William Hanley and Anthony Hanley are quite correct to emphasize the importance of time management in their consideration of the traditional (T) versus the cool (C) position for resting stethoscope placement.1 Before we adopt their recommendations, however, I will offer a word of caution via the following case report.
Forty years ago, I was called to the emergency department to examine an unconscious patient. Rapid assessment revealed a rather large, muscular 20-year-old male medical student who was apparently experiencing insulin hypoglycemia. Venipuncture was performed in the left antecubital fossa and a sample of blood withdrawn for glucose estimation. This was followed immediately by intravenous glucose injection. The patient began to stir, then suddenly sat up. With his right hand he grabbed the stethoscope from around my neck (T position) and, with an expletive, smashed it into my face with stunning force, lacerating my nose. I managed to keep the patient's left arm secure and complete the injection while others calmed him.
As a result of this unfortunate experience, I have made a practice of advising medical students and others to carry the stethoscope in the pocket (P position). Besides safety considerations, the financial benefits of this method to our national resources are obvious, as questions of workers' compensation are unlikely to occur.
Perhaps a more elegant position may be advocated by those of us who still wear jackets or white coats. This is the subaxillary (SA) position, in which the jacket is opened with a flourish, the stethoscope ear pieces are hooked into the upper inside sleeve and the jacket is rebuttoned. This is both safe and cool, and may even enhance the bedside manner. Regrettably, it is probably too time consuming and is unlikely to attract many adherents today.
May I therefore recommend the pocket as the safe, practical position for a stethoscope at ease.
Reference
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