I was surprised to find myself unaccountably upset after reading Prof Howell’s obituary in this week’s British Medical Journal. He had, after all, died apparently peacefully at the age of 88 after a great life, so why am I upset?
Prof Howell was the first consultant that I worked for after qualifying in medicine from Southampton University Medical School. I think virtually everything that I experienced from my final student years onwards would seem inconceivable to the doctors who will emerge newly qualified this summer. We were the third intake of students to the new medical school in Southampton, and when we started I think that there were possibly as many staff to teach us as there were students. Consequently we received nearly all our teaching from professors and senior lecturers; they were (for the most part) excited and enthusiastic about the medical school, and we were certainly excited to be there. As third year students we had what was then the novel integrated ‘systems’ teaching, where we learned basic sciences but always related to clinical practice. It was there that I first encountered Prof Howell and his right hand woman, Dr Anne Tattersfield. She inspired me as a woman who seemed eminently human, whilst being also clearly a rising star in her specialty. Prof Howell (who, as the obituarist said, was called ‘whispering Jack’ by all of us) seemed the archetypal kind professor – a man with a huge brain, but also a very human man.
When I started working for him Prof Howell made it clear that if there was anything that I was worried about, anything that I didn’t understand, I could always go to him for advice. Of course the (then) usual ‘firm’ structure existed on the ward, so I had three grades of junior doctors of increasing seniority between me and the Prof, but in retrospect it was another example of his humanity to recognise that there might be an occasion when one might wish to bypass that structure.
Prof Howell’s specialty was respiratory (chest) medicine, so most of the patients that I looked after on the ward had breathing problems of one sort or another. There was still quite a bit of TB in Southampton at the end of the 70s, but those patients were looked after in another hospital, so most of my patients’ problems had been brought on by smoking. Prof used to sit and chat to a patient, and then he’d ask me, ‘Di, why did I ask him when he stopped using matches and start using a lighter?’ (Remember this was 1978) The answer was ‘he stopped using matches because he couldn’t blow them out anymore.’ This of course was an indicator of the progression of the patient’s respiratory disease, a marker of his diminishing respiratory reserve.
This little anecdote encapsulates much of what I learned from Jack. He often wandered onto the ward at about six o’clock, just as I’d be preparing to leave (usually after having worked a day, a night, and a day). ‘Di’ he’d say, with a smile, ‘shall we go and talk to a few patients?’ At the time my heart would sink, as I knew that we would be at least an hour and a half, maybe two, and all I wanted to do was join the others in the wine bar! How much I value those sessions in retrospect. Jack would approach a patient, introduce himself, and ask me to tell him briefly about the patient. Then he would sit on the patient’s bed and chat to him, seemingly in an unstructured way, about his work, his family, where he lived, where he came from. After a while he would say goodbye to the patient with a smile, and move to the next one. At the end he would emphasise to me the one lesson that I needed to learn. ‘If you can’t get the patient to trust you, you won’t learn anything. If you let the patient talk to you rather than fire questions at them, you will learn all you need to know. And most importantly of all, eliciting a proper history from a patient is worth more than a thousand expert examinations. If you don’t know what is wrong by the time you’ve got the history then an examination isn’t going to help you. The examination is there to confirm what you know.’
Little did I know then how vital those words would be when much later I became a chronic pain consultant; a specialty where gaining the patient’s trust and letting them tell their story is of paramount importance.
Jack Howell embodied everything that I believed about good medicine when I trained to be a doctor. He was compassionate and approachable, yet had a rigorous intellect that he applied to his research. He believed that medicine was an art as well as a science, and that both aspects were co-dependent. He believed that the patient would tell you what was wrong with them if you allowed them to. He was an innovator (he was a co-founder of the medical school, with its radical new curriculum) but he was also a very humble man.
It would not be an exaggeration to say that I learned a great deal about how to practice medicine from Jack Howell, and I certainly learned much about how to be a good doctor. The sort of medicine that he practised, and that he taught me does not exist today. He was a kind and courteous man and I mourn his death.