Monday 20 May 2019

Rude health... Gaybo's doctor

Ireland struck medical gold with the late Austin Darragh, says Maurice Gueret, as he recalls a true gentleman

Dr Austin Darragh
Dr Austin Darragh

Maurice Gueret

The passing this month of Professor Austin Darragh of the Hermitage Medical Clinic marked the end of an era. In a profession that places so much emphasis on curriculum vitae, his was unrivalled.

His achievements and interests were many, but for generations of middle Ireland he was simply 'The Doctor' on Gay Byrne's legendary radio show. Gaybo knew medical gold when he saw it, and, for many years, the professor dispensed pearls of clinical wisdom, as the unofficial voice of Irish medicine. Gay played the role of doctor's assistant with wonderful aplomb. He brought interesting cases to the physician's attention, mopped the medic's brow when the studio got warm, and always ensured that his guest's towering intellect was used to best effect. Professor Darragh was unflappable, sure-footed, and possessed of many bees under his clinical bonnet. Coffee and tea were his particular betes noires. He certainly had no shares in caffeine!

Things weren't easy for Trinity medical graduates in the early decades of this State, but Austin Darragh bucked the trend by doing things himself, rather than relying on the State to do them for him. He founded the Irish Cancer Society, and later purchased Sir Patrick Dun's hospital to house a growing business in medical research. In later years, he practised privately as a physician, and gave tremendous assistance to patients with unusual symptoms such as chronic fatigue. Every time I ran for an elusive Trinity Seanad seat, he would write or ring with the most encouraging of words. He was a gentleman, an old-fashioned gentleman, the sort we might want all our doctors to be. Alas, year-on-year, there are fewer of them around.

Whiplash claims

Hefty increases in car insurance are around the corner. It may be timely to have another look at whiplash claims, which are on the rise again. At anything between €15,000 and €70,000 for Irish neck sprains, perhaps it's no surprise. One major insurer in the UK says that one quarter of every car premium goes on whiplash payouts. Our Personal Injuries Assessment Board (PIAB) has done a fine job reducing legal and medical costs, but not enough has been done to reduce cash payouts for invisible injuries that are prone to opportunistic claims. Figures on the exact number of whiplash claims are not given in the annual PIAB report, but it's reckoned more than 70pc all motor claims are for whiplash. Drivers in France have tougher necks. French whiplash, or coup de fouet, accounts for just three pc of claims. One interesting new suggestion is that insurers might offer free pain care and physiotherapy for these injuries, instead of cash. An Australian study has shown that making a claim for whiplash has the effect of exacerbating the condition. Insurers might avoid cash payouts by simply adding pain specialists and physiotherapists to their fixed lists of panel beaters and glass restorers. More rehabilitation and less reparation could be just the cure.

Neck sprains

Ireland spends far more money on neck sprains than on serious injuries to the spine. The recent announcement that a new 120-bed facility is to be built at the National Rehabilitation Hospital is welcome, but decades too late. Originally a TB hospital, rehabilitation facilities at Dun Laoghaire have been severely lacking since it opened its doors in 1961. Its year-long waiting lists are crazy, for what is an essential, time-dependent service, and it hasn't nearly enough beds for high-dependency patients. Earlier this year, listeners to Joe Duffy's Liveline programme heard the stories of Irish people injured abroad being forced, by their travel insurers, to leave high-tech hospitals and come home for rehabilitation services that are simply not there. One father told of an institution "like something from the dark ages" with dormitory-type rooms that have been patched up and painted-over for years. The pressure on beds and resources is such that some patients have to be transferred out for nursing-home care, rather than keeping them for intensive rehabilitation. There were no criticisms of its capable staff, just the pointing out of what happens when a Cinderella service is starved of investment. The recent funding allocated to rehabilitate the hospital was €15 million. A drop in the ocean for a fine nation that has found well over one billion euro to spend on whiplash.

Analysing your thatch

We continue our clinical examination this week with a brief look at your hair. Despite the fact that your local Chinese-medicine establishment can diagnose a million diseases from a single strand, doctors are more cagey when it comes to analysing your thatch. Nits and lice are the only things I can diagnose from a single lock of hair. Things that might spark medical interest are unusual bald patches, which can be a sign of underlying disease or stress. Hair loss is known as alopecia, and the scalp needs to be examined to make sure there is no scarring or underlying skin disease like ringworm in a bald area. Traction alopecia, where the hair is yanked out in clumps, is not uncommon in anxious children. Women who lose their hair in a typical male-like pattern may need to be investigated for hormonal changes. If the scalp looks healthy, but hair loss is profound, blood tests for anaemia or an underactive thyroid might be warranted. Temporary hair loss after childbirth or crash-dieting is a well recognised phenomenon. We were always trained to look out for the rare 'moth-eaten' alopecia of secondary syphilis. I am still looking for it. We'll inspect your ears next week.

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

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