Is the stethoscope dying?

[jmj11]

I think we are loosing an art form in medicine. I can still tell a lot by listening to a heart and lungs.

 

https://www.apnews.com/6cf7790448ee48b3a4844213c78e783b

[UGoLong]

Yes, we can learn quite a bit by listening, but not nearly what we could by seeing.

It’s like having plain films for 100 years and then adding a less expensive, smaller, lower radiation, smarter form of today’s CT scanner.

The march of progress.


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[thinkertdm]

A couple of thoughts, because it's still early- and this is purely from a primary care perspective.

First, when I'm in the room with a patient, I use every tool at my disposal.  That includes a couple of rubber tubes hanging around my neck.  

Second, the stethoscope was derived as an extension of ears, to amplify.  I can see this technology as doing the same thing.

C, The most important tool is between my ears.  Always.  A stethoscope or portable ultrasound or X-ray vision doesn't mean a thing if you don't know what to do with that information.  Too many times I have seen "no m/r/g" and wonder if they actually knew what they are listening for.  

Fourth, consider if the additional cost of these gizmos is warranted, in a primary care setting, especially if all you want to do is use the latest and greatest.  See number C.  If it helps you change their life, then haul it out.  If it doesn't, or won't, then don't.  

Auscultation used to be a fine art, much like handwriting.  Now that texting and type came along, people's hands cramp with writing a sentence, let alone a book, yet this is how we used to communicate, with beautifully written letters.

A hundred years ago, a physician could auscultate and use that skill alone; now people just get an echo.

[Reality Check 2]

I think technology has done a lot for her ability to care for patients. However, I would never give up the hands-on and intuitive history taking to assess a patient. 

The ability to function and use your brain should not always rely on technology. When the power goes out, a stethoscope still works. Out in the wilderness, a stethoscope works. In remote areas of Third World nations, a stethoscope still works.

Just like cursive handwriting, I hope we never lose the old tactile skills and the listening and reasoning ability that will always serve the patient, even when the power is out.

Let technology complement the art, not take it over.

[GetMeOuttaThisMess]

Silly, old-school me.  I actually check the PMI on school athletic physicals.  Years ago in cardiology I could hear S4's on all the HTN patients and even the diastolic blow murmurs on AI/MR.  Now?  I'm doing well to hear a heartbeat.  Guess I could palpate a pulse since last time I checked I could still feel.

[rev ronin]

I have had a Butterfly IQ for 2.5 months.  I use it on anything reasonable, but I still reflect on my days and think "Oh, duh, I could have..." once or twice a week.  It's earning back its purchase price and he attendant CME expenses nicely, for things which I can meet criteria for limited studies billing.

I still have a stethoscope, which I use far more.

[weezianna]

Can't tell you the number of patients who have told me that, after I listen to their heart and lungs, that their last provider never laid a hand on them.

[cinntsp]

5 hours ago, weezianna said:

Can't tell you the number of patients who have told me that, after I listen to their heart and lungs, that their last provider never laid a hand on them.

I hear that a lot in the hospital as well after taking over a patient.  "Provider X would just come in and talk for 30 seconds and walk out.  I don't even know their name."

[bike mike]

In the past two weeks I found severe aortic stenosis in one patient and another with "permanent AFib" who was in fact in SR......all from using the "rubber hoses".

[pa-wannabe]

Went to my PCP for my annual physical a week ago. I was wearing a very thick sweater. The MA threw on the electronic BP cuff over my sweater, despite me offering to take my arm out. Then she grew frustrated when the machine took three attempts to get a (likely inaccurate) reading. I was never asked to change into a gown or remove any clothing. NP came in and listened over the thick sweater to heart and lungs, moving the stethoscope only twice. No HEENT exam, no basic neuro tests. Light abdominal palpation. 

 

I was taught that the history and physical exam are the bread and butter of the PA profession. Imaging and other technology, when ordered, are great tools. But I, surely like many of you, was also taught it should be an addition to physical diagnosis, not a replacement.