Physician's black bag making a comeback

May 16, 2004|By Erika Niedowski | Erika Niedowski,SUN STAFF

There are two things to note about Dr. George Taler's black bag.

The first is that he carries one at all. The second is what he puts in it: a portable computer, a digital camera, an instrument for measuring oxygen in the blood and, depending on which patient he's headed to see, a hand-held EKG machine.

"You might liken it to a supercharged V-8 in a Model T frame," said Taler, director of long-term care at Washington Hospital Center.

Given that most doctors' visits are made in an office or hospital setting, few physicians use a black bag any longer - and, even if they have one, it's probably on an office shelf or in the attic.

But with technological advances that have made instruments smaller and an increasing number of doctors reviving the tradition of the house call, the time-honored black bag has undergone a revolution.

"If you're going to care for the sickest of the sick and the most complex cases, you had better be ready with the technology," said Taler, whose stocked bag weighs about 18 pounds. "If you're carrying around a little black bag of yore, then you're practicing as an amateur."

Doctors who use the bags still carry many of the old standards, including a stethoscope, blood pressure cuffs, gauze and tape and a thermometer (digital, of course).

But many also bring a laptop, to which they can attach equipment for monitoring everything from heart to lung function, and to keep electronic medical records.

The black bag has long been a symbol of medicine, much like the doctor's white coat. In a 1950 essay in the journal GP - for General Practitioner - Dr. William Hyatt Gordon noted the diversity of emotions the bag inspired:

Some despised it, believing it contained only "evil smelling and tasting concoctions." Others were awed by it. Children were sometimes told their baby brothers and sisters came from inside.

It's unclear who first used the bags or why, for that matter, they're black. Doctors began toting them in the 19th century for a simple reason: They had things to carry other than their knowledge. Among the first portable instruments was the stethoscope, invented in 1819, followed several decades later by the reflex hammer and the ophthalmoscope, used to examine the eyes.

The first addition Dr. David B. Hellman has made to his 21st-century black bag is a portable ultrasound, which is about the size of a small textbook. The chairman of the department of medicine at Johns Hopkins Bayview Medical Center proposes that all primary care doctors carry one, so they can see how well a patient's heart is squeezing and whether any valves are leaking.

He envisions one day using a high-tech gadget that doesn't yet exist: a Palm Pilot-like device that can, among other things, take photographs, list drugs and their interactions, measure oxygen levels and test blood right at the bedside - in the hospital or at home.

"The challenge is, the black bag has almost religious connotations for patients and for physicians. That's both good and it's part of the problem," said Hellman, whose physician-father carried a large black bag while making house calls in Kentucky.

"[Many doctors feel that] if they were to give up these nearly sacramental instruments that have been used for centuries, that somehow it would be forsaking the art of medicine. I think they're wrong."

According to the American Academy of Home Care Physicians, the number of house calls has risen in recent years, from about 1.5 million in 2000 to about 1.7 million in 2002, the last year for which federal statistics are available.

Along with other physicians who make occasional home visits, most of the group's 700 members make house calls - each with a version of the black bag.

"I went to CompUSA, and I got a bag that fits my needs," said Taler, who finds a leather laptop satchel works best.

Taler, who is part of a three-physician house call practice in Washington, has been creative with his carryall before. When he started visiting patients at home during his residency at the University of Maryland Medical Center, he rode a Schwinn bicycle and carried medical tools in a backpack.

Dr. Howard D. Weiss, chief of neurology at Sinai Hospital, wouldn't think of abandoning his black bag - a traditional leather model with two zippered compartments and a lock he doesn't use. He has gone through about 15 of them in his 27-year career; he needs to buy a new one about every 18 months because of normal wear and tear. He takes it from home to office to the hospital and back, every day:

"Literally, to be honest, I don't feel like a doctor unless I have that black bag in my hand."

Weiss' bag contains a few high-tech elements - a "flash chip" that plugs into his computer and allows him to transfer files from office to home - as well as a miniaturized ophthalmoscope. Otherwise, his tools aren't fancy. He has a reflex hammer, tuning fork, stethoscope, tongue depressors, pins to test skin sensation and, often, a few patient records.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.