Tools of Our Trade

There are a number of “tools” that identify physicians and healthcare workers. One that immediately comes to mind is the stethoscope. They hang from the necks of physicians and nurses but how often do you see them in use? Occasionally, one will see a healthcare professional taking a patient’s blood pressure with a stethoscope, but in today’s electronic age, automatic blood pressure devices are more common. The original intent of the stethoscope was to listen to the lungs. The professional who utilized the stethoscope was expected to identify rales, rhonchi, and tubular breath sounds. I remember spending countless hours listening to heart murmurs and heart sounds in order to identify most heart problems. The American College of Cardiology now has an online program specifically designed for today’s physicians and other healthcare professionals so they can learn to use the stethoscope to listen to heart sounds. Unfortunately, skillful use of the instrument is becoming a lost art.

Surgeons have many tools of the trade. We must learn to master very sharp tools, tools that cut in various ways, and tools that can be used to repair. Each of these tools must be used at the appropriate time and in the appropriate way or unwanted results can occur. Drs. Anderson and Romfh have stated, “Operating by Braille is often permissible with scissors, but never with a scalpel.”¹ I would guess that many of you did not realize some operations are done by Braille!

Another tool of our trade is our eyes. We are trained to use our eyes to look at our patients and see them. It is easy to look at a patient, but it can be difficult to truly “see” the patient. When I see a new patient walk from the waiting room to the examination room, I can learn many things. How well is he walking? Is there a limp? Which leg is being favored? Does he require assistance? Can he walk all the way to the examination room without stopping to rest? Once in the room, noting the appearance of the skin and the wound can give one a start on making a diagnosis and assembling a treatment plan. Is the leg swollen? Are both legs swollen? Is the leg red? What happens to the color when the leg is elevated? One can learn important things about a patient by “seeing” them.

The hands are two of the best tools available. Temperature differences of 1 to 2 degrees can be detected by simply using the back of the finger. Trained hands and fingers can detect abdominal masses, enlarged lymph nodes, the presence or absence of arterial pulses, and many other important things about a patient.

Are you using these tools to evaluate your patients? Most are not. In this day of laboratory-oriented medicine, most only know how to order tests. They either were not taught or have forgotten how to use their skills. This sad state of affairs has gotten so bad that it has a name—hyposkillia.² Even worse, those who do not know how to use their skills are called hyposkilliacs!² I hope this does not apply to you. It is important that we show our patients that we care enough for them to use the “tools of our trade” to care for them. Many times the most effective thing we can do for a patient is to see them and lay hands on them. As my father taught me, the time spent and the personal contact with a patient bestows confidence in one’s physician and a sense that he or she cares for them. Don’t waste all of your “tools of our trade” and merely order tests!

Terry Treadwell, MD, FACS
Senior Clinical Editor, WOUNDS