Australian Doctor Australian Doctor 28th July 2017 | Page 5

In Brief

Bush doc ’ s back to the work he loves

GEIR O ’ ROURKE ONE of the father figures of rural general practice is back at work , five years after being deregistered following a horrific head injury .
Dr Jack Shepherd , the founding president of ACRRM , regained unconditional registration in June after completing eight weeks of supervised work in Gilgandra , in western NSW .
And he says the rebound wouldn ’ t have been possible without the generosity and support of the former RACGP GP of the year , Dr Patrick Giltrap , who supervised his placement .
The 73-year-old is credited with writing much of the curriculum for GPs working in the bush , yet landing his new job at the Orange Aboriginal Medical Service may be among his most significant achievements .
“ I ’ m in clover . Feeling like I can still be of use is the greatest happiness to me ,” he says .
The rural GP ’ s career has taken him around the world — from London and East Timor to the tiny town of Derby in WA .
But it seemed all but over in 2012 , when a Meniere ’ s disease attack saw him collapse in the corridor of Charleville Hospital in northern Queensland , severely fracturing his skull .
Dr Shepherd remembers the sickening spin and his futile jump
to try to avoid hitting the ground in that moment .
“ I wanted to die because , while I knew I had a fracture at the base of my skull , I couldn ’ t remember the words ,” he says .
“ I thought I was done for , and it seemed utterly impossible that I would return to practice .”
After the collapse , the doctor became forgetful , prone to falling over and required full-time care
from his wife to manage basic tasks .
“ The only thing that saved me from going totally nuts was the fact that I was a returned soldier from Vietnam , and the Department of Veterans ’ Affairs was incredibly sympathetic and useful ,” he says .
The feeling that he was losing relevance was devastating .
“ I have learned to my sorrow
‘ I ’ m in clover . Feeling like I can be of use is the greatest happiness to me .’
— Dr Jack Shepherd
that among doctors , you are nothing if you are retired . You don ’ t have a say ; you don ’ t have a valid point of view ; you can ’ t influence anything unless you are working .”
He shunned the company of other doctors , but tried to ease his way back into society — slowly at first , by cooking sausages at the local Rotary Club , before moving on to sailing with other disabled adults .
With time and patience , his health began to improve and by 2015 , specialists gave him the green light to restart his medical career .
That glimmer of hope was enough , and he dedicated the next two years to relearning how to be a doctor .
In March he was placed under the supervision of Dr Giltrap , the 2005 RACGP GP of the year ,
“ It was terribly frightening , and I was nervous as hell in my first few days that I would be too forgetful , too slow .”
But Dr Giltrap is a “ model of kindly charm ”, he says .
“ He countersigned every referral I did , all my X-ray requests , and it must have taken him an extra hour every day ,” he says .
“ It wasn ’ t frustrating ; it was reassuring that I was protected from making a mistake due to memory lapses .”
No memory lapses occurred , although five years out of medical practice means Dr Shepherd has had to learn the names of hundreds of new medications and others that have been renamed .
Dr Shepherd says he once again feels confident that he can meet the challenges of caring for patients .
And those who have known him a long time say he has more to give to the profession he loves .

NOACs drive rise in AF anticoagulant use

MICHAEL WOODHEAD THE availability of novel oral anticoagulants ( NOACs ) has increased the use of stroke prevention therapy for atrial fibrillation , particularly for highrisk patients , an Australian study shows .
Rates of anticoagulation increased from 52.5 % to 60.7 % of patients with non-valvular atrial fibrillation between the pre- and post-NOAC eras , according to the study carried out at the Royal Hobart Hospital .
There was a notable increase in prescribing rates of oral anticoagulants for high-risk AF patients from 55 % to 63 % after 2013 , when NOACs became available .
However there was no reduction in overprescribing of oral anticoagulants in low-risk AF patients , according to the authors of the study .
Their research compared discharge antithrombotic prescribing patterns for 1089 AF patients in the pre-NOAC era ( 2011-2013 ) and 1029 patients in the NOAC era ( 2013-2015 ).
In the pre-NOAC era , 39 % of patients with AF received warfarin , but the rate fell to 20 % after NOACs became available .
NOAC use increased from 2 % to 34 % of patients with AF , up to 2015 .
Among low-risk patients , anticoagulant use rose from 35 % to 43 %.
The authors said the increase in anticoagulant use in patients with AF was driven by the availability of NOACs , such as dabigatran , rivaroxaban and apixaban , presumably because they did not require regular monitoring , in contrast to warfarin .
The increase in anticoagulant use among high-risk patients was reassuring , but there was still room for improvement , they said .
“ While oral anticoagulant under-use in high-risk patients persisted in the post-NOAC era , there was an apparent increase in oral anticoagulant use in low-risk patients .”
“ These findings highlight the need to identify the drivers of anticoagulant under- and over-use and address them accordingly ,” they concluded . American Journal of Cardiology 2017 ; online .

Could chocolate curb atrial fibrillation ?

EATING chocolate may prevent atrial fibrillation according to new study findings , but some cardiologists are not having a bar of it .
An inverse relationship between chocolate intake and AF was seen in a 14-year prospective cohort study of 55,000 people in a Danish study .
People who ate chocolate on a daily basis had reductions in relative risk of atrial fibrillation of up to 20 %, compared with people who ate little or no chocolate , according to the study by epidemiologists at Aarhus University .
The researchers said the cocoa in chocolate contained flavanols , which have vasodilatory , antioxidant and anti-inflammatory benefits .
This could improve endothelial function , decrease fibrosis , and prevent structural remodelling of atrial tissue , they suggested .
However , an accompanying editorial by US cardiologists said the findings sounded too good to be true and called for more rigorous research before recommending chocolate .
“ It will be interesting to see if chocolate is an effective preventive therapy . Perhaps what is bad for the pancreas is good for the atria ,” they postulated .

In Brief

Staff writers
Methotrexate dosing error DESPITE repeated warnings , overdosing errors continue to occur with methotrexate prescribed for patients with rheumatoid arthritis , the TGA says . The regulator has released a raft of recommendations on education , packaging and dispensing , to try to address the problem of patients mistakenly taking daily doses of the drug . Methotrexate is usually prescribed as a once-weekly low dose for rheumatoid arthritis patients .
Psychiatrists back vaping THE use of e-cigarettes has received cautious backing from the Royal Australian and New Zealand College of Psychiatrists ( RANZCP ). In contrast to the opposition expressed by other medical groups , the RANZCP says there may be a place for vaping as part of a harm minimisation approach for people who smoke . In a submission to a parliamentary inquiry , the college acknowledged the lack of evidence for e-cigarettes in smoking cessation , but said access should be allowed “ with an appropriate legislative framework ” to provide an alternative to the much more harmful use of tobacco .
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