Heart doctors are listening for clues to the future of their stethoscopes
, Washington Post,
DR. RESHEF’s Comments:
Ok, I admit it- I am a bit old-fashioned when it comes to using the stethoscope during a physical examination- I always use it. But make no mistakes- I view its use as archaic when it comes to diagnosing disease in my patient population. Remember that I deal mostly with healthy women, in whom the likelihood of discovering cardiovascular disease with this instrument is extremely low. I use it as a statement to my patients that I care deeply about their health. This fleeting physical contact with my patients, no matter its limited clinical utility, is necessary to bolster doctor-patient rapport. It is my subtle statement to my patients that I am thorough and caring. The bimanual gynecological examination, in a way, has similar utility as the stethoscope- it is infrequently useful in diagnosing disease in asymptomatic patients. It is also much more uncomfortable than the stethoscope examination. Should we omit it in favor of an ultrasound?
The stethoscope is having a crossroads moment. Perhaps more than at any time in its two-century history, this ubiquitous tool of the medical profession is at the center of debate over how medicine should be practiced.
In recent years, the sounds it transmits from the heart, lungs, blood vessels and bowels have been digitized, amplified, filtered and recorded. Four months ago, the Food and Drug Administration approved a stethoscope that can faithfully reproduce those sounds on a cellphone app thousands of miles away or send them directly to an electronic medical record.
Algorithms already exist that can analyze the clues picked up by a stethoscope and offer a possible diagnosis.
But whether all this represents the rebirth of diagnostic possibility or the death rattle of an obsolete device is a subject of spirited discussion in cardiology. The widespread use of echocardiograms and the development of pocket-size ultrasound devices are raising questions about why doctors and others continue to sling earphones and rubber tubing around their necks.
“The stethoscope is dead,” said Jagat Narula, a cardiologist and associate dean for global health at the Icahn School of Medicine at Mount Sinai Hospital in New York. “The time for the stethoscope is gone.”
Not so, counters W. Reid Thompson, an associate professor of pediatrics at Johns Hopkins University School of Medicine. “We are not at the place, and probably won’t be for a very long time,” where listening to the body’s sounds is replaced by imaging. “It is valuable,” he said…
Others wonder what might be lost when doctors stop placing that round, often cold disc against a patient’s skin. In an essay last month in the New England Journal of Medicine, Elazer Edelman pointed out that a stethoscope exam is an opportunity to create a bond between doctor and patient.
“The link between patient and physician . . . is unlike any other relationship between two non-related people,” Edelman, a doctor who teaches at both Harvard Medical School and the Massachusetts Institute of Technology, stressed in an interview. “When one physically moves oneself farther and farther away, that link is either frayed or is torn.
“You can’t trust someone who won’t touch you.”