In my efforts to tease out medicine's innermost secrets and succeed at the final hurdle to becoming a member of the Royal College of Physicians by passing the clinical examination (PACES), I have uncovered what I consider to be an interesting and neglected fact about the bell and diaphragm of most stethoscopes.
Like a migrating bird, I return each Christmas to my birthplace, and more importantly to my parents' address, and set aside a few minutes to sort through my obsolete but emotive adolescent belongings. Rummaging around, I unearthed my Littman stethoscope's box, which seemed slightly outlandish amid the photo albums and old school uniforms. Opening the box as if for the first time, I prised the instruction booklet from its foamy surround and began flicking through.
A single word caught my interest—“historical.” Fascinated, I read that the bell of the stethoscope had been, like my old uniforms, mercilessly superseded. I was astonished to find that the diaphragm side was capable of eliciting both high and low frequency sounds depending on the applicant's pressure. I suddenly realised that the diaphragm itself was brought into play only with firm pressure and that for the past seven years I had actually been listening to the lower frequencies previously ascribed to the bell only.
Disgusted with myself for having been so inept, I immediately attached the paediatric diaphragm, thereby annihilating the bell. I applied the stethoscope to my own heart with firm pressure—the sound was different, it was the sound I thought I had been hearing for seven years.
I was delighted to rid myself finally of the vulgarity of my stethoscope's bell. It had been the source of one of my most embarrassing medical faux pas. During my first year medical school objective structured clinical examination, one of the examiners asked which side of the stethoscope should be used for auscultation of mitral murmurs. Obsequiously I replied, “the bell end,” and was met by a barrage of laughter from the examiner and the surrogate patient, a third year medical student.
On the wards, I find my recent discovery has been greeted with scepticism. So many times, on auscultation, I have been cautioned by consultants to remember to use the bell or I might fail in the real PACES exam. Little do they realise that, by a subtle unseen alteration in my grip, the auscultatory frequencies shift from high to low. However, enfeebled by the examiners' authoritative presence, I usually swivel the chest piece and thank them for their kind observation.
With this article, I hereby proclaim that the bell should find its rightful place in the history books and not the PACES exam. I note that only about half of the population are likely to benefit from my discovery, as only we men fail to read the instructions.