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The Stethoscope Is Not Just a Prop

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by: Jane M. Orient, M.D.

Bio Below

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Stock photos of “healthcare workers” who attend patients—physicians are no longer distinguishable—usually feature a stethoscope draped around the neck.

But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”

The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence, and the rubber tubes by sophisticated electronic gizmos costing at least ten times as much as the humble stethoscope.

High tech is wonderful and increasingly capable, but if the stethoscope is dying, so is the art of clinical medicine.

The proper use of the stethoscope requires the doctor to touch, listen to the patient, and spend some time with a living person, not a computer. Patient and physician must cooperate: “Stop breathing,” “Take a big deep breath,” “Lean forward,” and so on. More

Who Is Your Doctor?

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April 2nd, 2019

Who Is Your Doctor?

by: Jane M. Orient, M.D.

People used to know who their doctor was. His name and phone number were on the wall or the refrigerator next to the telephone. He was there for you and could manage most of your problems.

When I was about 13, my mom took me to our pediatrician for belly pain. He was on his way out the door, but he stopped to take care of me. He diagnosed appendicitis based on history and physical examination. He called his favorite surgeon (“Billy,” a Tucson legend), who came from the golf course to meet me in the emergency room. Within hours, my red-hot appendix was in a jar. My parents paid the hospital bill ($150—10 days’ pay for a construction laborer) as I was discharged a few days later.

Today, the patient with abdominal pain could wait for hours to see the ER provider—possibly a nurse practitioner or physician assistant who had never seen a case of acute appendicitis. She’ll probably get a CT scan, after another wait. Eventually, Dr. On-call may take her to the operating room, hopefully before the appendix ruptures. And the bill will be beyond the means of ordinary people.

I used to be able to direct-admit patients from my office and send them with a set of orders to the hospital admitting office. For years, this has been impossible. The hospital is decidedly unfriendly to independent doctors. There’s now a gatekeeper in the emergency room, and most patients are under the control of a hospitalist. More

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