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[Guest guest]

Well, it's somewhat comforting to know that EMS isn't alone in its assessment

skills suffering due to technology...

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Doctor, what's that thing around your neck?

Physicians are re-learning the art of using stethoscopes

By Healy

LOS ANGELES TIMES

Monday, March 06, 2006

The stethoscope might 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 percent

of new doctors and 40 percent 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.

Dr. Weitz, a cardiologist at Jefferson Medical College in

Philadelphia, says new generations of student-doctors don't think listening to

the heart through the stethoscope is a skill worth developing..

" For many, " he says, the device slung around the neck or tucked into the pocket

of a crisp white coat " has become useless. "

But a handful of veteran physicians are struggling to revive the dying art of

cardiac auscultation, or examining the heart with a stethoscope. But these

defenders of the stethoscope are no Luddites. They are banking on

computer-generated heart sounds, virtual patients, CD-ROMs and iPods to help a

new generation of doctors overcome what Dr. 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, reduce costly tests and

preserve one of medicine's most revered rituals ? the laying on of hands to

treat patients.

" A lot of people have talked about the lost soul of medicine, how medicine has

changed, " says Dr. Salvatore Mangione of Jefferson College, 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 the University of California at Los Angeles, Dr. Criley has been

collecting heart sounds, diagnostic images and patient histories for almost five

decades. His jumble of recordings, images, videotapes and scribbled notes is now

preserved on a CD-ROM that Criley calls a " weapon of mass instruction. " It lets

medical students see " virtual patients " complete with the physical signs ? a

heaving chest or pulsating neck ? of heart disease, and to hear their hearts'

sounds.

" 'Let's face it, every physician, even proctologists, have a stethoscope in

their pocket. You shouldn't have one if you don't have the correct knowledge, "

Criley says.

In a study published recently in the American Journal of Medicine, Barrett, a

cardiologist, detailed his method of teaching third-year medical students to

discern a heart murmur or a weakened heart muscle by the telltale sounds that

such abnormalities make.

Early in that year ? during which they're expected to hone their clinical skills

? medical students could, on average, recognize six abnormal heartbeats four

times out of 10, Barrett found. Using computer-gen- erated " templates " of

diseased heart sounds, which are free of background noise or interference caused

by chest hair or fat layers, Barrett had 80 students listen to each of six

sounds at least 500 times. (Most students promptly converted the CDs to MP3

files and downloaded them to their iPods, he said.)

By year's end, the " intensive repetition " group raised its ability to recognize

those sounds to 89 percent of the time. A control group that had received

regular classroom instruction and the same experience during clinical rounds

showed no improvement in the ability to discern abnormal heart sounds.

" We used to say you'll learn it on the wards, " Barrett says. " They weren't

learning it on the wards. " Barrett says studies suggest that internists' ability

to detect and diagnose heart disease with a stethoscope alone is " basically at a

level of guessing. "

To compensate for their lack of skills, experts say, physicians are now quick to

order high-tech heart tests such as the echocardiograph ? basically ultrasound

imaging of the beating heart that can cost up to $1,000 a shot.

And newer technologies continue to be developed.A small New Hampshire company

called Biosignetics Inc. is readying for market a stethoscopelike device

equipped with software that would translate a patient's heartbeat into a visual

display and compare it with a vast bank of normal and abnormal heart sounds. The

software would recognize abnormalities and spell out their likely significance

almost instantly.