It's a simple maneuver I perform without a second thought countless times each workday.
As I finish the auscultatory exam of a patient's heart, lungs or abdomen, I nonchalantly pop the stethoscope out of my ears and toss it over my head onto the nape of my neck, where it comes to rest across my shoulders. The diaphragm and bell drape down on one side of my chest, the earpieces hang suspended on the opposite side.
As any avid fan of TV series like “ER” or “House” can attest, this maneuver is almost universally practiced by clinicians. It's certainly a handy way of retiring the instrument for the moment to free up your hands for the next procedure, or just to step back and contemplate your physical findings before offering a pronouncement.
The numbers of maneuvers associated with the art of the physical exam are legion. Most are referred to by specific name—except for this one. Just this morning I was thinking that you might call it “donning the yoke.”
Before the age of modern mechanized agriculture, draft horses or oxen were employed as beasts of burden to till the fields. Animals were paired in harness by means of a yoke, which usually took the form of a wooden, double U-shaped device. Each inverted U-section rested over the neck and shoulders of each beast, effectively linking them together. This forced the animals to use their combined strength in unison for the heavy work of pulling the plough. Yoked together, they formed a team to make the day's work more bearable and efficient.
A single yoke can be a burden; a double yoke allows the load to be shared.
Although PAs are defined as dependent healthcare practitioners, many of us work independently in medical settings where the burden of responsibility can be great. Those of us who practice as part of a medical team might find workdays to be less stressful, more satisfying. At the very least we have other colleagues immediately available for quick consultation and support.
Yet each one of us, when we don the yoke at the start of the workday, also puts on a mantle of sorts—a mantle of recognition and respect most certainly, but also a mantle of responsibility for the health and well-being of those we serve.
Burnout can be a very real challenge to clinicians who have spent years in the field of direct patient care. Some days the yoke may weigh heavily upon their shoulders. Like an intolerable burden, it can drag them down. More than once I have found myself in that situation over my three decades of medical practice as a PA.
When burdens become heavy, seemingly more than I can handle, I sometimes sit at my desk and reflect on why I chose to enter this profession in the first place. In all honesty I can tell you that it wasn't for prestige or recognition or money (back in the 1970s there was little of that going around for PAs). Rather, it was in response to a deep-seated desire to serve my fellow human beings, to offer some assistance to those who suffer.
Sometimes when I contemplate those initial motivations, my hands raise involuntarily to touch the stethoscope draped across my shoulders. Almost without thinking, I lift the instrument, and suddenly realize how weightless it has become.
Brian Maurer practices pediatrics at Enfield Pediatric Associates, Enfield, Connecticut. He is the author of Patients Are a Virtue and blogs at http://briantmaurer.wordpress.com/