Notes from a Medical Student:

Let’s Play It by Ear

In Greek, stéthos means “chest” and skopé means “examine.” And from the Mediterranean to the far side of the Atlantic, from its invention in 1816 to modern times, the stethoscope has become perhaps the most recognizable symbol of the medical profession in the world.

Simply walk into a hospital, and you'll see physicians and medical students with their stethoscopes tucked into a pocket of their white coats-amidst sheets of papers, penlights and reflex hammers.

Often, we wear them around our necks like gaudy pieces of jewelry. In our defense, it's a comfortable location, and besides, that's what the doctors on television do.

When we use it, the stethoscope transmits sounds from inside the body. It's a simple but impressive instrument that somewhat magically allows us to hear a malfunctioning heart valve or detect the presence of a defect in the heart wall.

It lets us take a journey through the skin and chest wall, into the patient's lungs, and it can warn us about the possibility of narrow blood vessels, among other things.

But the stethoscope isn't what we use to actually listen to the other human being in the room. We rely most of all on our ears, which we use-by training, yes, but by human nature most of all-every moment we are with a patient.

One could, in fact, argue with ease that our ears are the most important diagnostic tool we have at our disposal-more useful and more meaningful than X-rays, blood tests and blood pressure cuffs.

After all, with our ears, we listen to our patients' stories, long before we put on the stethoscope to listen to their hearts.

Recalling William Osler's frequently quoted observation-"The good physician treats the disease; the great physician treats the patient who has the disease"-the difference between "good" and "great" may simply depend on our willingness and ability to use those two appendages on the sides of our heads.

With them, we learn not only the history of the patient's present illness, but we provide the patient with an outlet to share any deep concerns, worries, and feelings. Just like the rest of us, patients need an opportunity to share their stories-medical or otherwise-and that's why, in my experience, the patient does most of the talking.

Soon after beginning my third-year clinical rotations this August, I met a patient who came to the office with a sore throat. But the visit focused very little on the sore throat and very much on the mounting stress in her life-from losing her job to caring full-time for a family member recently diagnosed with Stage 4 cancer.

There are many more solutions for a short-term sore throat than for long-term stress. There's no question about that. But at least she was able to tell me her story, and all I needed to use for those 20 minutes were the great "medical devices" that all humans have, and that are used by physicians all around the world for listening to patients.

Ultimately, as I walked out of the room, the patient — her throat probably still sore but her mind, I hope, more at ease-offered one last sentence for me.

“Thank you so much, for listening.”

My stethoscope, of course, had never left its comfortable location, securely draped around my neck.