I broke my stethoscope this week. I was listening to a chest, on a ward round, as you do, and the ear-pieces just went all wonky. The metal spring hidden in the rubber tubing had snapped. <\/p>\n
My stethoscope is like Trigger\u2019s broom \u2013 I\u2019ve had the same stethoscope since 4th year of medical school; I\u2019ve only replaced the diaphragm twice, the bell rubber three times, and the tubing once. The metal bit \u2013 the business end \u2013 is the original, shonkily engraved with my name.<\/p>\n
I borrowed my registrar\u2019s guessing tubes for the rest of the ward round. I think I used them once.<\/p>\n
I\u2019ve found a place that will sell me a replacement tube\/earpiece thing. Last time it broke, in 2001, I think, I went to a medical supply store, and picked out the replacements. This time it\u2019s the internet to the rescue, of course.<\/p>\n
I was very excited about getting my first stethoscope. 1997, 4th year of medical school, and the Littmann reps came to the students\u2019 mess with a range of excitingly coloured stethoscopes, and boxes of complimentary fish and chips, I recall. The decision of colour was simple \u2013 hunter green, obviously \u2013 but the mode of transport was perhaps more important: over the shoulders, round the neck, in a pocket?<\/p>\n
Fast forward 5 years and I was using (mostly) the same stethoscope sitting my PACES exams. No longer guessing with my tubes, I was dedicated to the fine art of differentiating a murmur of aortic stenosis from that of mitral regurgitation. Fortunately the murmur in my exam was aortic regurgitation, and I didn\u2019t have too much trouble.<\/p>\n
I was regaling my registrar with this tale of exam pressure in 2002, when she asked me \u201cBut what\u2019s the point, though? You\u2019re going to get an echo regardless, aren\u2019t you?\u201d Yes, that\u2019s as maybe, but they\u2019re really important for listening to lungs, say I. \u201cBut aren\u2019t you going to get a CT?\u201d Sigh.<\/p>\n
She makes an interesting point though. <\/p>\n
10 years ago, when I started my respiratory registrar post, we had access to an ultrasound machine. It was the size of a top-loading washing machine (remember those?), and weight about 20 metric tons. We didn\u2019t use it very much. Now we have a number of portable USS machines, all the size of a chunky laptops, and every chest SpR has to be trained to \u2018level 1\u2019 before they can get their CCT. Is there a pleural effusion, is it consolidation, is it an elevated diaphragm? We don\u2019t listen, we don\u2019t percuss any more, we get the ultrasound machine out and we know.<\/p>\n
Should we be training up all our doctors to use the same ultrasound machines to look for valve abnormalities? I\u2019m no cardiologist, so I have no idea how long it must take to train up to be able to look at valves, but the cardiology trainees manage.<\/p>\n
In days of yore the fine details of murmur analysis were critically important. When to refer for an aortic valve replacement? When the second heart sound disappears, of course. Who would refer for an AVR without a valve area, or pressure gradient? W don\u2019t put in a chest drain without doing an ultrasound of the thorax immediately beforehand, would we?<\/p>\n
So should I get those replacement parts for my stethoscope? It\u2019s going to cost me over \u00a3100 after all. Or would I be better off putting that money towards an echo course?
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I broke my stethoscope this week. I was listening to a chest, on a ward round, as you do, and the ear-pieces just went all wonky. The metal spring hidden in the rubber tubing had snapped. My stethoscope is like Trigger\u2019s broom \u2013 I\u2019ve had the same stethoscope since 4th year of medical school; I\u2019ve […]<\/p>\n