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January 5, 2016

Why some doctors are scrapping the stethoscope

Daily Briefing

A stethoscope hanging around a provider's neck is an iconic image in medicine. But with the rise of sophisticated imaging devices, experts are debating if the stethoscope still has a place in cardiovascular care, Lenny Bernstein writes in the Washington Post.

The tool, invented in the 19th century, is only as good as the provider using it, relying on physicians to correctly identify what they're hearing. According to recent research, auscultation skills—listening to the body as a method of diagnosis—can decline after years of practice, and improvement generally stops after the third year of medical school.

Are these the last days of the stethoscope?

Many experts agree that the stethoscope is still useful for detecting diseases by listening to the bowels and lungs. But some say the act of listening to a patient's heart is being outstripped by modern, more sophisticated imaging devices.

Hand-held ultrasound devices can generate real-time images right at the patient's bedside, and echocardiograms have shown vastly greater accuracy rates for diagnosing common cardiac conditions than stethoscopes alone. A 2014 study in JACC: Cardiovascular Imaging found that cardiologists using hand-held ultrasounds accurately identified 82% of patients with heart abnormalities, while those using physical examination only identified 47%.

"The stethoscope is dead," says Jagat Narula, a cardiologist and associate dean for global health at the Icahn School of Medicine at Mount Sinai Hospital. "Why should I not have an echocardiogram in my hand if it's as small as the stethoscope?"

Stethoscope's 'iconic' role

But with the right training, Reid Thompson, associate professor of pediatrics at Johns Hopkins University School of Medicine, believes that auscultation can be a valuable skill for providers. And Thompson says echocardiogram quality is not yet high enough for routine use in non-emergency care settings.

Optimizing the cardiovascular patient experience

Meanwhile, others say the act of using a stethoscope on a patient helps physicians facilitate a human connection that the other devices can't replicate.

"The link between patient and physician ... is unlike any other relationship between two non-related people," Elazar Edelman, a professor at Harvard Medical School and the Massachusetts Institute of Technology, wrote in a New England Journal of Medicine essay last month. "You can't trust someone who won't touch you" (Bernstein, Washington Post, 1/2).

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