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An all-black cardiology stethoscope hangs around my neck on the ward round in intensive care.
‘We should really ban those from intensive care,’ states the consultant. I interject that the cheap, toy-like stethoscopes that hang at each bedside are laughable pieces of plastic. That I might as well put my ear to somebody’s chest, because really, I would hear more in that instance.
‘If you’re reviewing on the wards,’ the consultant adds, ‘fine, but here in intensive care that stethoscope contributes nothing to patient care’.
‘What if I listen and hear a severe aortic stenosis we didn’t know about or a quiet base, which induces me to look at the patient’s most recent chest x-ray and white cell count and treat them for pneumonia?’
‘You should look at those things anyway.’
They are right and the truth is I continue to possess this stethoscope mostly for when I go to the wards, but I do love a good debate. So, I pull out another reason, and one that actually I am not sure we can do anything about.
‘What if I never listen to anybody’s chest on the ICU ward round and then something bad happens and they say you should have listened, if they say a reasonable doctor would have done that as part of a basic clinical examination.’
And I am answered that a reasonable doctor witness wouldn’t attest to that, in the setting of intensive care, because they’d be wrong.
‘Ah,’ I reply, ‘but what if my fate is not dependent on the opinion of a reasonable doctor or expert, but primarily on a jury of lay people who decide that doctors use stethoscopes?’
But at this point, the F1 approaches. He has been examining the patient on front of us, as I had asked him to, and he wanted to tell me that he wasn’t really sure if the patient had ‘crackles’ or ‘wheeze’.
So, I smile, take the stethoscope from around my neck, give it a rub with the disinfectant wipes at the bedside and say, ‘that’s not a problem, why don’t we have another listen together’.
And it is impossible for me not to look at the consultant and smirk, but knowingly, she smiles back and says: ‘That is teaching, which I am sure you know is something different entirely.’
‘Did you do that on purpose?,’ I ask the F1 when we reach the bedside and he says ‘no, I really just don’t know which it is’.
‘She’s probably right you know’ I tell the F1 as we listen ‘but I do love my stethoscope’.
They were crackles.
By the Secret Doctor
Read the blog and follow @TheSecretDr on Twitter and on Facebook
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