Heartstrings
Despite throwback vibe, many doctors stand by stethoscope,
The stethoscope slung over Dr. Diego Delgado’s chest is very close to his heart.
“I’m wearing my father’s,” says Delgado, 45, a cardiologist at Toronto’s University Health Network.
“He was also a cardiologist. He gave it to me when I graduated from medicine.”
Delgado says he’ll still be wearing and using his father’s gift when his own career ends decades hence — even as many are now sounding the death knell of the 200year-old listening device.
“The stethoscope is dead,” Dr. Jagat Narula, a top cardiologist at New York’s Mount Sinai Hospital, told the Washington Post recently. “The time for the stethoscope is gone.”
Narula and others say the emergence of hand-held devices that can electronically chart the heart’s rhythms, clicks and mur- murs is rendering the iconic stethoscope obsolete. Ohers argue that precious few physicians can accurately interpret the heart sounds that are amplified into their ears through the device’s rubber tubing.
Studies over the past 20 years have indicated that a low percentage of young doctors could identify many common heart ailments with stethoscopes.
They also found doctors’ diagnostic listening skills — known as auscultation — commonly peaked before they graduated medical school.
But Delgado says the stethoscope will continue, at the very least, to be an important complement to modern diagnostic gadgets.
“You’ll always have to rely on what you hear,” he says.
“And sometimes with a stethoscope you get everything you need.”
The new-generation devices include pocket-size echocardiogram and ultrasound scanners that can picture the beating heart and chart its pumping rhythms at bedside.
While these can produce superior information on the heart, Delgado points out that they have little capacity to detect problems with other organs typically probed by stethoscope.
“The stethoscope has more of a unique value . . . when you examine lungs and bowels,” he says. “Currently no technology can replace that.”
Delgado says the problems physicians have demonstrated with stethoscope diagnoses are not innate, but due to a lack of training and ongoing mentoring.
“Personally, I trained in Argentina,” the heart transplant specialist says.
“And I have seven years of medical school where, from the first day until the last day, we trained using the stethoscope. I think that’s the key.”
He does admit that time pressures on today’s high-throughput physicians make them less willing or able to conduct stethoscope examinations bedside.
But Delgado says a stethoscope can provide benefits for patients, beyond the diagnostic — particularly in the comfort its familiarity confers and the human touch it requires.
“Patients feel satisfaction and sometimes a better understanding of a disease when you put a stethoscope to the chest and you tell them what you’re hearing,” he says.
“And I think there is an issue of . . . the human touch, the human contact with patients and I think that strengthens the patient and doctor relationships.”
If this tactile intimacy provides a true patient benefit, however, it does so ironically.
The stethoscope was actually invented by a prudish French physician who, in1816, balked at placing his head on a female patient’s bosom.
That’s when Dr. René Laënnec — who went on to refine the device soon after — rolled papers into a conical tube to amplify the sounds of her heart into his respectably removed ear.
New-generation stethoscopes, Delgado says, may also provide a reprieve for the neck-slung standby.
These include recently approved electronic versions that can transmit heart sounds to remote computers, where algorithms can parse them and suggest possible diagnoses.
And in many parts of the world, Delgado says, the “stethoscope and tongue depressor” are the only tools many physicians have.
“So you need to really know how to use it,” he says.
At the University of Toronto’s faculty of medicine, students will be taught how to use them for the foreseeable future, for a number of reasons. For one thing, says Dr. Marcus Law, wearing one makes them feel like doctors.
“The stethoscope is very symbolic and sometimes it helps to build the
“The stethoscope is very symbolic and sometimes it helps to build the physician’s identity.” DR. MARCUS LAW UNIVERSITY OF TORONTO FACULTY OF MEDICINE
physician’s identity,” says Law, a top official in the faculty’s undergraduate program.
“When you wrap (it) around your neck as a physician, you have a sense of responsibility and identity . . . and that’s what we want our students to develop,” he says.
Aside from its symbolism, however, Law says the stethoscope will continue to be an important tool of the students’ future trade, especially for the many who will enter general practice. “Even if we have (other) technology, it’s not that widespread,” he says.
Cardiologists, who examine hearts exclusively, might fully embrace the newer and more precise instruments, he says.
But as part of a routine visit to the doctor’s office — where heart health is just one component of an examination — a stethoscope will suffice.
“To train (as) a generalist, you need to know how to use a stethoscope as a basic tool,” Law says.