President of the association, with a seat on the Representative Body.

It is an impressive CV and one that is told forthrightly with a touch of humour. Geoffrey comes across as a dentist dedicated to his profession and passionate to hand on his 'art' to the next generation.

Readers also gain an insight into his private life and especially his long and happy marriage to Heather, who urged him to write this account before she died. It is an intensely personal work and it is here that my doubts set in. We hear much of his disagreements with colleagues, but I feel a book such as this is no place to resolve private feuds. Very few of those who read it now will be interested in what happened in Hong Kong years ago, let alone his judge-ment of an Army dentist he encountered a year or so after qualifying.

This could have been a first class account of a profession responding to the challenges of a changing world. It could have recorded the development of dentistry during some momentous years. Some of that is there, but in my opinion this book could have been so much more.

M. Watson OBE [BR5061]

Consent in dental care

  • J. King,
  • L. Doyal &
  • S. Hillier
London: King's Fund Publishing price: £ 7.99 ISBN 185717416X | ISBN: 1-857-17416-X

This short and very readable booklet provides many more surprises than its 63 A4 pages would lead the reader to expect. It provides a very engaging and perceptive insight into the consent process, as seen from the very different perspectives of clinicians, patients and carers/parents.

So much of what has been written on this topic in the past reveals too great a distance between an academic and legal model at one extreme, the hurly burly of patient care in 'real life' settings in the middle, and an understanding of the practical medico-legal implications from firsthand experience of actual cases.

The reality is that patients and clinicians spend too little time exchanging information, asking questions of each other, and listening to the replies. When discussing issues of consent, it is essential that the clinician talks with the patient (or carer, parent, interpreter etc) as opposed to talking to them, or at them.

Early on in this text, the authors stress that consent is not simply a signature on a form, or a formality carried out at a moment in time, but a detailed communic-ation process. How right they are, and how refreshing to see the emphasis placed squarely where it belongs. It was all the more surprising, then, that one of the closing recommendations is that the NHS Treatment Plan Form should be further developed into a 'usable and patient-friendly consent form.'

Setting aside this reviewer's dislike of the phrase 'informed consent', it is surely not in the clinician's gift to decide that consent is 'informed'. This presumption that the clinician knows the moment when the patient has received and understood sufficient information to make rational healthcare choices is precisely the outdated, paternalistic approach that this booklet tries so hard to consign to history.

Although published in 2000, this booklet does not specify when this study took place and most of the bibliography refers to publications from 1989 to 1997. A lot has changed in the field of consent during that time, and it seems curious that the refer-ences did not include any publications from the UK protection/ defence organis-ations, despite the wealth of material which they have published on this subject, especially in the last five years.

To establish consistency in approach to consent, the authors have proposed a structured, nine-stage continuum between establishing an initial rapport between clinician and patient, and the patient eventually 'indicating' consent to a particular treatment. This stepwise approach is sensible and helpful, but alas their study revealed a much more ad-hoc approach to this aspect of patient care.

Perhaps this highlights the fact that for dentists and patients alike, the provision of information is only half of the challenge.

This is a compelling perspective on a topic of ever-increasing importance. A very good and manageable read.

K. Lewis [BR5030]