The Stethoscope

Not all negative letters that I receive are stupid. On the contrary, many are well constructed, erudite pieces worthy of consideration. The last thing I really want is for everyone to agree with me all the time (and it's a good thing I don't). Most often, I want to expose my readers to divergent ideas for their cogitation and evaluation.

Then there are the ones which are just plain stupid. Certainly one of the more ridiculous commentaries I receive is the one about the picture with this column. While I've addressed these criticisms in the past, they keep coming in. Just the other day I received a letter from a doctor whose letterhead listed him as a chiropractic "physician." Good -- I agree -- that's what we are. He then proceeded with a snide little note about how the stethoscope in the picture demonstrated how I was undoubtedly a frustrated medic. This from an individual listing himself as a "chiropractic physician."

What's so astounding is how such a simple diagnostic instrument can arouse such distress within some quarters of the chiropractic profession. To some, wearing a stethoscope is a form of heresy -- like, "How dare you want to listen to a patient's heart, you unqualified cretin." To others, wearing one is nothing more than an exercise in professional frustration -- like, "How come you want to be an MD?"

How sad it is that the appearance of a stethoscope could generate so much stupidity.

Now I, of course, can't speak for my critics on this subject, but it appears that their thinking is mired in some kind of philosophical bog hole that sucks them deeper whenever they struggle to obtain common sense.

In the first place, I feel that chiropractic students in most Council on Chiropractic Education (CCE) schools have a better program in diagnostic procedures than their medical counterparts. Certainly, I've never felt less qualified than any medical doctor and I've had most of my offices in medical buildings, and worked as a chiropractor in a medical clinic for over a year. If you don't feel the same way, maybe you went to the wrong school.

It would seem to make sense that we should put into practice the things we're taught -- especially if we're to be considered primary health care providers.

This brings the old stethoscope back into focus. Let's understand one thing -- I'm not a rack 'em, crack 'em, bone-popping chiro. To me the most important thing is to find out what's wrong with the patient before I attempt to minister to his needs.

One of the best ways to find this out is with a thorough physical examination. And guess what? This means using that dirty old stethoscope. With it I listen to the heart and lungs and, if deemed necessary, for possible bruits. If this indicates a pathological process I then proceed with more comprehensive procedures to determine a course of treatment or referral.

Doesn't that make sense? Don't patients deserve the benefit of everything we've been taught in our schools? Should we do things that might harm them simply because we don't want to take the time to give a proper examination or because some of us might live in a philosophical land of make believe? Should we blindly give adjustments to patients who might have conditions that should be referred for more radical procedures? Should we give cervical adjustments to those with discernible vascular aberrations and thereby cause a possible severe life-threatening reaction?

Yes, diagnosis -- proper diagnosis -- takes time and a measure of thought, and a stethoscope is an important and viable diagnostic tool.

Some time ago, a patient came to me for a low back problem. He was a farmer and had hurt himself while working on his tractor. During the physical examination, cardiac auscultation (that's right -- with a stethoscope) revealed a marked arrhythmia and murmurs at the valves. Because of this I ran a phonocardiograph with alarming results. He told me that he was on some medication that didn't seem to have much effect so I put him on an aggressive nutritional program. The results were astounding and more dramatic than I could have imagined. It's certainly possible that the treatment could have added years to his life. Was that wrong? Many of the lazies and loonies might think so, but the patient and I don't.

In our rush to be "different" we give away everything but the kitchen sink. We can't use a stethoscope because medical people do, the caducesus is off limits, tongue depressors, cotton, bandages, ophthalmoscopes, sphygmomanometers, and watches (unless used to tell time only) are all verboten to the supers. Those who dare to use any or all of the proceeding are to be placed in chiropractic purgatory for practicing the art of being a physician without BJ's consent.

The stethoscope stays around my sturdy neck. For those objecting -- the pity is not for you but for those you pretend to care for.

RHT