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Letters

The stethoscope at ease

John D. Campbell
CMAJ March 20, 2001 164 (6) 748;
John D. Campbell
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The groundbreaking research of William Hanley and Anthony Hanley into the efficacy of the traditional versus the cool placement of the stethoscope when at rest has made a valuable contribution to medical practice.1 However, the good doctors have missed the true significance of the position of the resting stethoscope. It is, in fact, all about the power of the physician and the stethoscope's place as an icon of that power.

Down through the ages the physician's power has been symbolized by various icons. In ancient Greece it was the caduceus, later the physician's staff, and so on. In the 19th century it became the white lab coat. However, lesser members of the “health care team,” jealous of the physician's power, have usurped that symbol so that today even the volunteer working in the hospital admitting office wears a white coat.

Through all of this, the stethoscope remained uniquely the physician's. The surgeons, recognizing its symbolism early on, took to carrying one as well. However, because they did not understand its use, they took to letting the instrument peek coyly out of the pocket of their lab coat. A true physician, of course, always has his stethoscope at the ready around his neck in the traditional position.

It was inevitable that sooner or later the lesser orders would take to wearing a stethoscope in the hope that some of its power would pass to them. And so, for example, the stethoscope used for taking blood pressures no longer hangs on the blood pressure machine but around the nurse's neck. However, some nonphysician wearers of the stethoscope, not being skilled in its use, have taken to just slinging it around their neck in the cool position. Hanley and Hanley have shown us just how inefficient this position is, but as the wearers have no practical use for their stethoscopes, it doesn't really matter.

It is a telling commentary on the quality of clinical teaching in today's medical schools when we see so many of our younger colleagues wearing their stethoscopes in the cool position. Obviously, they too are unfamiliar with its use and rely entirely on the lab and the diagnostic imaging department to make their diagnoses for them.

It is interesting that it was the surgeons who first recognized the symbolism of the stethoscope and it is they who have been the first to recognize its decline. Our surgical friends have turned in their stethoscopes and have taken to parading around in their scrub suits as their icon of power. Inevitably, others, jealous of the power surgeons now exude, have taken to wearing scrub suits as well. Sadly, the nursing profession has given up its symbol of power, the crisply starched uniform, in favour of this forerunner of the grunge look.

As for the stethoscope, I would suggest that the T or traditional position be renamed the U or user's position and that the C or cool position be renamed the U2 or usurper's position. Meanwhile, the traditional in-the-pocket position can remain the SP or surgical position as a reminder of the good old days.

Reference

  1. 1.
    Hanley WB, Hanley AJG. The efficacy of stethoscope placement when not in use: traditional versus “cool.” CMAJ 2000;163(12):1562-3.

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