To stethoscope or not, that is the question..

[Brodiatrist]

My 2nd year colleagues have yet to learn or even use one on a patient, as its not protocol for our clinic participation. However this summer I had the opportunity to perform physical exams with a podiatrist who assured me that podiatry students/residents will be expected to know how to check blood pressure/pulses/etc. However, I'm noticing not even attendings or ANY upperclassman carrying one, so I feel like a tool. Should I keep it home from now on? Advice from anyone?

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[diabeticfootdr]

My 2nd year colleagues have yet to learn or even use one on a patient, as its not protocol for our clinic participation. However this summer I had the opportunity to perform physical exams with a podiatrist who assured me that podiatry students/residents will be expected to know how to check blood pressure/pulses/etc. However, I'm noticing not even attendings or ANY upperclassman carrying one, so I feel like a tool. Should I keep it home from now on? Advice from anyone?

A stethoscope is useful to the podiatrist for things other than measuring BP or cardiac auscultation. You need it to listen for bruits - aortic, femoral and carotid. These are diagnostic of PAD and directly relate to your podiatric treatment.

 

[Feli]

I'd get a decent but not super expensive one. If nothing else, you will use it on family med, IM, ID, anesthesia, g-surg, etc etc as a resident.

As Dr. LCR said, it's also prudent for DPMs to evaluate the whole pt... most pts with PAD also have CAD and/or HTN, pts with HTN need BP check during inital pod office eval, you will end up clearing some of your own pts for surgery (at least during residency), etc

 

[darazon]

My 2nd year colleagues have yet to learn or even use one on a patient, as its not protocol for our clinic participation. However this summer I had the opportunity to perform physical exams with a podiatrist who assured me that podiatry students/residents will be expected to know how to check blood pressure/pulses/etc. However, I'm noticing not even attendings or ANY upperclassman carrying one, so I feel like a tool. Should I keep it home from now on? Advice from anyone?

Our faculty gave us all stethoscopes as a gift during our first week. We are only 2 months or so in and we have used them numerous times on standardized patients for H&P.

We were told that we could be doing our own H&P during rotations. Some of the faculty members say that they routinely do their own H&P when they admit patients.

 

[Toohotinvegas33]

Considering that every nurse, tech, child life specialist, and volunteer greeter at the hospital has one, you should too as a doctor. Although, some specialist just borrow one from the nursing station if they need it.

 

[Brodiatrist]

Thanks for the insightful replies everyone.

 

[PADPM]

Yes, you should own a stethoscope. At least one of the hospitals where I have staff privileges encourages DPM's to perform their own H&P's, and that's difficult without a stethoscope! And as diabeticfootdr discussed, there are times when we are obligated to look past the "foot" and our exam must be more comprehensive.

But PLEASE, PLEASE, fold it and keep it in your pocket and don't walk around with it draped around your neck. That's for t.v. and a-holes.

 

[Feli]

...walk around with it draped around your neck. That's for t.v. and a-holes.

And my ID rotation tomorrow am

 

[PADPM]

Feli,

Two of my good friends are very well respected cardiologists, one at a major university teaching hospital, and he never has his stethoscope "draped" around his neck. He pulls it out of his pocket or simply walks around with it folded in his hand.

Represent our profession well and please keep your stethoscope in your pocket and not draped around your neck!

 

[NatCh]

But PLEASE, PLEASE, fold it and keep it in your pocket and don't walk around with it draped around your neck. That's for t.v. and a-holes.

Ha! That's pretty funny. Better yet, hang it from the rearview mirror of your car for all to admire.

 

[Feli]

Feli,

Two of my good friends are very well respected cardiologists, one at a major university teaching hospital, and he never has his stethoscope "draped" around his neck. He pulls it out of his pocket or simply walks around with it folded in his hand.

Represent our profession well and please keep your stethoscope in your pocket and not draped around your neck!

I have too much other crap (books, supplies, etc) in my coat pockets, and all the gen and specialty medicine specialty students/residents/fellows/attendings in my teaching hospital do the neck thing.

I have the stethoscope belt clip for the scrub pants drawstring, and that will work out great for anesth, ER, and the various gen and specialty surg rotations where I can wear drawstring scrubs every day. However, with slacks and business dress, the clip thing (and scope) falls off my belt every time I sit down or try to "unholster" the scope. It's not D-baggery as much as just 'form follows function' when I'm on a svc that needs scope + demands biz clothes (IM, FM, ID, rheumat, etc). Hey, maybe someday I will get the headband + reflective saucer to complete the look.

 

[krabmas]

I have too much other crap (books, supplies, etc) in my coat pockets, and all the gen and specialty medicine specialty students/residents/fellows/attendings in my teaching hospital do the neck thing.

I have the stethoscope belt clip for the scrub pants drawstring, and that will work out great for anesth, ER, and the various gen and specialty surg rotations where I can wear drawstring scrubs every day. However, with slacks and business dress, the clip thing (and scope) falls off my belt every time I sit down or try to "unholster" the scope. It's not D-baggery as much as just 'form follows function' when I'm on a svc that needs scope + demands biz clothes (IM, FM, ID, rheumat, etc). Hey, maybe someday I will get the headband + reflective saucer to complete the look.

I agree.

On some rotations I wore it around my neck and others in my pocket. Even on podiatry and ortho it helps to have it. If you admitted the patient and medicine is not following - who is listening to the heart, lungs, abd everyday?
And if you get called in the middle of the night or any time of day about a patient that is not saturating well, is febrile, tachy... you should listen to them, as well as order other tests, but physical exam is extremely important and the more you do the better you get at them and picking up subtle differences.

 

[PADPM]

You'd better not get too comfortable with all that stuff in your lab coat pockets. One of the hospitals where I'm on staff just "banned" doctors from wearing lab coats with the ridiculous premise that these coats aren't always cleaned/laundered on a regular basis, therefore can be spreading infection from room to room.

That's really ludicrous, since a doctor takes the same stethoscope from patient to patient and rarely cleans it off between patients. And it's been found that despite doctors washing their hands, one of the biggest culprits for spreading infection is the often overlooked PEN that the doctor carries from room to room and writes with all day long.

So, if you really need all that stuff in your pockets, AND your stethoscope and they ban lab coats, you may have to purchase a Batman utility belt!!!

 

[krabmas]

You'd better not get too comfortable with all that stuff in your lab coat pockets. One of the hospitals where I'm on staff just "banned" doctors from wearing lab coats with the ridiculous premise that these coats aren't always cleaned/laundered on a regular basis, therefore can be spreading infection from room to room.

That's really ludicrous, since a doctor takes the same stethoscope from patient to patient and rarely cleans it off between patients. And it's been found that despite doctors washing their hands, one of the biggest culprits for spreading infection is the often overlooked PEN that the doctor carries from room to room and writes with all day long.

So, if you really need all that stuff in your pockets, AND your stethoscope and they ban lab coats, you may have to purchase a Batman utility belt!!!

and ties. some people have switched to bow-ties.

There are those that wipe the stethescope with alcohol after each patient, but those are few.

 

[cwdlswnerd]

I agree.

On some rotations I wore it around my neck and others in my pocket. Even on podiatry and ortho it helps to have it. If you admitted the patient and medicine is not following - who is listening to the heart, lungs, abd everyday?
And if you get called in the middle of the night or any time of day about a patient that is not saturating well, is febrile, tachy... you should listen to them, as well as order other tests, but physical exam is extremely important and the more you do the better you get at them and picking up subtle differences.

Tagalong question if you don't mind: I'm still in the process of learning about podiatry for a possible career so please feel free to talk to me like I'm dumb.

From what I can gather you are saying that sometimes you have to watch out for problems\issues with your patients that aren't directly related to the foot\ankle area: in the case that you notice a problem is it your obligation to treat or do you call in another doctor? I've read a lot of posts and literature on the net about "scope of practice" and to be honest, I have seen conflicting things.

Thanks in advance.

 

[NatCh]

Tagalong question if you don't mind: I'm still in the process of learning about podiatry for a possible career so please feel free to talk to me like I'm dumb.

From what I can gather you are saying that sometimes you have to watch out for problems\issues with your patients that aren't directly related to the foot\ankle area: in the case that you notice a problem is it your obligation to treat or do you call in another doctor? I've read a lot of posts and literature on the net about "scope of practice" and to be honest, I have seen conflicting things.

Thanks in advance.

In Residency you pretty much act as a specialist in whatever rotation you are in, so you would be expected to recognize and treat many non-foot and ankle pathologies. I did a few hernia repairs and lap-choles for instance, and managed more cases of congestive heart failure than I care to remember. I'm not sure what exactly the law says about it, but scope of practice seems to be lifted while in training.

In private practice it's our obligation to recognize but not necessarily to treat. It is our obligation to refer to the appropriate specialist, however. If you see an uncontrolled diabetic then you had best make sure he has a Family Practitioner, Internist, or Endocrinologist to consult. I think there is a reasonable limit though. For example, if a patient presented to your office with a complaint of an ingrown nail I don't think anyone would criticize you for not noticing he has a cavity and is in need of dental work. It's hard to imagine getting sued because a patient ended up with a root canal after we did not do a dental exam.

Scope of practice is a legal concept and varies from state-to-state. We are restricted by the state to treating only that which is within our scope of practice.

 

[NatCh]

I have too much other crap (books, supplies, etc) in my coat pockets, and all the gen and specialty medicine specialty students/residents/fellows/attendings in my teaching hospital do the neck thing.

Are reference sources getting close to being all electronic yet? Whip out the iPhone to look up meds, write Rx's, buy movie tickets, and order chow fun all from the same device?

Hey, maybe someday I will get the headband + reflective saucer to complete the look.

Don't forget your black bag and bottle of elixir!

P.S., I think as a Resident you don't look out of normal to be slinging that stethoscope wherever you like or need. In private practice however, it would look kind of pretentious to enter the exam room with it around the neck.

 

[PADPM]

NatCh,

I can't believe you're NOT doing root canal procedures in your office. Didn't you ever notice how much our "podiatry" chairs look like dental chairs?

Come on NatCh.....you've got the chair.....you've got the good 'ol Dremel drill.....you've even got x-rays and a lead apron.....what more to you need?

You just have to practice saying "Rinse and spit".

 

[NatCh]

NatCh,

I can't believe you're NOT doing root canal procedures in your office. Didn't you ever notice how much our "podiatry" chairs look like dental chairs?

Come on NatCh.....you've got the chair.....you've got the good 'ol Dremel drill.....you've even got x-rays and a lead apron.....what more to you need?

You just have to practice saying "Rinse and spit".

You know, I watched my daughter's dentist extract some teeth last spring and it did look remarkably similar to doing a nail avulsion...

 

[cwdlswnerd]

I think I understand.


Are podiatrists required to get an MD\DO to sign off on their work or are they self sufficient in their field? I know it seems like a dumb question but the only podiatrist I have talked to(not shadowed) in his office recalled having to have an "actual doctor" sign off on every decision he made and fully admitted wishing he had never entered podiatry to begin with. Should be mentioned he is in his 60s.

I'm really interested in Podiatry; I just don't want to enter into something where my professional opinion matters less and less as laws\rules\times change. I'd hate to have to go the MD\DO route just to end up doing what I want in the medical field with the foot and ankle region.

 

[NatCh]

I think I understand.


Are podiatrists required to get an MD\DO to sign off on their work or are they self sufficient in their field? I know it seems like a dumb question but the only podiatrist I have talked to(not shadowed) in his office recalled having to have an "actual doctor" sign off on every decision he made and fully admitted wishing he had never entered podiatry to begin with. Should be mentioned he is in his 60s.

I'm really interested in Podiatry; I just don't want to enter into something where my professional opinion matters less and less as laws\rules\times change. I'd hate to have to go the MD\DO route just to end up doing what I want in the medical field with the foot and ankle region.

We are independent decision makers and do not need an MD or DO to sign off (other than perhaps within the Veterans Affairs or military system -- not exactly sure about that these days but when I trained at a VAMC the Podiatry Dept. did fall under the umbrella of the Surgery Dept. and The Chief of Surgery, an MD, did sign off on Podiatry matters).

We are limited by state law and hospital bylaws to working only on areas within our scope of practice. In other words, if it pertains to the foot and ankle (with some variation from state to state) then we can do what we feel is appropriate. If the pathology is outside of scope, say the patient has a rash on his face, then we may not treat it whereas an MD or DO technically can (but might choose not to if it is outside of his or her specialty).

Edit: If it help to understand things, you can think of it like dentistry in that the training is within a school system separate from the MD or DO system, we learn more in training than what we end up eventually managing in practice, we don't need immediate supervision by an MD or DO, we have four years of professional school plus a Residency, we can write prescriptions, we can do surgery, we have a geographic region (versus an organ system) of the body for which we are responsible.

Compare and contrast to a mid-level such as a Physicians Assistant, who can diagnose and treat the entire body but only under the supervision of a Physician. The MD or DO does not have to be physically standing right behind the PA, but he or she will sign off on the chart. BTW, I've met some PA's who were sharp as heck and probably didn't need any supervision, but them's the rules.

 

[cwdlswnerd]

Are there a lot of opportunities for Podiatrists to work in hospitals? Working in an office setting does not interest me a bit.

I know on these forums I've read a lot of MD\DO\DPM hate but in working practice do you ever come across an MD\DO that doesn't respect you and your decisions as a doctor? Sort of like "I'm an actual doctor, you are just a podiatrist sort of thing? My aunt is an Emergency Room RN and she told me that at her hospital docs from all services are more then happy to call the Podiatry service and everyone works as a team. That's the situation I want to find myself in if I do go with Podiatry. As an Army vet, I'm big on teamwork.


Thanks for all the info, I'm sure you've answered this kind of stuff a million times.

 

[PADPM]

This question has been asked before, and it's not a simple answer. If you are strongly set against practicing in a private practice setting, my recommendation would be "buyer beware".

Although there are DPM's that are employed by hospitals, those numbers are relatively low at the present time. Yes, there are hospitals across the country that are waking up and realizing the value of DPM's and are beginning to hire DPM's. In the past there were a handful, and this number is increasing annually.

Some of the larger university teaching hospitals are beginning to hire DPM's if they don't already have DPM's on staff. However, in the "overall" scheme, these numbers are still relatively low when you consider the amount of DPM's in practice. Therefore, there's obviously no guarantee you will eventually be offered a job with a hospital. So if that's the only situation that will make you happy, at this point in time it's basically a gamble.

That doesn't mean you can't be in private practice, group practice or practice with an orthopedic group, etc., and still have hospital privileges and spend a significant amount of your time in the hospital as many DPM's do regularly. Additionally, many DPM's have earned the respect of other department members as you have pointed out, and have ER/on call privileges without being employed by the hospital.

 

[cwdlswnerd]

Alright, thanks.

 

[skiz knot]

Represent our profession well and please keep your stethoscope in your pocket and not draped around your neck!

I'm wondering how wearing a stethoscope "draped around your neck" is considered representing your profession poorly?

Don't fall into stereotypes like "that's how the fleas wear 'em." Who gives a F***? Wear your stethoscope however you would like.

 

[PADPM]

You apparently took my comment and twisted it's context. I said "represent our profession well AND please keep your stethoscope in your pocket and not draped around your neck...."

I didn't say that if someone draped the stethoscope around his/her neck it wasn't representing our profession well. I said to respresent the profession well AND keep the stethoscope in the pocket.

My point was that when these residents are making rounds with the IM residents, GP residents, infectious disease docs, etc., I want them to represent our profession well. I also asked them to please keep the stethoscope in the pocket and gave examples of friends of mine who are cardiologists who keep their stethoscopes in their pockets.

It's simply my opinion, because I personally believe that doctors that wear stethoscopes around their necks look like jack-as--es. That means doctors of ANY specialty. I also think doctors that walk around in public places or go out to dinner still wearing scrubs look foolish as if they are trying to hard to let people know that they are "doctors".

I don't know, maybe it's just me. I keep a low profile and never introduce myself as "doctor" in social settings, when making hotel or restaurant reservations, etc. I don't even introduce myself as "doctor" to my patients. When I walk into a treatment room to meet a new patient I simply extend my hand to shake the patient's hand and introduce myself by my first and last name. I don't have to say I'm "doctor" XX. They already know I'm the doctor, since I'm the guy in the white coat with the name embroidered on the coat and my name on the door and on all the diplomas and certificates on the walls.

 

[prettypod]

it's for the pain pill seekers. when they scream and moan about their hurting foot but you suspect seeking behavior... whip it out and pretend to listen to arteries and blood flow in the foot while pressing real hard, you'll find out if the pain is fake!

 

[gustydoc]

The bell of a stethoscope actually makes a pretty good reflex hammer too.

 

[krabmas]

The bell of a stethoscope actually makes a pretty good reflex hammer too.

so do my fingers, and I only have a few places to keep them

 

[podpal]

Not all stethoscopes have bells. It's better to get one with one side flat and the other side the bell. You may use the bell to appreciate carotid bruits; it's hard to hear them. You should use the flat side for lung and heart evaluation prior to surgery. If you hear something abnormal, such as regurgitation, mention it to the attending or anesthesiologist so they may double check. You should assess surgical patients daily for atelectesis of the lung. If you hear any abnormal lung sound mention it to your attending so they may double check.
Littman is a good brand. They have different color options too.