It has become a badge of office: a symbol of the power to heal. Therefore the wearer must be the genuine article, possessing extraordinary skills and veiled in respectability, not to mention being a member of a rather exclusive club.

However, the increasing frequency of its appearance in recent times has, in my mind, diluted that very exclusivity of the person wearing it. I am, of course, referring to the stethoscope.

That bifid, tubular appliance is seen to adorn the figure of every member of the healing fraternity (or sorority) who find themselves being interviewed or photographed by the media. Standard equipment: an absolute “must.”

Previously confined to its use by doctors, it is now an integral part of the apparel of not only physicians, but also nurses, paramedics, and noisy medical students: anyone upon whom the evil eye of the camera is beamed. Thus, a prominent rheumatologist, when appearing on television, has, draped around his shoulders, the inevitable small black snake. But does he use it?

Is he indeed to be found listening to creaking hips or clicking knees? Similarly festooned is the community nurse benignly dispensing free needles and condoms. We won’t go there, but it makes you wonder all the same.

Of additional intrigue, at least to me, is the manner in which the stethoscope is actually worn.

In my day (“Oh-oh” I hear you say) the elegant internist, or “consultant physician” as he was respectfully known, had the ear pieces round his neck and the business end fell down perpendicularly, or was tucked into the pocket of his waistcoat to be kept warm prior to being applied to a patient’s chest wall.

We surgeons, on the other hand, carried ours in the pocket of our white coats, out of sight and out of mind. Very occasionally, we would listen for the presence or absence of bowel sounds, but of course, we had already made up our minds to operate regardless!

The current trend of wearing the instrument draped casually over the shoulders like an after-shower towel is, I feel, to be roundly deprecated, especially if the male wearer compounds the felony by failing to wear a necktie.

So the next time that you see a stethoscope carefully and artfully arranged round the neck of a young man, tieless and sporting “designer stubble,” you can safely surmise that he doesn’t know one end of it from the other.

On the other hand, however, he may be very proficient in its use.

He could be a safecracker.

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Graham C. Fraser, MD

Dr Fraser is retired from pediatric general surgery at BC Children’s Hospital, where he was head of surgery. He enjoys reading, writing, and erratic golf.