Reviving the stethoscope

But a handful of veteran physicians are struggling to revive the dying art of cardiac auscultation, or examining the heart with a stethoscope. They may fault the advance of technology for what they believe is a decline in doctors8217; skills, but these defenders of the stethoscope are banking on computer-generated heart sounds, virtual patients, CD-ROMs and iPods to help a new generation of doctors overcome what Dr Michael Barrett of Temple University recently called their 8216;8216;woeful lack of stethoscope skills.8217;8217;

By honing those skills in the next generation, defenders of the stethoscope hope to shore up physicians8217; first line of diagnosis, to stem the growth of healthcare costs and to preserve the purpose and integrity of one of medicine8217;s most revered rituals. 8216;8216;A lot of people have talked about the lost soul of medicine, how medicine has changed,8217;8217; says Dr Salvatore Mangione of Thomas Jefferson Medical College in Philadelphia, who in 2000 co-wrote an editorial on declining stethoscope skills in the American Journal of Medicine. 8216;8216;The demise of the bedside examination and the refuge we seek in powerful technology is a symptom of that8212; we8217;re becoming more technicians and less healers.8217;8217;

At the University of California, Los Angeles8217; Harbor medical campus, Dr John Michael Criley has been collecting heart sounds, diagnostic images and patient histories for almost five decades. For years, he hauled his jumble of recordings, images, videotapes and scribbled notes into his lecture rooms, until one day a student asked him, 8216;8216;Dr Criley, wouldn8217;t it be easier to put all this on a CD-ROM?8217;8217; He did. The result is something that Criley calls a 8216;8216;weapon of mass instruction8217;8217;. His teaching CD-ROM lets students see 8216;8216;virtual patients8217;8217; complete with the physical signs8212;a heaving chest or pulsating neck8212;of heart disease, and to hear their hearts8217; sounds.

8216;8216;These are things that should be in your armamentarium as you enter the bedside with a stethoscope in your hand,8217;8217; Criley says. 8216;8216;Let8217;s face it, every physician, even proctologists, have a stethoscope in their pocket. You shouldn8217;t have one if you don8217;t have the correct knowledge.8217;8217;

Since 2000, American internal medicine doctors who renew their board certification in the specialty a step required every 10 years have had to pass an examination of stethoscope skills. At the same time, new technologies continue to raise the question of whether it is worth the time and trouble to polish doctors8217; stethoscope skills. In addition to the ubiquitous ECG, a small New Hampshire company called Biosignetics Inc. is readying for market a stethoscope-like device equipped with software that translates a patient8217;s heartbeat into a storable visual display and compares it with a vast bank of normal and abnormal heart sounds. The software would recognise abnormalities and spell out their significance almost instantly.

Los Angeles Times