Murmur

Medical students don't want to miss out on examining patients with abnormal heart sounds or heart murmurs, because these patients often appear in the final examination. The students are expected to feel the pulse, listen with the stethoscope, and then come up with an answer to the question of which heart valves are leaking or narrowing.

The examination is not for the faint-hearted. I saw beads of perspiration over my student's forehead when I led her to examine a lady with narrowing of the aortic valve. I had a hunch (and it later proved to be pretty accurate) that my student’s heart was doing pirouettes in tandem with the noises of the patient’s heart.

When I debriefed the medical students about the lessons learned, I told them an important tactic. "Pause," I said. "What’s the most important thing to a patient when a doctor or student comes into the room – before you stick that needle in or take out the stethoscope? Stop, and see him as a person first and a patient second. A gentle greeting with a smile would do. As simple as that. Make your patient (and yourself) comfortable."

That's what I learned from my patients and recent reading of Nance Guilmartin's book.