“The stethoscope is dead,” declares cardiologist Dr. Jagat Narula, who believes the time for the iconic tool is gone. What is the real lowdown on the stethoscope and its role in medicine?
A pronouncement like that of Dr. Narula, the associate dean for global health at Mount Sinai Hospital’s Icahn School of Medicine in New York, re-examines the status of the two-century stethoscope, an ubiquitous medical tool that transmits sounds from the heart, lungs, blood vessels and bowels that have been amplified, even digitized, and recorded.
Four months earlier, the U.S. Food and Drug Administration approved a type of stethoscope that can recreate those sounds on a phone app or transmit them directly to an electronic medical record. In addition, information picked up by a stethoscope can be analyzed by algorithms, leading to a diagnosis.
At the same time, the use of pocket-sized ultrasound tools and echocardiograms continue to flourish.
Do these developments then revive the importance of the stethoscope or kill its position in fields like cardiology?
How Doctors Are Using Stethoscopes
Research raised the issue of doctors’ ability and skill in using the stethoscope, which was invented by French physician René Laennec, the father of what is known as auscultation. A 1997 study, for instance, probed how well more than 450 physicians and 88 medical students interpreted information from a stethoscope.
“Both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events,” the study stated.
A separate team investigated when doctors stopped relying on the list of listening to the body to identify disease. The finding: they stopped improving at auscultation after their third year in med school.
“[This] has important implications for medical decision-making, patient safety, cost-effective care and continuing medical education,” the team wrote in the journal Archives of Internal Medicine.
Contrary to claims that the stethoscope and what it stands for is already dying in the medical practice, some experts believe listening to the body’s sounds will hardly be replaced by imaging and digital tools.
“We are not at the place, and probably won’t be for a very long time,” said pediatrics professor Dr. W. Reid Thompson of the Johns Hopkins University School of Medicine, highlighting auscultation’s value.
Medical Woes
Today, the device has unfortunately become one of the last that health care providers rely on, despite its symbolic value of bridging the gap between doctor and patient and promoting human touch.
This is especially pronounced in cardiology, where there is a great abundance of heart tests – some of which are even charged of exposing patients to risks such as excess radiation.
And there are other contributors to the problem, including less time spent by doctors with patients due to tight schedules, less time devoted for physical tests and less time for listening to stethoscopes.
In addition, the demand for electronic medical data has surged, eating time supposedly spent with patients.
For professor emeritus Dr. John M. Criley of UCLA’s David Geffen School of Medicine, it’s “all chart rounds and computer readout rounds.” At present it appears easier to have a patient undergo echocardiogram than conducting scope-to-chest interpretations.
There’s a financial incentive as well: providers and hospitals earn from echocardiograms, not from stethoscope-involving chest exams that cost nothing. This leads to a cycle where younger doctors have fewer predecessors to teach them the fine science of auscultation.
The Future Of The Cold Round Disc
While experts agree that the stethoscope has remained important for tuning in to signs of disease in the lungs and bowels, they said the tool could already be outdated for cardiology and would likely be reserved for emergency room settings where speed is everything.
There are others, however, who continue to argue the value of a stethoscope exam in creating a doctor-patient bond.
Dr. Elazer Edelman said in an essay last month that the physician-patient link is unlike any other relationship found between people who are not related.
“You can’t trust someone who won’t touch you,” he emphasized.
Photo: Helge V. Keitel | Flickr
