Tuesday, December 1, 2015

I'm Already A Relic

If you know what this is, you are old.
At the age of 47, I am now officially an old anesthesiologist, a relic. I had an illuminating conversation with one of our anesthesia residents about the monitoring of patients while under sedation. Now mind you this resident is a CA-3 and smarter than a whip. He'd already easily passed the early board exam required by the ABA nowadays for anesthesia residents. We discussed the role of capnography, the physiology behind the pulse oximetry, and the indications for arterial lines.

Then I asked him about the precordial stethoscope. All I got was a blank stare. I asked him if he knew what a precordial stethoscope was. He replied that he thought he had read about it in a textbook once. Did he ever see an anesthesiologist use one? No. Not even during their rotation through Children's Hospital? No. Oy!

I then fished out my precordial stethoscope from my bag, which for some inexplicable reason I still carry around. He held it and gazed at it with befuddlement and amusement. He asked about how it worked. I explained that we used to have round double sided tape that fit over the bell of the stethoscope which was then affixed to the patient's chest wall. The earpiece was custom made for each of us with an actual mold of our ear canal. I showed him how my candy apple red device fit snugly and perfectly into my ear. With this stethoscope, I explained, the anesthesiologist can hear instant changes in the patient's respiratory and cardiac status without relying on electronic devices.

The resident just looked at me with bemusement and a little sadness. It's the pathetic look you give somebody who still treasures their old eight track tapes or AMC Gremlin. When we have so many electronic wonders at our disposal that precisely measure every important body function then automatically inputs the data into the electronic anesthesia record for permanent archiving, why would anybody still use an old analog stethoscope? How can a simple rubber tube connected to the ear possibly be of any worth to the modern anesthesiologist?

While the precordial stethoscope may not be "better" than all the electronic gizmos that we attach to patients, the level of intimacy we attain with our patients by actually having be physically close to them is itself informative. By sitting or standing next to the patient, we can derive information that is is not picked up by our electronics. Important things like the color of the patient's skin, pressure points that may cause injury, how a patient starts developing increased airway resistence.  Important information like this is easily missed when the anesthesiologist is only staring at his computer monitors or, worse, cellphone.

It makes me wonder about where the future of anesthesiology is heading. Are we all destined to become mere observers of the events unfolding in the operating room, like a security guard watching over a bank of video monitors in a department store? Or is there still a role for us to become more actively involved in the care of the anesthetized patient?

1 comment:

  1. Just splice in a stopcock and you can monitor BP via the same earpiece, works like a charm. When intubation for all became the standard, it freaked me out to see the anesthetist so far removed from the actual patient. You could not get to far away holding a mask on. I blog at oldfoolrn.blogspot.com if you would like to learn how to cook a Thanksgiving turkey in an autoclave or other old school foolishness. At the age of 47 you are still a young whippersnapper.