Auscultation and asking questions

Hi Everyone,
I’m on a cardiopulmonary placement at the moment and this reflection is based on something I learnt about auscultation and communication over the last week or so. I have been working on a ward and many of the patients I have seen have had quite severe dyspnoea. When I first started the clinic, I would auscultate posteriorly but whenever I went to listen anteriorly my supervisor said not to worry about it. Rather than asking why, I figured it was because the patients were too short of breath and so began fairly routinely just listening posteriorly. Then I had another supervisor for the day and they wanted to know why I was only auscultating posteriorly and therefore missing the whole of the middle lobe and lingula. I explained that based on my experiences with the other patients that I had thought that it was OK to only listen posteriorly if the patient was very dysponeic; however I now realized that it really wasn’t, because it meant that I had been missing a significant portion of the lungs. From then onwards I have been listening both posteriorly and anteriorly and the very next patient I saw actually had very significant wheeze in the middle lobe and lingula that could not be heard posteriorly. So, I have learnt how important it is to auscultate in a routine fashion both posteriorly and anteriorly. After this experience, I asked my initial supervisor why she hadn’t wanted me to listen to those initial patients anteriorly as well. She said it was because she already knew that their pathology was in the lower lobe and not the middle lobe and so she had thought it unnecessary to make the patient go through all of the auscultation when we wouldn’t learn that much from it.
So while this experience has taught me a bit more about auscultation, I have also learnt how important it is to ask questions about why someone is asking you to deviate from what you have learnt. They probably have a good reason and it lets you learn from their experiences.
Mel.