Rule 267: When talking with partially deaf patients, put your stethoscope in their ears and talk into the bell.
They will appreciate your thoughtfulness even if they still cannot hear.
This rule comes from Dr. Clifton Meador’s A Little Book of Doctors’ Rules, a book I received early in med school. What follows is a deep dive of Dr. Meador’s 267th rule: When talking with partially deaf patients, put your stethoscope in their ears and talk into the bell. They will appreciate your thoughtfulness even if they still cannot hear.
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When I first read this rule, three questions jumped into my brain.
a) What does it mean to be thoughtful?
b) Why is it good to be thoughtful?
c) How do I become thoughtful?
Let’s dive in…
What does it mean to be thoughtful?
Thoughtful is a state of mind that is focused on others. We know this by looking at the opposite – thoughtless. We say someone is thoughtless when they act without taking others into consideration. Someone who is thoughtless is inconsiderate or careless. When you are thoughtful, you act in a way that shows your focus is on another. You are selfless. Case in point: the example embedded in Rule 267.
The patient in this scenario is 100% most likely NOT in the hospital because they are having trouble hearing. No, this patient’s trouble hearing is something other relative to their primary concern. Whether they’ve been hospitalized for an exacerbation of COPD or they’ve gotten into a traumatic accident; they didn’t come to the hospital for new onset hearing loss. The point I’m making here is that, helping them hear by giving your stethoscope is not a part of their primary reason for seeing you. So, lending your stethoscope is not something defined by your role as “the doctor” diagnosing and treating “the patient,” it’s something above and beyond. Something inaccessible unless you are thoughtful.
Why is it good to be thoughtful?
This requires us to analyze the role of a doctor - of diagnosing and treating patients. Let’s dig into that a bit.
- A doctor diagnoses and treats patients.
- A doctor diagnoses and treats sick people
- A doctor helps and cares for sick people.
- A doctor is a person who helps and cares for sick people.
That last line is the most accurate, in my view, because it strips away the varnish of big words and special terms. What remains is simply an interaction between two people; with one trying to help the other. Take away the white coat, titles, and technical terms, and you’re left with an act of service. Medicine, as a profession, is founded in the virtue of service to others.
Now, obviously diagnosis is the most important part of a doctor’s job, but diagnosis is still rooted in helping others. In other words, you would never diagnose for the sake of diagnosing… you diagnose because you want to help someone else.
And yet, I’m not sure service alone explains this rule in its entirety. Service, as a virtue, is a sense of moral responsibility to others. You can join a movement, or institution, or even attend medical school out of a deep sense of service - to care for those who are sick. And that is a great and noble thing. But in this context, I’m not sure that a sense of moral responsibility alone would lead a doc to do something as clever and thoughtful as lending their own stethoscope as a pair of ears. In other words, being thoughtful isn’t solely a part of service, but something that also exists outside of it. When you add them together – service + thoughtfulness – you get charity. And I don’t mean charity like you’ve got to give money to Goodwill or something. I mean charity in the sense that your actions are founded in truly caring for others. Put differently – you love your neighbor as yourself.
To try and gain some clarity, let’s compare service and charity in the context of medicine.
The moral responsibility of service to others starts from within yourself. You may say “I am a good person,” and “a good person serves those who are less fortunate (sick).” Therefore, you reason, you have a moral responsibility to be of service to the sick and then use this as motivation in pursuit of medical school. This is a true and noble statement. Where charity differs is that you view others as an extension of yourself. In charity, there exists a special union between you and your patient, whereas service emphasizes your patient as a separate individual. You act not out of a reasoned responsibility to others, but out of love, grace, and sense of kinship: charity. It is these values from which your responsibility is derived. As a result, charity is a virtue best suited to motivate the lending of one’s own stethoscope, a clever and thoughtful acknowledgement of a patient’s humanity.
This is important because people are the only ones capable of doing this – of deeply caring about someone other than themselves. White coats cannot, titles cannot, and systems certainly cannot. Only people can care about people. And in the ever-growing heath care system – an inefficient, bloated, unfeeling machine – friendly faces and thoughtful people are increasingly important to deliver that care.
How to be thoughtful?
To borrow from Nike - just do it. We can think about how we ought to be, and how we ought to act, and then think about thinking about that…and on and on and on. But, at the end of the day, you must act.
The best way to be thoughtful is to just be thoughtful.
Let me give you an example. During my surgery rotation I had the opportunity to scrub into a hip replacement for an older man we’ll call “Mr. Smith.”
“Scrubbing in” refers to the special, thorough way of washing your hands in preparation for an operation. It is followed by putting on your surgical gloves and gown on, with the help of other members of the surgical team. This is all done while remaining “sterile.” The goal is to limit the chances of infection for your patient.
So anyway… understanding that ortho surgeons scrub a certain way (but not actually knowing the way) I asked the surgeon how to proceed. He instructed me (after making a few good-natured jokes at my expense). I responded with something like I wanted to make sure I was doing it right because I was a “guest in his house” (meaning the operating room). And he quickly corrected me. “It’s not my house, it’s Mr. Smith’s, and we’re all his guests.”
That statement stuck with me. It perfectly encapsulated the relationship between doctor and patient – we are in service to our patients and our patients alone: they come first. A doctor’s best service is done out of a deep sense of caring - a thoughtful application of charity.
Thank you to both Dr. Meador and to that remarkable ortho surgeon who will remain anonymous.
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- Tyler