The stethoscope may be an icon of the medical profession. But as a tool of the trade, many veteran physicians fear it is becoming a useless prop of doctorhood.
As physicians rely on more accurate and expensive tests of cardiac function, including echocardiography, the art of listening to the heart has fallen on hard times. In recent years, a spate of studies has shown that as few as 20% of new doctors and 40% of practicing primary-care doctors can discern the difference between a healthy and a sick heart just by listening to the chorus of whooshes, lub-dubs, gallops and rubs that compose the distinctive music of the human heart.
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 doctors' skills, but these defenders of the stethoscope are no Luddites. They are banking on computer-generated heart sounds, virtual patients, CD-ROMs and that ever-present student friend the iPod to help a new generation of doctors overcome what Dr. Michael Barrett of Temple University recently called their "woeful lack of stethoscope skills."
By honing those skills in the next generation, defenders of the stethoscope hope to shore up physicians' first line of diagnosis, to stem the growth of healthcare costs and to preserve the purpose and integrity of one of medicine's most revered rituals -- the laying on of hands (not to mention hard metal) to treat patients.
"A lot of people have talked about the lost soul of medicine, how medicine has changed," 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. "The demise of the bedside examination and the refuge we seek in powerful technology is a symptom of that -- we're becoming more technicians and less healers."
At UCLA's 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, "Dr. Criley, wouldn't it be easier to put this all on a CD-ROM?"
