National Post (National Edition)
the beat stops here
WHY THE ICONIC STETHOSCOPE IS FACING ITS LAST GASP
The stethoscope may be listening to its own last, lingering wheeze.
Two hundred years after its invention, the humble, iconic symbol of medicine risks becoming obsolete, squeezed out by upstart, miniaturized, palm-sized ultrasound devices that allow doctors to instantly visualize the heart’s structure and function.
Some doctors have already written its obituary (“The stethoscope’s 200th anniversary should also be its funeral,” American cardiologist Eric Topol tweeted this year, while journal articles ask, “Celebration, or cremation?”)
Others are pleading for the gadget’s revival, arguing the stethoscope remains as valuable a diagnostic tool today as it was two centuries ago and that its demise would spell an end to the “art and romance” of the physical exam.
“We are getting more and more distanced from our patients,” laments Ottawa cardiologist Lyall Higginson, among the experts debating the stethoscope’s future this week at the Canadian Cardiovascular Congress in Toronto.
Higginson worries doctors are over-relying on technologies that turn people from living, breathing humans into computer-generated images of their organs, and argues “superb” diagnoses can still be made by deciphering the wooshes, gurgles and sounds emanating from human bodies.
If or when the new handheld ultrasounds get their own billing code — meaning doctors would get money for doing them — “it would be the demise of the stethoscope,” Higginson predicts. “It’ll be a problem.”
Still, even the pro-scope side concedes many doctors are not as skilled as generations before them in the art of auscultation and that medical students today are receiving only cursory training.
“Some of the protocols tend to be a bit on the casual side — taking students around to listen to a couple of patients in a clinic, and maybe listening to a couple of recordings,” said Dalhousie University pediatric cardiologist Dr. John Finley, who has spent much of his career helping teach advanced stethoscope skills.
Some studies suggest hand-held ultrasounds provide more accurate diagnoses for a majority of cardiovascular abnormalities. One study found first-year medical students with 18 hours of ultrasound training were able to correctly flag more cardiac abnormalities than trained cardiologists performing a traditional, stethoscope-assisted exam.
“There are conditions where physical findings are very obscure,” says Dr. ChiMing Chow, an attending staff cardiologist at St. Michael’s Hospital in Toronto.
“And often we end up requiring an ultrasound to confirm a physical finding anyway. So, you can argue you can actually jump one step, and save time.”
Birthed by French physician Rene Laënnec in 1816, the stethoscope replaced direct auscultation — putting the ear to the patient’s chest, and listening that way.
Immediate ultrasounds can be critical in emergency situations — trauma or heart attack victims, he said. With only a stethoscope, “you can find out how fast the heart is going and measure blood pressure, but you can’t really look directly at the func- tion of the left ventricle,” the heart’s main pumping chamber, Finley says. If the left ventricle isn’t functioning properly, blood pressure can’t be maintained and the person can die.
However, doctors can tell by listening with an educated ear which heart murmurs are normal or abnormal, Finley says. (A normal murmur in a child sounds like a vibration — vvvv, vvvv, like a child making the noise of a toy truck. The abnormal type sounds like the wind blowing — sshhhh.)
“In the end, it’s not going to be one versus the other,” predicts Higginson, a clinical cardiologist at the University of Ottawa Heart Institute. “It’s going to be, how do you fit the new technology in with the old?”