I’m just the slightest bit annoyed. The day being slow, and one of the residents being gone, so that I could use his computer, I decided to take advantage of the fast internet connection to figure out the inner workings of the blog site I’ve decided to transfer to in May. I spent a couple of hours fiddling around inside, figuring out the pathways and shortcuts, and laboriously designing a header, and adding lots of links to the page. When I arrive home, what do I find, but that Blogcity has decided to redo their structure too, and I had to redo this blog too – otherwise you would only be seeing a bunch of gibberish, lines all intermingled and sliding off the edge of the page. . . Blogcity must be jealous of the new site.
Other than that, Dr. B noticed that my pretest results in the areas of “cardiac murmurs and how to elicit them” were very bad indeed. So he gave us a lecture on that topic, and now for the first time I understand the significance of handgrip, and why that would increase the murmur of aortic insufficiency. Very enlightening, and worth the miserable experience of guessing wildly on the test.
He told us about how at medical schools in India (where he trained), during the clinical years there are two hours of required bedside teaching every day. Unbelievable. And about how, early on, a resident took him and several other medical students to hear a patient with mitral stenosis. They all listened, and nodded, and said, “Oh, yes, definitely.” Dr. B was asked what he heard, and he described in detail the appropriate sounds for mitral stenosis. The resident then observed that he had turned the head of the stethoscope such that they could not possibly have been hearing anything through it. That seems to have made quite an impression on Dr. B.
It’s true that at the beginning (and now too, to some extent) we have no idea what anything sounds like. It’s impossible to really describe how rales are different from crackles, and how that is different from wheezes, or what counts as decreased breath sounds. It’s impossible to explain verbally the minute pause that distinguishes the first and second heart tones, or how to catch that faint stutter which is the all important S3 or S4 gallop. The only way to find out is to be told what a patient has, and then listen. Eventually by osmosis and contextualization, we figure out what’s what. I’m still not completely sure when it’s rales or crackles, or when it’s S3 or S4. The rest, I have a decent chance of catching.
I’ll have to remember that trick with the stethoscope for my students.
What a funny idea. Me, have students?
