Tales from the tools: My stethoscope

Chris Hogan

28/05/2019 12:23:43 PM

Dr Chris Hogan reflects on what his mentors taught him about the vital tools of healthcare.

A stethoscope
Every medical tool of the trade has stories attached.

It is said that people communicate best when they work with each other.
And so it was with my father and I.
In our backyard shed, he would explain to me not only what a tool was called and the function it had, but he would tell me a story; how it had come into his possession – or stewardship, as he described it. Many times, the tool was old.
‘If it has lasted this long, son, it will last a lot longer,’ he would say.
My father would use the tool as a story stone, an aide memoire for a grand tale. The stories would often be about the person who gave him the tool and how they had worked together.
After a long career as a GP, I came to realise that I, too, had a story for each of my pieces of medical equipment.
My first stethoscope was special. It was an awe-inspiring tool and a badge of my new life and identity. I inscribed it with my name and learned to care for it through trial and error.
My stethoscope – a gift from my proud parents – was usually crammed into a pocket of the short white coat I wore around the wards. When the tubing split one day, I understood the most durable way to wear it was draped around my neck.
I slowly learned to use this tool to its fullest. How to keep it clean, how not to transfer infection and how to wield it (without embarrassment) to the patient’s benefit. I built up a library of sounds in my own head and developed a sense of what was normal, what was not normal but not pathological, and what was definitely pathological.
I remember when it did not work.
I could not get a BP reading because the pressure was too low for Korotkoff sounds – I was riding in the back of an ambulance going lights and sirens to hospital, attending to a patient in dire peril and the pounding of blood in my ears blocked out any other sound.
I listened and no noise came from one side of my patient’s chest. I took a slow, deep breath to focus on the needs of the patient. My own fear served no function, except as a distraction.
I heard the wheeze of asthma, the rales and crepitations of infection and the pleural and pericardial rubs, the hollow echoes of cavitated TB. There were things absent that should have been present, and vice versa. I heard the unilateral wheeze of a stone in the right bronchus, of a compressive cancer.
Far too often, I heard nothing. After that silence, I turned to the nearest table and completed the death certificate.
I remember the roadside trauma, the cricothyroidotomies I had to do. I recall the anaesthetics.
Did I really do all that?
I remember all the techniques I was taught by those who had seen and done it all, and who were only too glad to have an eager pair of ears. These mentors had so many stories bound up in medical confidentiality that they could not share with family or intimates. Only as teachers could they speak about.
Their passion imprinted their stories into my consciousness. Though they are gone, I can see them still.
In spite of my encouragement, these doctors never wrote their life stories, which is probably why I have become a researcher, a teacher and now the RACGP Victoria Historian, to see that they are remembered. They learned their craft by the trial and error of everyday practice. Sometimes, they had paid a high price for their knowledge, and if I or any other doctor could be spared by their experience, they would rest happy.
I remember one of my teachers told me something that rang true: ‘Chris, experience is what is left when you survive your errors.’
The RACGP is seeking contributions for stories about GP tools of the trade. Submissions can be made on the RACGP website. This column is adapted from RACGP History.

medical history stethoscope

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Dr Pradeep Jayasuriya   29/05/2019 10:49:09 AM

Wonderful article, Chris. This is the essence of what we do.

Igor Jakubowicz   29/05/2019 11:13:20 PM

Indeed, a moving article. People forget the decades we have spent acquiring skills. They think the skills can be taken over by nurses or pharmacists. Some even think that Apple or Google are equivalents.

Trisha Boetto   30/05/2019 5:07:13 PM

A great story Chris. I was enthralled from woe to go. What an interesting life you have led as a GP! I agree that our stories and those of our patients are worth telling.

Elizabeth Martin   30/05/2019 8:24:15 PM

Hi Chris, I remember a story from working with you when you mentored me as a registrar (trainee then), where a patient presented having battled asthma overnight but had waited valiantly till the clinic opened, only to go into respiratory arrest as I took a detailed history and formulated a plan... Luckily you were there to intubate her!

Chris D Hogan   26/06/2019 1:53:37 PM

Thank you all for your comments. Liz, I remember that patient of ours. We set up a case conference for her with me, a pharmacist, asthma educator & practice nurse. It turned out that she had greatly underestimated the severity of her asthma. She increased her knowledge significantly & turned from a "frequent flyer" to someone who needed to be recalled for review. She did particularly well & left the practice for a retirement village near her daughters 7 years later.