Could This Be the End Of the Stethoscope?

In the days before x-rays, there was no way for doctors to see what was going on inside a living human body. But in 1816, still before x-rays, a new invention allowed them to listen to what was going on inside — the stethoscope, of course.

Two centuries later, it is one of the few diagnostic methods still around that does not utilize a visual image of the body’s insides. From the x-ray to the CAT scan, and from otoscopy to endoscopy, doctors look at the body, or samples from it, in order to formulate diagnoses and prescribe treatment.

Listening to the heartbeat may soon become a thing of the past, too, as technology such as the echocardiogram makes it possible for doctors to look at the heartbeat. The sounds of the heart can now be transmitted, digitized, amplified, filtered and reproduced onto a cellphone anywhere in the world, and included in the patient’s electronic medical record.

Just four months ago, the FDA approved a smart stethoscope for the medical market. By inserting the device into the tubing of a conventional stethoscope, doctors can take digital recordings of heartbeats, which can then be wirelessly transmitted to a phone app. By looking at the imaging and readouts, they will be able to see exactly how the heart is functioning.

The iconic rubber tubes and earpieces and the old, cold metal disc may soon be replaced by a more compact, more efficient, handheld device. In fact, some medical schools have already begun experimenting with such gadgets, capable of producing real-time images of the heart on the spot.

There seems to be good reason to put away the stethoscope. For one thing, listening and interpreting the human heartbeat is a subtle art, one that many doctors never master. A 1997 study found that doctors have surprisingly great difficulty in making correct diagnoses of common cardiac events with a stethoscope.

The evidence shows that the echocardiogram is more accurate and reliable. A 2014 study published in the Journal of American Cardiological Imaging said that cardiologists using the new technology accurately identified 82 percent of heart abnormalities, while cardiologists using physical examination caught only 47 percent. Stethoscope advocates are urging better training in their use to improve diagnostic accuracy, but if the research is accurate, it’s doubtful if better training could close such a gap.

Dramatic data like that has prompted the announcement in some quarters of the demise of the stethoscope. “The stethoscope is dead,” Jagat Narula, a cardiologist and associate dean for global health at the Icahn School of Medicine at Mount Sinai Hospital in New York told The Washington Post.

Not all of Dr. Narula’s colleagues are so sure, though. W. Reid Thompson, an associate professor of pediatrics at Johns Hopkins University School of Medicine, told the Post: “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. Most do agree that stethoscopes have not yet been surpassed for listening to lungs and bowels for signs of disease. As for the heart and lungs, global sales data also would seem to indicate that Narula and friends have misdiagnosed the supposed death rattle of the stethoscope.

On the contrary, the medical market appears to be moving in the direction of a better stethoscope, not a replacement for it. The forecast of Transparency Market Research predicts the market will expand to $342 million by 2017 due to increasing demand for fetal heart rate detectors and electronic stethoscopes. The rise in demand is being felt particularly in the Asian Pacific and Latin America.

Part of the resistance to digitalization is, undoubtedly, due to the conservatism of the medical profession which doesn’t like change, period, and especially given the sentiment attached to a device so long symbolic of modern healing itself.

A more serious objection was raised in the New England Journal of Medicine last month: that the stethoscope helps create a personal bond between doctor and patient. In a medical world so utterly dominated by technology and bureaucracy, whatever touch of the healer remains should be preserved, if possible.

But neither mere sentiment nor the admitted value of the personal touch would justify clinging to a traditional instrument when a better one is available. Too much is at stake for that.

It is not we, but the medical experts who will have to decide in the coming years whether the time has come to take off the stethoscope once and for all. The personal interaction between a physician and patient is crucial, and experience has shown that not always is the “new” and more advanced really better. Only time will tell. We should not use a tool just because it seems more sophisticated, but when it really is more precise and effective.

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