What’s in your medical kit?

In the late 1970s, in Madras, India, Ethiopian-born medical student Abraham Verghese observed and sometimes carried his uncle’s medical bags. The first was a trunk-shaped “mobile office” filled with alcohol and needles, and a later model was a locked suitcase that gave off a pungent medicinal smell.

When Verghese moved to Johnson City, Tennessee, in 1980, he admired the worn leather of his mentor’s bag and the meticulous care it reflected in its carrier. A few years later, Verghese became chief resident and picked up his own stately bag to go with his new position.

Today, doctor’s bags are often considered relics of the past. Time and technology have literally lightened the burden on physicians and in many cases have completely eliminated the need for elaborate toolkits. Yet doctors remain tied to the things they cling to: reminders of their own stories and those of the doctors who came before them; tools that reinforce their identities in the field; innovations that have changed the practice of medicine; and the “old-fashioned” instruments they are reluctant to let go.

Like many physicians, Verghese, MD, MACP — now a Stanford University medical professor and best-selling author — has long since ditched his once treasured bag. He continues to carry much of his old contents in the pockets of his white coat. “I think these instruments are not just of historical importance; they have diagnostic value,” he says. “I think, if anything, there’s more stuff we could carry.”

A Brief History of “Physician’s Necessity”

The first known mention of a medical bag appeared in the Hippocratic Corpus around 350 BCE. “For your travels you will carry a simple and portable kit”, writes Hippocrates in his treatise “Decorum”. “The most appropriate is one that follows a methodical pattern, because the doctor cannot remember everything.” By 1885 the physician’s necessity had become luxurious. Mayer and Meltzer boxes made of mahogany, oak or walnut; lined with velvet or leather; and scalloped with brass or ivory handles. Each costs the modern equivalent of almost US$3,000.

Among their instruments, the medical bags hold a history of medical advancements. The standard accoutrements of each decade are telling: chloroform and soap in the 1920s; Steri-Strips and Dextrostix in 1980. Doctor’s bags have been popping up in pop culture, in places since Norman Rockwell’s 1929. Saturday night post cover, “The doctor and the doll“, to the baby’s father’s medical kit in the 1987 film dirty dance.

“The last time I used the bag, a patient told me [it] reminded [them] of The Exorcist get rid of evil spirits,” says Joseph Sirven, MD, professor of neurology at Mayo Clinic. (The patient’s family member began humming the chilling theme from the 1973 movie, “Tubular Bells.”) Neurologists are among the dwindling group of specialists whose home visits remain standard practice, and medical bags remain necessary accessories.

Although the need to carry full medical kits has diminished, many doctors continue to carry the associated cultural baggage. Once Verghese transferred the tools of his trade to his coat pockets, his students called him “MacGyver” behind his back. This student-teacher tease was a case of repeating history: when Verghese was a medical student, one of his professors walked through the halls throwing and catching his Queen Square reflex hammer like the leader of a marching band, while Verghese and his classmates walked behind, playing imaginary trombones.

A few decades ago, Verghese wrote about his unwitting group leader teacher in the literary review, Granta. The professor’s widow read the article and wrote a letter to Verghese, which culminated in the two tea meetings at a London train station, where she presented him with the sacred bamboo-stemmed reflex hammer. It is now a possession of the Verghese Prizes, an emblem that the student has become the teacher (or rather, the trombonist has become the conductor).

Doctor’s bag, doctor’s identity

When he was in medical school, Verghese noticed that the bags of his professors and peers were characterized by these kinds of personal effects. “They were well worn and very much like a feminine handbag, very individual,” he said. “There were things you had to have in there, but there were also things that were uniquely yours.”

In addition to a reflex hammer, the traditional medical bag contained essentials such as a stethoscope, penlight, and blood pressure cuff. Sirven wears these essentials, but in addition, his eye chart, tuning fork, and sensation test pins identify him as a neurologist. The bag itself identifies him as one of the last defenders of the medical bag tradition. “The bag served multiple purposes,” Sirven said. “One purpose was practical. The other purpose was that of identity. Those of us of a certain generation always remember the black bag that announced to passers-by that the doctor had arrived.”

The medical bags carried in today’s medical schools go against tradition while maintaining their identity. In her first year as a medical student, Siobhan Deshauer, who posts YouTube videos under the username violin doctor, was carrying items in his roll call bag that would be standard for college students in any field: a sweater, lip balm, several pens and, “the most important thing,” snacks. Four years later, she graduated from medical school as a rheumatologist equipped with vials of corticosteroids and injection equipment.

From evolution to extinction

So why has the once-essential doctor’s kit become, by some measure, dispensable? “The easy answer is there’s an app for it,” Sirven said. “Apps and phones with their electronic accessories – not to mention wearable devices – have made the bag less necessary, or at least shrunk the bag. The lack of medical bags shows me how much technology has changed medical practice over years. “

Modern, mobile technologies may have freed the hands of many physicians, but they are not always conducive to a hands-on approach.

Deshauer carries a smartphone loaded with apps like UpToDate, RheumaHelper, Eponyms and Figure 1, but she relies more on her university’s “Residence Survival Guide,” a handy reference that streamlines the information she needs most. “One of the challenges of having access to so much information is that you have to know what you’re looking for and how to get it very quickly. The other side is, definitely, your phone can die,” says- she. “There’s no doubt that there are limits to what you can do with a phone, especially when it comes to things like dermatology, where you need specific equipment to look good and grow much larger. [to] the phone.”

For this reason, Verghese carries a traditional magnifying glass and “a number of tiny disposable flashlights”, which he distributes to his students to enhance physical examination. “I think it’s quite telling that very few doctors carry much of anything,” he said. “My feeling is that this reflects the current state of patient examination, which tends to be quite superficial, a trend that I regret, because the body is text, and the ability to read it is something that patients people were very good in the years past.”

Yet the doctor’s bag as we once knew it has literally become a museum piece. The Smithsonian Institution seized Verghese’s old medical briefcase for an exhibition on the American Indians which was shown at the National Museum of Natural History in Washington, DC, for most of 2014 and 2015.

“I felt sorry to see him go,” he said, “but it wasn’t like I intended to use him, so I couldn’t argue.” In the years since the initial display, the bag has traveled to museums across the country as a piece of Verghese’s own history and that of a bygone medical era, kept behind glass.

Molly MacGilbert is a Brooklyn-based freelance writer and editor.

For more information, follow Medscape on Facebook, Twitter, instagramand Youtube.

Previous 2022 Audi e-tron GT Review: The Deafening Sound of Electric Excellence
Next K-SWISS athlete Cameron Norrie defeats David Goffin to advance to Wimbledon semi-finals