Whatever happened to the doctor's bag?

Abstract

When I qualified in medicine in 1970, I was unable to get a job in Ireland and decided to go to America. Several of my friends took me aside and gave me grim warnings of what to expect. At that time it was a firmly held belief that American doctors had no clinical skills and that all they could do was order investigations. However, on my first day as an intern, I was handed a doctor’s bag to ensure I had a stethoscope, flashlight, ophthalmoscope, reflex hammer, etc. with me at all times so that I could always perform a full history and physical examination. Ever since, my doctor’s bag has remained my constant companion and I never examine a patient without it. However, I seem to be alone and, for reasons that are unclear, all my colleagues seem to have abandoned the use of their doctor’s bag. Yet, augmented by new technology, the doctor’s bag has now much more to offer and brings back considerable diagnostic ‘‘firepower’’ to the bedside. Modern advances have made traditional diagnostic equipment easier and quicker to use. There are now disposable peak flow machines, and tiny battery-powered spirometers are given away free by the pharmaceutical industry. The withdrawal of the traditional mercury sphygmomanometer has resulted in several ingenious alternatives. Personally, I have found that the speed and convenience of a small wrist blood pressure monitor more than compensates for its slight loss of accuracy since I measure more blood pressures more often. A bewildering array of stethoscopes is available. However, caveat emptor since the traditional ‘‘gold standard’’ Sprague–Rapport stethoscope is hard to beat, and the