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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