The stethoscope as stole or placebo   3 comments

Posted at 9:14 am in Medicine

Domhnall MacAuley reports on a recent respiratory medicine master class, from which he comes off thinking about the stethoscope:

Do you still use a stethoscope…? So, last century. Traditionally trained clinicians might have come away from the masterclass a little disillusioned: The stethoscope, our traditional garland of honour, may be of little value in respiratory medicine and, possibly in general practice; its sensitivity and specificity is poor.

…and Anthony Papagiannis, a respiratory physician in response to the post says:

As to the stethoscope, one of my mentors used to say that the modern chest physician can be deaf but cannot be blind as radiology is a key instrument in our diagnosis. However, the stethoscope is to the clinician the equivalent of the stole to the cleric: a mark of authority, a symbol of Hippocratic (or Laennecian) acumen, a powerful placebo that we can only ignore at our peril.

So frankly, it does bear some thinking about, doesn’t it? How do you really use the stethoscope? As stole or as placebo, or in the traditional twentieth century fashion?

Reblog this post [with Zemanta]
  • Share/Bookmark

Written by SA on October 25th, 2009

Tagged with ,

«
»

3 Responses to 'The stethoscope as stole or placebo'

Subscribe to comments with RSS

  1. Hi,

    Dr Nolan blog about “What does you stethoscope say about you” on BMJ’s community site doc2doc.

    http://ow.ly/wNjs

    David

    David Admin

    27 Oct 09 at 9:08 pm

  2. Thank you for bringing my remark to the fore. I would contend that it is not just how WE use our stethoscope, but also how OTHERS interpret our use of it. I do not wear a white coat in the hospital I work in, but I always carry my stethoscope draped over my neck. Patients and visitors immediately know me as a doctor, though I could easily be a bold and confident impostor. I may or may not apply the stethoscope on every patient I see in my rounds, but I know it is usually anticipated: it is part of the “laying-on of hands” in medicine. Its use builds confidence and establishes rapport between the patient and me, even when it does not significantly promote my clinical knowledge. As long as I am aware of its limitations, I hope it will continue to serve me well in its dual capacity.

    Anthony Papagiannis

    29 Oct 09 at 8:02 am

  3. Thank you very much Dr Papagiannis for your once again pithy comment. The use of the stethoscope has always fascinatied me, especially how it is perceived by the patient. In my early days as a green preregistration house officer back home in Nigeria, whenever I saw a patient without using the sthetoscope and try to reassure them that all is well, I often heard the complaint: “But doctor, you have not tested me.” And I would ask, “What do you mean by testing you? I’ve talked to you, discussed with the nurses and had a look at your charts and you are fine.” And the patient answers back: “The stethoscope.” It was not long before I learnt to always use the sthetoscope on every patient in out patient clinics and whenever I’m called to see or review a patient.

    SA

    29 Oct 09 at 10:36 am

Leave a Reply