When I graduated from my Family Practice program, my doctor’s bag was full of tools and hopeful expectations. It was a rather large black bag that opened from the top and revealed my stethoscope, otoscope, ophthalmoscope, reflex hammer, tuning forks, and spaces for an assortment of injectable medications, gauze, alcohol wipes and needles and syringes. I carried gloves, lubricant, and suture material as well.
I was equipped to handle a wide assortment of medical problems during a home visit. Yes, I made home visits. Home visits were routine. When I was 10, I realized that if Doc Perlman came to the house, I would get a shot of penicillin in my buns. I hated being on the receiving end of a home visit.
Over the last 40 years, the doctor’s bag as shrunk to the point that, in short order, it will be gone. Yep, even the stethoscope is vanishing. Most of my docs use it inappropriately, listening over the clothes and speeding through the exam so fast that I doubt that they can hear anything. Stethoscopes are being replaced by echocardiograms and CT scans.
The last thing to go is going to be the doc who carried the bag. Nurse practitioners and physician assistants are performing more and more of the physical exam and almost all of the medical history taking. They have also taken on diagnosis and treatment of an ever-increasing list of disorders. In other words, they assume the role of the doctor.
Doctors have become supervisors, watching over the “midlevel” practitioners. I have written about being demoted to a “provider” before. We are all providers now and my prediction is that in the next 20 years, there will be no MDs. I’m happy I won’t be around to see the demise of my calling.
So, what does the patient do? The patient sees a provider and determines if they trust their provider with their health. When possible, the patient sees an MD as their training is much more extensive than the non-MD providers. As with any provider, if you are uncomfortable with your provider’s care, get a second opinion.
One last comment. The stethoscope has a diaphragm which picks up sound and delivers it to your ears. The difference between an expensive stethoscope and a cheap one is often the quality of the diaphragm. When someone listens through your clothing, they dampen the diaphragm by inserting a material that will not transmit sound, thus decreasing the ability to hear murmurs or other diagnostic sounds. My nurses knew that taking a patient’s BP through a sleeve or other clothing was a fireable offense.
Here’s your joke of the day:
Doctor: “You have high blood pressure and amnesia.”
Patient: “Well, at least I don’t have high blood pressure!”
So Stuart a question for you! If u were I practice today would you still do walk ins the way u did? We have had to go to immediate care which is walk in but they have all been closed because they are full to capacity. U now can go online to set an appointment to walk in clinic. Hence no walk in available so u can’t see your Dr because she is booked , no walk in because they are booked, only thing left to do is go to ER! Totally ridiculous finally got into immediate care today went from acute bronchitis three weeks ago to sinus infection bu5 took me a week to get in.
Medical field sucks right now. So Ray asked what would Stu be doing now if in practice.
Oh by the way stethoscope was over clothing as was blood pressure in fact he had the stethoscope close to wrist for BP cuff was over elbow!
MJ
That’s where our noble profession has gone too.