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On Being a Doctor |

My Stethoscope

George A. Sarosi, MD
[+] Article, Author, and Disclosure Information

From Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417.

Corresponding Author: George A. Sarosi, MD, Minneapolis Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55417; e-mail, george.sarosi2@va.gov.

Ann Intern Med. 2012;156(1_Part_1):62-63. doi:10.7326/0003-4819-156-1-201201030-00015
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As I dug through the drawers of a forgotten cabinet, I found my old slide rule. Forty-five years ago, this instrument had been critical to my daily life and dangled from my belt for at least 2 years. It saw steady, daily use, and with it, I was able to do complex calculations effortlessly. I immediately tried to use it, and to my chagrin, I found I could not. Even after searching online for operating instructions, I found it all but impossible.





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My Stethoscope
Posted on January 27, 2012
Joel D., Brown, MD
University of Hawaii
Conflict of Interest: None Declared

TO THE EDITOR: Dr. Sarosi (1) laments the apparent lack of value of his cherished stethoscope and his skill in using it. Residents on the wards of tertiary care hospitals often see patients who have had extensive outpatient evaluations by referring physicians. The residents review the laboratory and imaging results, the prior physicians' notes, and the current diagnosis, all of which seem to make their bedside exam irrelevant. This discourages residents from doing a good clinical evaluation, and encourages them to spend more time with the computer than with their patient. Their physical exam note is often written with a template indicating "No JVD, NSR, normal S1,S2, no murmurs, rubs or gallops," despite the abnormalities described on the echocardiography report.

Unlike echocardiography, stethoscopes are immediately available during daily bedside rounds to detect the new murmur of aortic insufficiency due to infective endocarditis, the delayed appearance of the pericardial rub of pericarditis, or the accentuated pulmonic second sound due to a hospital acquired pulmonary embolism. Although the abnormalities detected by echocardiography or other modalities may diminish the added value of the physical exam, such findings provide opportunities to teach physical examination at the bedside. When tricuspid insufficiency has been demonstrated by echocardiography, the teaching attending can demonstrate the characteristic jugular vein pulsation and the lower parasternal systolic murmur that increases with respiration.

When their residents enter practice and become the first physician to see the patient, they will not have such ready access to echocardiography. But they will have their stethoscopes.

Joel D. Brown, MD, FACP, FIDSA, DTM&H University of Hawaii John A. Burns School of Medicine Honolulu, HI 96813

Reference 1. Sarosi GA. My stethoscope. Ann Intern Med. 2012; 156:62-6.

Conflict of Interest:

None declared

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