The First Step to Show "I Care"

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Photo by Hush Naidoo Jade on Unsplash

On the first day of the first year of medical school, we students were each given a free “Doctor’s Instrument Bag” which included a stethoscope inside. It was as if we doctors-to-be were being anointed to physician-hood. It was a proud moment that I still recall nearly six decades later. That black bag with its stethoscope inside had my name embossed on the outside followed by M.D. to indicate the beginning of the long schooling that lay ahead for me to become a full-fledged Medical Doctor.

The first year of medical school in that era of the late 1960’s did not include direct patient care. Classes and instruction were limited to Anatomy, Histology and Physiology. But time began to fly and by the end of the second year, clinical training began with direct patient contact, and, lo and behold, out came our stethoscopes as we medical students began to develop our skills to physically examine patients

Listening to a patient’s heartbeat and breath sounds with our stethoscopes was often the first thing we would do. In addition to auscultation (listening to the heart, lungs, arteries and abdomen)one of my professors pointed out that the stethoscope had the important function of normalizing physical closeness between doctor and patient. This physical closeness would set the stage for more intimate aspects of a normal physical examination which would include nearly all parts of the patient’s body. Using the stethoscope normalized this reality so that physical closeness might not be experienced as intrusive.

Comprehensive physical exams by a physician can be unsettling to some people as the most private parts of one’s body may need to be looked at and examined. Essentially no one else touches many parts of our bodies that we ourselves take care of once we are no longer in early childhood. Being examined by a physician can feel intimidating, awkward, or even embarrassing to many people; how physicians proceed requires establishing trust, including the use of a stethoscope on the part of the physician to help establish that trust with benign physical closeness.

I recall that as a child, when I was first brought to my pediatrician for a yearly physical examination, one of the first things he said to me — abruptly — was “take off your clothes!” This introduced me to having another human being, besides my parents, see me without clothes on. That memory still resides within me at my advanced age. It felt awkward to take off my clothing to allow the doctor to examine my naked body. It was an unnatural experience. But if it had occurred after being examined with a stethoscope under my shirt to listen to my heart and lungs before beginning to take off my clothes, things might have gone more smoothly as a way of moving past a normal “barrier.”

In this era where video visits often replace in-person physician-patient contact, or when physicians are ensconced behind their computers not making eye contact, the simple act of using a stethoscope can create a silent bond, saying “I care!”