For the first part of its working life, a medical student’s stethoscope is mostly worn. It hangs around the neck or folds into the pocket of a white coat, and it announces something about its owner long before it has been asked to do any work. There is nothing shameful in this. Every calling has its insignia, and a student is entitled to a little pride in the first piece of equipment that belongs to medicine rather than to school. The instrument has, besides, become one of the most widely understood pictures in the world. It is the doctor on hospital signs and in advertisements, the small coiled icon on a phone screen that means health, the prop that tells an audience who the man in the white coat is supposed to be. Few objects have travelled so completely from use into symbol.
But the stethoscope in the photograph and the stethoscope in use are different objects, and the distance between them is one of the first things medical school teaches. I studied medicine at Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar from 1997 to 2002, and I learned to use a stethoscope there, as every medical student learns somewhere. I will not pretend to recall a first instrument or a first heartbeat. What has stayed with me is the shape of the lesson, which is much the same everywhere, and which I have come to think is less a lesson about sound than about attention. The rolled paper tube with which René Laennec began, in Paris in 1816, has become two earpieces, a length of tubing and a chestpiece; its story belongs to another essay on this site. Here I want to ask a narrower question. What does a person mean when he says, of a sound inside another person, I heard it? And how would anyone, the listener included, know whether that was true?
The Instrument Does Not Listen #
The first instruction a student receives is mechanical and faintly comic. The earpieces must point forward, along the angle of the ear canals, toward the nose. Put them in the other way round and the instrument delivers very little, and a beginner can stand for some time with a chestpiece pressed to a chest, concentrating fiercely on almost nothing. It is a useful first humiliation, because it establishes at once that the equipment does not listen on anyone’s behalf. It has to be fitted to a particular pair of ears before it can carry anything to them.
A good seal does something else as well: it shuts out the room. For the seconds of listening, the physician hears the inside of another person’s chest and very little of the voice that usually comes out of it, which is why patients are asked to stop talking while someone listens. I find this one of the quiet paradoxes of the examination. To hear the body more clearly, the clinician briefly stops being able to hear the person. A good deal of what follows is about that paradox, and about the obligation, once the listening is done, to take the earpieces out and come all the way back.
Then there is the chestpiece. The traditional arrangement has two faces. A flat diaphragm, pressed firmly against the skin, favours higher-pitched sounds; a shallow cup, the bell, laid on lightly, favours the low ones. Press the bell hard and the skin stretched across its rim begins to behave like a diaphragm itself, and the low sounds one wanted fade away. That rule is still taught, and still true of the instruments it describes, but it is no longer the whole story. Many modern stethoscopes have a single “tunable” diaphragm, and one manufacturer’s instructions turn the old rule into a matter of touch: rest the chestpiece lightly for low-frequency sounds, press firmly for high ones. The pressure of the hand has become the tuning dial. Nothing could make the point more plainly. On such an instrument there is no separate tool for the quiet sounds. There is only the decision to press less.
All this matters because auscultation happens near the lower edge of human hearing. A review of stethoscope technology published in 2018 gives the normal range of heart sounds as roughly 10 to 200 hertz and notes that some sounds, below about 50 hertz, may not be heard at all; the ear is least sensitive just where the heart does much of its talking. Lung sounds sit higher, mostly between a hundred and a thousand hertz. The same review observes that an acoustic stethoscope also loses some of what it carries on the way. The instrument, then, is a small and imperfect bridge across a gap in our own equipment, and everything that crosses it arrives mixed with something else: chest hair rasping against the diaphragm, the rustle of a sleeve, tubing knocking on a bed rail, the listener’s own breathing, a trolley in the corridor. Learning to use a stethoscope is partly learning to recognise these artifacts as one’s own noise and not the patient’s.
Effort and Grip #
Every student has to learn the business of pressure against instinct. The natural response to a faint sound is to press harder, and pressing harder is precisely what makes certain sounds disappear. I know few better small demonstrations of something true about attention in general, and the best account of that truth I have read was written by someone who never held a stethoscope.
In 1942 the French philosopher Simone Weil wrote a short essay, published after her death in Attente de Dieu and known in English as “Reflections on the Right Use of School Studies with a View to the Love of God.” Its subject is the schoolroom: Latin prose, geometry problems, the exercises students do because they are set. Weil argues that the real value of such exercises lies less in their content than in the attention they train, and she is sharp about what attention is not. “Most often,” she writes, in Emma Craufurd’s translation, “attention is confused with a kind of muscular effort.” She describes students who believe they are attending because they frown, hold their breath and stiffen their muscles, and who are in fact only tired. Attention, as she understands it, is closer to waiting: thought held loosely, suspended, emptied, ready to be entered by its object.
I do not want to recruit Weil into medical education. Her essay is about the love of God, and it would be a small vandalism to flatten it into a study tip. But anyone who has watched a beginner bear down on a bell will recognise her frowning students. The body meets difficulty with force, and the instrument punishes that instinct physically: the harder the grip, the less there is to hear. Some things are available only to a person willing to hold the instrument lightly and wait. The waiting is not passive. It is effort of another kind, an effort of not interfering, harder to sustain than the obvious kind because from outside it looks like doing nothing.
Weil makes a second claim that I find both consoling and, for a physician, slightly dangerous. She says that no genuine effort of attention is ever wasted, even when the problem is never solved, because the faculty itself is being formed. A student who listens hard to a chest and hears nothing distinct has not wasted the effort. That is true, and it matters to every learner who has stood at a bedside hearing only a wash of noise. But medicine adds a condition Weil did not need. Attention without correction can train confidence as easily as perception. A student can attend with complete sincerity to the wrong thing, or to the right thing under the wrong name, and come away more certain and no more accurate. Weil’s geometry problems had an answer somewhere, if only in the teacher’s hands. The bedside often has none unless someone supplies it. I will come back to that.
One Sound at a Time #
The beginner’s heart is a single noise: the familiar two-part beat and, around it, an undifferentiated wash. The traditional remedy is to stop trying to hear everything at once. Students are taught to attend to the first heart sound alone, over several beats, ignoring the rest; then to the second alone; then to the interval between them, which is systole; then to the interval after the second, which is diastole. At an ordinary resting rate the second interval is the longer, which helps a beginner tell the two apart, although the difference narrows as the heart speeds up and cannot be relied on in every patient. For the lungs, the method is comparison: a point on one side, then the matching point on the other, so that each side becomes the other’s control.
This is attention narrowed on purpose, and the narrowing is the real education. A listener who tries to take in the whole sound at once hears its loudest parts and little else. To hear a particular thing, one has to decline, for a moment, to hear the others.
Narrowing has a cost, though, and a lyrical account of listening tends to leave it out. In 2012 two psychologists at Royal Holloway, University of London, Polly Dalton and Nick Fraenkel, played people a recording of two conversations, one between two women and one between two men, and asked each listener to follow one of them. Partway through, a man’s voice broke in, repeating “I’m a gorilla” for nineteen seconds. In their first experiment, seven in ten of those following the women’s conversation did not notice it. The researchers called the effect inattentional deafness. An ear set to find one thing can be remarkably good at not finding another, even something absurd and prolonged.
The lesson for the chest is uncomfortable. A student told to listen for a particular murmur may hear it, or imagine it, and miss the scratch of a rub or the stumble of an irregular rhythm that nobody asked about. The fixed sequence of the examination is partly a defence against this. Its order makes the listener narrow and widen and narrow again, this sound, then the next, then the whole, so that attention cannot settle for good on the first thing it was told to want. A routine can look like the opposite of attention. Often it is attention’s scaffolding, the means by which a fallible ear is made to visit the places it would otherwise skip.
Listening to Quiet #
In a healthy heart, much of each cycle is quiet. A good deal of what auscultation can reveal appears in those quiet stretches; many murmurs, and extra sounds such as gallops, occupy intervals that ought to be silent. Not every abnormality lives there. Some show up as a change in the heart sounds themselves, louder or softer than they should be, or split where one expects them single. But the beginner’s habit is to listen for noises, and a large part of the training is learning to listen to quiet as well, and to notice when quiet is not quite quiet.
That is a strange skill. Hearing an absence means holding in mind what the silence ought to sound like and comparing the present silence against it. It requires a memory of normal, which can only be built by listening attentively to a great many ordinary chests, including the many in which nothing is wrong and nothing interesting will ever be written down. The dull hours are not wasted. They are where the standard for silence is made, and without that standard the significant sound has nothing to stand out against.
Nor is the normal a single sound. In many healthy people the second heart sound splits audibly in two as they breathe in and closes again as they breathe out. Many children and young adults have soft murmurs produced by nothing more than blood moving briskly through a sound heart. A beginner who has learned normal only as a diagram will hear these as faults. The memory of normal has to include its variety, which is one more reason the dull hours matter.
Three Statements in One Sentence #
Perceiving a sound and understanding it are separate accomplishments, and the second takes far longer. There are, in fact, at least three statements hidden inside the phrase I heard it. The first is that a sound reached the listener. The second is that the listener could describe its features: where it fell in the cycle, its pitch and shape, whether it changed with breathing or position. The third is that those features were interpreted correctly in the circumstances of this particular person. Success at one stage does not guarantee success at the next, and the failures at each stage are different.
A learner may notice something unfamiliar and have no words for it. Another may know the vocabulary perfectly well and give a confident name to a sound that was never clearly distinguished. Both need correction, but of different kinds. The first needs help organising perception, someone at his shoulder to say that, there, the thing just after the second sound. The second may need to go back to what was actually heard before defending the label. The danger in the second case is that the name arrives first and recruits the perception afterwards. One hears the murmur one has already decided is there.
Words themselves are part of the difficulty. The vocabulary of lung sounds has an untidy history, with the same noise named differently by different schools, and the consequences are measurable. In a study published in 2016 in BMJ Open Respiratory Research, Hasse Melbye and colleagues asked twelve doctors, six paediatricians and six who examined adults, to classify twenty recorded lung sounds. Using ten detailed categories, their agreement was usually poor to fair. When the categories were collapsed into broader ones such as crackles and wheezes, agreement became moderate to good. A richer vocabulary did not produce a more shared hearing; it produced more ways to disagree. The finding does not make fine distinctions worthless. It means a distinction is only as useful as the ability of two people to make it the same way.
I find myself thinking, in this connection, of the structure of a text that has nothing to do with medicine. In the Japji, Guru Nanak’s composition that opens the Guru Granth Sahib, four successive stanzas take up suniai, listening, and the four after them take up mannai, accepting, taking to heart. Their subject is spiritual, and I would not press scripture into service as a manual of auscultation. But the order has stayed with me as a reader. Listening is given its own room before acceptance is given its own. At the bedside, too, the hearing has to be allowed to finish before the believing begins. A clinician who accepts too early hears what he has already accepted.
The Queue at the Bedside #
There is a social version of the same danger, and its setting is familiar to anyone trained in a teaching hospital. A patient with a clear and instructive finding, a murmur as tidy as a textbook’s, may be listened to by a succession of students in a single morning, each bending in turn to the same place on the same chest. At the end the teacher asks who heard it. The pressure in that moment is not acoustic. Nobody wants to be the one who failed to hear what everyone else apparently heard, and so the easiest answer, the one that costs nothing in front of one’s peers, is yes.
I suspect this small scene, repeated in teaching hospitals everywhere, does more to form a physician’s relation to evidence than any lecture on the subject. A student who says yes without having heard learns two things at once: that the word can stand in for the perception, and that the substitution will usually pass unnoticed. A student who says I’m not sure; there was something after the second sound, but I couldn’t describe it has taken a small social risk for the sake of accuracy, and if the teacher responds well, he learns that the risk was worth taking. The difference between those two answers is the whole difference between a performance of listening and listening that can be corrected. Good teachers know this, and ask in a way that makes the honest answer cheap: not Did you hear it? but Tell me what you heard.
The scene has a third participant, easily forgotten. The patient with the instructive murmur has lent his chest to a line of strangers. Teaching hospitals depend on that generosity, and it is real generosity, offered by people who are often unwell and not always asked whether they mind. The minimum return is the one the instrument itself keeps teaching: an explanation, a request, a warmed chestpiece, thanks, and the freedom to say that enough is enough. A student who learns to hear well at the expense of a patient who was never really asked has learned the acoustic lesson and failed the other one.
What the Studies Heard #
How well do physicians actually hear? The most quoted answer comes from a study published in JAMA in 1997 by Salvatore Mangione and Linda Nieman. They tested 453 physicians in training from eight internal medicine and twenty-three family practice programmes in the mid-Atlantic United States, along with 88 medical students. Participants listened to recordings of twelve cardiac events, murmurs and extra sounds among them, and answered multiple-choice questions about what they heard. The residents recognised about 20 percent of the events. Improvement from one year of training to the next was small, and the residents did not significantly outperform the students. As the American Academy of Family Physicians summarised the study, more training and higher self-rated confidence did not translate into better accuracy, while those who had listened to teaching audiotapes, and those who could play a musical instrument, scored higher.
The study’s limits matter as much as its headline. It used recorded sounds, not living patients, so the listeners had no history to go on, no pulse to feel, no chance to move the patient or listen again. Multiple-choice questions test recognition among offered names, which is not the same as describing a sound unprompted. The participants were trainees in one region of one country in the 1990s. It would be a mistake to turn the figure into a universal estimate of what doctors hear. Later work nonetheless points the same way. A multicentre study by Jasminka Vukanovic-Criley and colleagues, published in the Archives of Internal Medicine in 2006, tested 860 medical students, residents, cardiology fellows, physicians and others with a computer-based multimedia examination at sixteen sites in the United States and Venezuela between 2000 and 2004. Cardiac examination skills improved through the third year of medical school and then, on average, stopped improving. Residents and practising physicians did no better than third- and fourth-year students; only the cardiology fellows scored significantly higher.
I do not read these findings as a scandal so much as a description of how skill works. Exposure alone does not train the ear. Repetition without correction tends to confirm whatever a person already believes he hears. The detail about musicians is telling in a quieter way. People who have spent years listening deliberately, and being corrected by a teacher or by the plain evidence of a wrong note, bring that habit to the chest. Hearing is not a gift some doctors are born with and others lack. It is a trained capacity, and like most trained capacities it decays when it is no longer checked.
There is a further irony. The tools that now allow a physician to check what he heard, imaging above all, also reduce the pressure to hear well in the first place. If a scan will settle the question, why labour over the murmur? There are good answers. Not every patient can be imaged, a sound that nobody notices prompts no test, and the bedside is where most questions are first raised. But the temptation is real, and it may explain part of the slow erosion the studies describe.
The Person at the Far End #
So far I have written as if the stethoscope connected a listener to a chest. It connects a listener to a person, and the person is not a passive source of sound. Auscultation depends on cooperation at nearly every point. The patient must agree to be examined, often to undress, to sit or lie a certain way, to stop talking, to breathe deeply through the mouth, to hold a breath, to turn. A frightened patient breathes differently. A cold one shivers, and shivering is audible. The explanation that comes before the examination, the asking of permission, the attention to comfort and modesty, are not courtesies laid over the technical act. They are among its conditions. A patient who understands what is happening, and why, is a better participant in the acoustics.
William Carlos Williams, who practised medicine in New Jersey for four decades while writing poems and stories, left the starkest account I know of an examination without cooperation. In “The Use of Force,” first collected in 1938, a doctor on a house call needs to see a feverish girl’s throat, because diphtheria is about, and she will not let him. The struggle escalates. She has to be held; he forces her mouth open and finds what he feared. The story is not simple. The examination was necessary, and the doctor is right about the disease. What disturbs the reader, and plainly disturbed Williams, is the doctor’s own feeling as the struggle goes on: a pleasure in winning, an anger that carries him further than judgment would. The instrument of examination has become a weapon in a contest of wills. I think of that story as the shadow of every examination. Usually the shadow is very faint, and the reason it is faint is that the patient has been invited in rather than overpowered.
There is one more instruction, and it belongs to courtesy rather than acoustics. The chestpiece is metal, and metal is cold. Held for a moment in the palm before it touches anyone’s skin, it arrives at something nearer the temperature of a hand. It is the smallest gesture in the whole examination, and it makes the same point as all the others: there is a person at the far end of the tubing, and the listening begins with them.
It also ends with them. The patient has an account the instrument cannot acquire. A change in how far she can walk before she has to stop, a symptom that comes only at night or only on stairs, a fear about what all this listening means: these have to be heard in conversation. Taking out the earpieces is therefore part of finishing the examination. Williams, in the chapter of his Autobiography called “The Practice,” wrote that his poems sprang from “the half-spoken words” of the patients he saw from day to day. The stethoscope hears the heart well and half-spoken words not at all. They become audible again only when the listener returns.
Ritual and Counterfeit #
There is a defence of the examination that goes further than courtesy. The physician and novelist Abraham Verghese, in a widely watched talk at TEDGlobal in 2011, called for a return to the traditional physical examination and spoke of it as a ritual whose meaning for the patient is not exhausted by what it finds. In the passage he read to close the talk, a dying man unbuttons his shirt for the doctor, and the small act is treated as an offering and an invitation. The examination, on this view, says something a doctor could not say as well in words: that this body is still worth attending to, that it has not been handed over to the machines.
I think he is right, and the argument carries a warning inside it. A ritual can be counterfeited, and the stethoscope is unusually easy to counterfeit. A chestpiece rested for a second or two on a shirt, the earpieces in, a nod: the gestures of auscultation can be performed without much auscultation taking place. Examination teaching asks for the chestpiece to sit on skin, partly because fabric brushing against the diaphragm makes noise of its own, and a brief pass across the front of the chest hears little of what a deliberate examination would. The patient, who cannot hear what the doctor hears, has no way to tell the real ritual from its imitation. That asymmetry is exactly what turns the imitation from a harmless shortcut into a small breach of trust. The patient believes he has been listened to.
The temptation is not usually cynical. It comes from pressure of time, from a sense that the finding will not change the plan, from habit. Sometimes a brief listen really is all a visit requires, and saying so honestly is better than staging a longer one. The distinction that matters is not between long and short examinations. It is between an examination whose gestures match what it is actually doing and one whose gestures promise more than it delivers. A counterfeit examination is the emblem pretending to be the instrument, at the bedside, in front of the one person with most reason to believe it.
What the Instrument Cannot Settle #
Here the essay has to argue against itself, because a lyrical account of listening can overstate two things at once.
The first is diagnostic power. A sound heard is one fact among many. It has to be placed beside the history, the rest of the examination and, where they are warranted, appropriate tests, and it can be outweighed by any of them. An absent sound does not exclude disease; plenty of serious conditions make no noise a stethoscope can catch, and a murmur’s loudness is a poor guide on its own to how much it matters. A physician who treats a quiet chest as a clean bill of health has mistaken the limits of the instrument for the limits of the illness. The opposite error is just as real: a confidently named murmur can set off tests and worry that the patient did not need. Some physicians now argue that handheld ultrasound will eventually do to the stethoscope what the stethoscope did to the ear pressed against the chest. They may be right. If they are, I hope the habits outlive the instrument: dividing the task, comparing, naming carefully, and checking the name.
The second overstatement is moral. It is tempting to say that a physician who listens well through a stethoscope is therefore a good listener in the larger sense, attentive and humane. The connection is not automatic. A brusque clinician can hear a murmur perfectly, and a kind one can miss it. Technical attention to a chest and generous attention to a person draw on some of the same capacities, patience above all, but they are not the same act, and the first does not guarantee the second.
In a letter of 1942 to the poet Joë Bousquet, who had been paralysed by a wound in the First World War, Simone Weil wrote that “attention is the rarest and purest form of generosity,” in the usual English rendering of her French. It is one of the most quoted sentences of the last century, and it deserves its fame. In the schoolroom essay she goes further: the fullness of love for one’s neighbour, she says, is simply being able to ask a sufferer what he is going through, and to attend to the answer.
Punjabi has an idiom that sits close to her sentence. English speaks of paying attention, as though it were a fee or a debt. In Punjabi one gives it: ਧਿਆਨ ਦੇਣਾ, dhiaan dena, to give dhiaan. And ਧਿਆਨ, from the Sanskrit dhyāna, covers both attention and contemplation, the ordinary noticing a child is told to bring to his lessons and the absorbed stillness of meditation. I would not build an argument on an idiom; languages are full of dead metaphors, and nobody saying dhiaan dena is thinking about gifts. But the grammar is a useful corrective to the English. Attention, in that construction, leaves the giver and arrives with someone else.
I believe Weil, and I also notice what her sentence requires. The generosity is in the attention to the sufferer, not to his chest wall. A stethoscope can serve that generosity. It can also become a way of attending carefully to everything about a person except the person: a few seconds in which he is asked, quite properly, to be silent, which can stretch, improperly, into a visit in which he never quite gets to speak.
Attention That Can Be Checked #
What, then, would good listening look like, if it is to be more than a performance of discernment? I think the answer is calibration: listening whose quality can be stated and tested.
A careful account of what was heard includes the conditions of hearing it. Was the room noisy? Could the patient sit up, hold a breath, stop shivering? Was comparison possible, side against side, this visit against the last? Did another examiner hear the same thing? What else in the history and the examination supports the interpretation, and what challenges it? A physician who can say I think I hear a soft murmur; the room was loud; I would like to listen again, or have it checked has said something more useful than one who names the murmur crisply and moves on. Uncertainty stated plainly is a form of precision. It tells the next person exactly how much weight the observation will bear.
Calibration also means looking for correction. The ear improves when it learns afterwards what was there: from a teacher listening at the same spot, from a recording played again, from an echocardiogram that confirms or contradicts. Digital stethoscopes, which can amplify, filter and record, make one part of this easier, since a sound can be saved and heard again by someone else. They do not dissolve the three statements inside I heard it. They make the first of them easier to share, and so make the second and third easier to check.
The finding in the 1997 study that confidence did not track accuracy seems to me the most important thing in it. Confidence is a feeling. Accuracy is a relation between a claim and the world. The only way to bring them together is repeated checking, which is humbling, slightly tedious, and exactly the kind of work Weil had in mind when she separated attention from straining. It does not show. A physician bent over a chest with a furrowed brow looks attentive. A physician who later sets what he heard beside what the echocardiogram found, to learn what that finding sounds like, looks like nothing at all.
The same discipline governs the longest listening. Prolonged auscultation is not proof of skill. Sometimes it is the opposite, a listener searching for a sound he has already decided to find. Knowing when to stop, when to ask someone else, and when to send for a test that will hear what the ear cannot are part of the craft, and none of them is a failure of attention. They are what attention looks like once it has learned its limits.
The Instrument in Use #
What the stethoscope offers, then, is an occasion, and what comes of it depends on the person at the earpieces. Attention displayed is the instrument around the neck. Attention given is the instrument in use: fitted to the listener, held lightly, aimed at one thing at a time and then widened again, with the listener willing to stay in the silence long enough to notice what it holds, and willing afterwards to have what he heard checked by someone, or something, else.
I said earlier that the phrase I heard it contains three statements. A fourth belongs at the end, because it is the one the instrument cannot make for anyone: and then I listened to you. The earpieces come out, the chestpiece goes back into the pocket, and the person on the examination table, who has been quiet for the length of a few breaths, has something to say. The sound was one contribution to understanding her. She has not finished speaking merely because the listening has stopped.
Evidence and Editorial Note #
Documented findings. The essay relies on the author’s public biography: MBBS at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, 1997–2002; Sikh. Laennec’s paper tube of 1816: standard histories of medicine, treated more fully in the site’s essay on the computer in the examination room. Forward orientation of earpieces; diaphragm and bell and the effect of pressure on the bell; listening to each heart sound and interval in turn and comparing symmetrical points on the chest; the typical relation of systole and diastole at resting heart rates: standard textbooks of physical examination. Light contact for low-frequency and firm pressure for high-frequency sounds on a single tunable diaphragm: a stethoscope manufacturer’s published instructions (“Using Tunable Technology”), consulted November 2026; no product is named or endorsed. Heart sounds of roughly 10–200 Hz, some sounds below about 50 Hz possibly inaudible, lung sounds of about 100–1,000 Hz, and attenuation in acoustic stethoscopes: Swarup and Makaryus, “Digital stethoscope: technology update,” Medical Devices: Evidence and Research, 2018. Simone Weil’s “Reflections on the Right Use of School Studies with a View to the Love of God” (1942; in Waiting for God, trans. Emma Craufurd), including attention confused with muscular effort, no genuine effort of attention wasted, and the question to a sufferer: the essay’s English text. Weil’s sentence on attention and generosity in a 1942 letter to Joë Bousquet, first published in 1950: secondary account by Kathleen Fitzpatrick, “La plus rare et la plus pure.” Inattentional deafness: Dalton and Fraenkel, “Gorillas we have missed: Sustained inattentional deafness for dynamic events,” Cognition 124(3), 2012 (bibliographic record, Royal Holloway repository), with figures as reported by NBC News. Lung-sound agreement: Melbye and colleagues, “Wheezes, crackles and rhonchi: simplifying description of lung sounds increases the agreement on their classification,” BMJ Open Respiratory Research, 2016. Mangione and Nieman, JAMA 1997;278:717–722: the JAMA abstract and the American Academy of Family Physicians’ summary in American Family Physician, 1998 (linked). Vukanovic-Criley and colleagues, Archives of Internal Medicine 2006;166:610–616: EurekAlert news release. The Japji’s stanzas on listening (suniai) and accepting (mannai), Guru Granth Sahib, Angs 2–3: SadhSangat commentaries on Japji pauris 8–11 and 12–15; no scripture is quoted. William Carlos Williams’s “The Use of Force” (Life Along the Passaic River, 1938): standard literary references; “the half-spoken words,” from “The Practice” in his Autobiography (1951): quoted as reproduced in a published commentary. Abraham Verghese’s talk “A doctor’s touch,” TEDGlobal 2011, and the closing passage he read: the TED talk page and an NPR transcript; the passage is paraphrased, not quoted. Physiological splitting of the second heart sound with inspiration, innocent flow murmurs in children and young adults, and the request to auscultate on skin rather than through clothing: standard textbooks of physical examination. The Punjabi ਧਿਆਨ ਦੇਣਾ and the Sanskrit origin of ਧਿਆਨ in dhyāna: standard Punjabi usage and reference. Vendor representations. None.
Recollection and tradition. That the author studied medicine at Sri Guru Ram Das Institute of Medical Sciences and Research is part of his published biography. No first stethoscope, purchase, teacher, examination, patient or remembered moment of listening is described; the stages of learning and the beginner’s mistakes are those of medical students generally. The patient addressed at the end is a general figure, not a person or scene. The reading of the Japji’s order is the author’s own, offered as a reader’s reflection, not as a statement of what Sikh teaching holds.
Analysis and forecast. The reading of the stethoscope as a lesson in attention, the distinction among hearing, describing and interpreting, the interpretation of the studies, the remark about handheld ultrasound and the case for calibration are the author’s personal interpretation as of November 6, 2026. Independence. This essay is not sponsored by any institution, company, health system or technology developer. It is personal reflection, not medical advice; readers seeking care should contact their own physician’s office.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.