How To Run A Clinic Without A Voice

When I was asked by Figure 1 which one piece of medical equipment I valued above all others, I said “my hearing”. We were taught from the very beginning that a good history was our first step to an accurate diagnosis, and I have always valued a physician who LISTENS: to their patients, their students, their allies, and their contemporaries.

Remember the game we always played? – “If you had to lose one sense, which would it be?”

I thought of my dad, who is blind: when he applied to do an honours degree in Psychology, his application was denied based on the fact that he would not be able to see his client’s faces (ridiculous, really. That was nearly 30 years ago). It had me thinking: what about a blind physician? We have many blind physiotherapists, but surely doctors must SEE… a quick Google search proved me wrong.

Blind doctor Albert A. Nast holding his ear to the back of a 3 month old instead of using a stethoscope. Image: Time Life. Click for link.

There have been a few blind physicians over the years. Many, like the French Dr Nast (1950, pictured above), became blind after completing their medical training. Tim Cordes, however, lost his sight to Leber’s Hereditary Optic Neuropathy by the time he was sixteen, and completed his entire medical training as a blind individual. (Read this speech by him. He did gross anatomy by palpation and intubated patients – no shortcuts or special treatment.)

And if I were to lose my hearing… What would I do if I could no longer hear my patients’ stories? One might argue that since I often don’t speak their language it hardly makes a difference; or that one would most likely have access to a hearing aid of some sort. Communication is of course not purely verbal, either. I was reminded of Dr Helen Tausig, paediatric cardiologist extraordinaire, and very, very deaf by the age of 31. She used palpation in lieu of a stethoscope (maybe just as well, as the value of stethoscopes is being questioned).

In these musings I never considered my voice. Not to be alarmed of course: it will come back – but our specialist orthopaedic clinic where we saw over 200 patients really impressed upon me just how much I speak.

In med school they taught us that the average physician cannot go seven minutes without interrupting their patient. I definitely practised my listening skills a lot in an effort to spare my voice (and exquisitely raw larynx).

I did learn that certain tones are easier to produce, which resulted in a very monotonous falsetto voice for much of the day. Imagine how difficult that was for those patients who already struggle to understand English!

When I send patients on their way without admitting them to the wards, I often greet them with “Get better!”

This was the first time that one patient solemnly met my eyes and said,

“You too, Doc!”