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Whither the stethoscope?

When we go for a routine visit to the doctor’s office, we take it for granted that he or she will use a stethoscope to listen to our heart and lung sounds. But as I discovered recently, this time-honored medical tool is in danger of being cast aside.

In researching a story for Stanford Medicine magazine on the stethoscope’s future, I found the medical literature replete with articles, particularly in cardiology journals, questioning whether the stethoscope’s time has passed. Some say the 200-year-old device has become obsolete, with one leading cardiologist calling it a “vintage accoutrement.”

Imaging technology, particularly hand-held ultrasound, is quickly outpacing the usefulness of the stethoscope as a way to discern what is happening in the body. “The truth is if you use technology well, you can get a lot more information,” pulmonologist and critical care specialist Ann Weinacker, MD, told me. She says she sometimes feels use of the stethoscope is just “pro forma.”

Still, there are those who argue the stethoscope is not going away anytime soon. Lars Osterberg, MD, MPH, an associate professor of medicine, says the stethoscope puts physicians in close physical touch with patients, helping solidify the doctor-patient rapport.

It gives "that touch that is not only diagnostic but also therapeutic,” he told me. “That connection is so important to the physician-patient relationship and building that and physician trust. You don’t get that with ultrasound.”

He and his colleagues worry that as younger practitioners rely more heavily on technology, they'll lose vital exam skills, including the ability to listen with a stethoscope. These skills are particularly crucial for physicians working in low-resource settings where ultrasound and other costly technologies are out of reach. Andre Kumar, MD, co-chief resident in internal medicine at Stanford, acknowledges that he has found his skills wanting while doing global health work in Uganda, Bangladesh and Nepal.

“There were so many times when I felt woefully unprepared to diagnose what was wrong with my patients, sometimes as a direct consequences of my physical-exam skills,” he told me.

At Stanford, Abraham Verghese, MD, a professor of medicine, has been leading a movement to keep alive these basic bedside skills, including the art of listening. And the medical school continues every year to honor the stethoscope’s traditional place in medical practice with a ceremony in which all incoming medical students receive their first listening device.

“This stethoscope represents the physician-patient connection,” Lloyd Minor, MD, dean of the medical school, told this year’s group of new students in August. “When you wear this, you commit to the physician-patient relationship above everything else.”

Previously: The power and limits of zeroing in: Stanford Medicine magazine on diagnosticsListening to the stethoscope's vitals and What will become of the stethoscope?
Photo by Max Aguilera-Hellweg

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