“Psst! Turn your Stethoscope Around!”

The “Clue-O-Meter” has many different readings. Just a few of the possibilities are: “Stills needs some guidance, but has the big picture” “Generally out to lunch, but occasionally has moments of understanding,” “Pretty clueless,” “Definition of clueless,” and “So completely clueless, that the Clue-O-Meter can’t even get a reading on how clueless this person is.” Unfortunately, at our stage in our medical educations, many of us are at the last of those Clue-O-Meter readings. In fact, it is my new found conviction that if our future patients could see us right now in our education, they would never come to us for medical advice and they would definitely never let us treat them.

Allow me to demonstrate from my own experiences (and those of one of my friends) to refute the widespread belief that being in medical school equals intelligence and medical knowledge. Allow me to start with the basic tool of all of medicine and a physician’s best friend - the stethoscope. The earpieces of a stethoscope actually tilt in a certain direction. Please see the picture below. They are supposed to be worn so the earpieces point towards your nose. (So in the picture below, if I was wearing the stethoscope, my nose should be pointing towards my hand).

The School of Medicine alumni association generously gave us each a stethoscope at the beginning of fall quarter (previous pictures posted). However, many classmates and I haven’t really used them before in a practical setting. This quarter several of my friends and I are taking our very first preceptorship. We get to follow around a real doctor and get a taste for what we might be doing several years from now. It is so much fun (I am planning on posting more about my preceptorship in the future). At the end of my first morning with my preceptor she told me to bring my stethoscope next time. I was pretty excited, what was I going to be doing? The night before my next preceptorship I realized that I wasn’t exactly sure how to wear my stethoscope. I looked up the directions and discovered that the earpieces were supposed to point forward and I successfully listened to my own heart beat.

The first patient that morning was in for a health check and a referral. I was watching the visit with interest and suddenly my preceptor turns to me and says, “Great. Well Christine, why don’t you listen to this patient’s heart and lungs while I get this referral form?” Slightly startled, I said “OK” and approached the patient as my preceptor left the room.

(This is what I felt like as I approached the patient, although I tried to hide it in an appearance of calm)

He was an elderly gentleman and the lifted up the back of his shirt so I could listen to his lungs. He gave me a look of complete confidence and trust. I quickly put on my stethoscope (ensuring the earpieces were facing forward) and looked at the patient’s back with trepidation. I had never actually listened to someone’s lungs before. I thought back to anatomy and placed my stethoscope in the general vicinity of where I thought the left lung should be. It sounded sort-of like wind blowing through a tunnel. I figured I’d better move the stethoscope around a bit (like I had seen my preceptor do on an earlier patient). While I was doing this I thought to myself, “I am so totally faking this right now and this guy doesn’t have a clue that I have no idea what I am doing!” I also successfully listened to the patient’s heart and was finishing just as my preceptor stepped back into the office.

She looked over at me and asked, “So everything sounds good?” I said something like, “Well, um, it is my first time listening to the heart and lungs of a patient so I don’t really know what to listen for. But I think it might have maybe possibly sounded like what I would imagine good heart and lungs to sound like.” She said, “Well, if you aren’t sure, I guess I’d better listen then.” My internal reaction to this statement was “WHAT?” Apparently, if I had said that I was completely sure this patient’s lungs and heart were fine, she wouldn’t have even listened to them. I think she had much more confidence in my skills than I did. She listened to the patient’s heart and lungs and determined that they were in great condition, so I guess it would have turned out fine anyway.

One of my friends who also just started his preceptorship had a similar experience, except he didn’t practice with his stethoscope the night before. Therefore when his preceptor told him to listen to the patient’s lungs, he put on his stethoscope on backwards (earpieces pointing towards the back of his head). He later described his extreme mortification when his preceptor whispered behind the patient’s back, “Psst! Turn your stethoscope around the other way.”

Now, you may be thinking, ‘Oh, that isn’t so bad.’ Unfortunately, my embarrassment does not end there. I must further display my lack of knowledge of medical instruments, by admitting my difficulties in trying to find the on/off switch on my Oto/Opthalmoscope. For Christmas, my grandpa, grandma, aunt, uncle and dad all generously pooled together some money to buy me an otoscope/throat (and eye) illuminator which is required for spring quarter when we start learning the physical exam. Last week I decided that I was going to get it out and experiment with it. I briefly considered reading the directions and then scoffed at the idea. I am a medical student after all, how hard could it be? When I first took it out of the case I tried to find the “on” switch, without much luck. Then I realized in a stroke of genius that it probably had to be charged before it could be turned on. I successfully managed to take it apart and place the base in the charger overnight.


(Ahhhh... Genius. You have to charge it before it will produce light)

The next evening I decided to try again to conquer my now charged otoscope and learn how to turn it on. It sounded so simple, and yet, the on/off switch still remained a mystery.

(My bewilderment as I tried to figure out how to turn on my otoscope).

Finally, after at least five minutes of additional experimentation, I found the elusive on/off switch. It was at the top of the handle. You had to push a green button and rotate a black ring about a quarter of a turn until the green button popped back into place. Intuitive? Not for me!

The on/off switch circled.

“On”

“Off”

At last, complete success – stethoscope correctly positioned and otoscope turned on. Whew. I have a bad feeling this is just the beginning of feeling cluelessness as I embark on many years of medical training. Will my future patients ever find know just how clueless I was during medical school? I hope not. (Although the fact that I am publishing this on a website available to any internet user does not bode well for hiding my ignorance. Hmm... Perhaps this blog entry will mysteriously disappear after a few months).