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-like "mobile office" stocked with alcohol and needles, and a later model was a latched suitcase that emitted a pungent medicinal odor.
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 sprung for a stately bag of his own to go with his new position.
Today, doctor's bags are often seen as relics of the past. Time and technology have literally lightened physicians' loads and, in many cases, have eliminated the need for elaborate toolboxes altogether. Still, physicians remain bound to the things they hold on to: reminders of their own histories and those of the physicians who came before; the tools that reinforce their identities within the field; the innovations that have changed the practice of medicine; and the "old-fashioned" instruments they're reluctant to let go of.
Like many physicians, Verghese — now a professor of medicine at Stanford University and a bestselling author — has long since ditched his once-treasured bag. He continues to carry many of its former contents in the pockets of his white coat. "I think these instruments aren't just of historical importance; they're of diagnostic value," he says. "I think, if anything, there are more things we could be carrying."
A Short History of the "Physician's Necessity"
The first known mention of a medical bag appeared in the Hippocratic Corpus around 350 BCE. "For your trips, you will carry a simple and portable kit," Hippocrates wrote in his "Decorum" treatise. "The most appropriate is the one which follows a methodic layout, because the physician cannot keep everything in mind." By 1885, the physician's necessity had become luxurious. Mayer & Meltzer manufactured cases made of mahogany, oak, or walnut; lined with velvet or leather; and festooned with brass or ivory handles. Each cost the modern equivalent of nearly US$3000.
Among their instruments, medical bags hold a history of medical progress. The standard accoutrements of each decade are revealing: chloroform and soap in the 1920s; Steri-Strips and Dextrostix by 1980. Doctor's bags have popped up throughout pop culture, in places from Norman Rockwell's 1929 Saturday Evening Post cover, "The Doctor and the Doll," to Baby's dad's medical kit in the 1987 movie Dirty Dancing.
"The last time I used the bag, a patient told me [it] reminded [them] of The Exorcist getting rid of the bad spirits," says Joseph Sirven, MD, professor of neurology at the Mayo Clinic. (The patient's family member began humming the 1973 movie's creepy theme, "Tubular Bells.") Neurologists are among the shrinking group of specialists for whom house calls 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 into his coat pockets, his students called him "MacGyver" behind his back. This student-teacher teasing was a case of history repeating itself: Back when Verghese was a med student, one of his professors would walk through the halls tossing and catching his Queen Square reflex hammer like the leader of a marching band, while Verghese and his fellow students marched behind, playing imaginary trombones.
A couple of decades ago, Verghese wrote about his unwittingly band-leading professor in the literary magazine, Granta. The professor's widow read the piece and wrote Verghese a letter, which culminated in the two meeting for tea at a train station in London, where she bestowed him with the hallowed, bamboo-stemmed reflex hammer. It's now a possession Verghese prizes, an emblem of the fact that the student has become the teacher (or rather, the trombonist has become the bandleader).
Doctor's Bag, Doctor's Identity
When he was in med school, Verghese noticed that his professors' and peers' bags were characterized by these kinds of personal effects. "They were nicely worn and very much like a woman's 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 held essentials such as a stethoscope, a pen light, and a blood pressure cuff. Sirven carries these essentials, but in addition, his eye chart, tuning fork, and sensation-testing pins identify him as a neurologist. The bag itself identifies him as one of the remaining upholders of the medical bag tradition. "The bag served multiple purposes," Sirven said. "One purpose was practical. The other purpose was one of identity. Those of us from a certain generation always remember the black bag which told onlookers the doctor had arrived."
The medical bags carried in medical schools today buck tradition while retaining identity. In her first year as a med student, Siobhan Deshauer, who posts YouTube videos under the username Violin MD, carried items in her call bag that would be standard for university students in any field: a sweater, lip balm, several pens, and, "the most important thing," snacks. Four years later, she is emerging from med 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 measures, dispensable? "The easy answer is that there is an app for that," Sirven said. "Apps and phones with their electronic attachments — not to mention wearables — have made the bag less of a necessity, or at least shrunk the bag. The lack of medical bags tells me how much technology has changed medical practice over the years."
Mobile, modern technologies may have freed up many physicians' hands, but they are not always conducive to a hands-on approach.
Deshauer carries a smartphone loaded with apps like UpToDate, Medscape, 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 the most. "One of the challenges with having access to so much information is that you need to know what you're looking for and how to get it very quickly. The other side is, certainly, your phone can die," she says. "There's no doubt there are limitations to what you can do with a phone, especially when it comes to things like dermatology, where you need specific equipment to look properly and to magnify in a way that's far superior [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 the physical exam. "I think it's quite telling that very few physicians are carrying much of anything," he said. "My sense is that this reflects the current state of examining patients, which tends to be fairly cursory, a trend that I bemoan, because the body is a text, and the ability to read it is something people were very good at in the years past."
Still, the doctor's bag as we once knew it has quite literally become a museum piece. The Smithsonian Institution took hold of Verghese's old medical bag for an exhibition on Indian Americans that was shown at the National Museum of Natural History in Washington, DC, for most of 2014 and 2015.
"I felt sorry to see it go," he said, "but it wasn't as though I was intending to use it, so I couldn't argue." In the years following the initial exhibition, the bag traveled to museums throughout the country as a piece of both Verghese's own story and that of a bygone medical era, preserved behind glass.
Molly MacGilbert is a Brooklyn-based freelance writer and editor.
Lead image: Dreamstime
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Cite this: What's in Your Medical Bag? - Medscape - Jul 05, 2022.