Listen Deeper Than Words

On Friday our youngest Beth will graduate, and about 2 weeks later she’ll put one of these around her neck (the current fashionable way to wear it) and step on to the wards of the hospital for her first day as a doctor.
 
It got me thinking about my first day, which was frankly more like a sit com that nearly ended my career prematurely (no patient suffered) than the fulfilment of years of study. I was thinking what advice would I give now to my younger self and I’ll try a put something down here over the next few days.
 

So you get a stethoscope, you’ll be trained to listen beneath the surface with this for dub-dub, for crackles and crepitations, for rhonchi and wet sounds, for whooshes and snaps, for rhythms and irregularities, for sounds and …absence, for gurgles and tinkles – but all of that will rarely tell you something you didn’t already know or suspect. You see even the diagnostic geniuses of old were clear 90% of diagnosis is made before you examine, you need to take a a good history. But – it is more than that, we need to listen beneath the story, the symptoms and signs, to hear beyond the stethoscope the story beneath, for it’s when you hear the fear, the sadness, the anxiety, the hope, the joy, the confusion, the running, the settling, the unutterable request, the anger, the real beat of the heart, as well as all that text book stuff which is so important, that you enter into the true art of medicine. The dis-ease and healing is more often there than any books will tell you.