Washington, Jan 3 (PTI) The role of the stethoscope, the ubiquitous tool of the medical profession for over 200 years, is at the center of debate in the US with a leading Indian- origin cardiologist declaring "the stethoscope is dead".
In recent years, the sounds it transmits from the heart, lungs, blood vessels and bowels have been digitised, amplified, filtered and recorded.
Algorithms already exist that can analyze the clues picked up by a stethoscope and offer a possible diagnosis.
But whether all this represents the rebirth of diagnostic possibility or the death rattle of an obsolete device is a subject of spirited discussion in cardiology, The Washington Post reported.
The widespread use of echocardiograms and the development of pocket-size ultrasound devices are raising questions about why doctors and others continue to sling earphones and rubber tubing around their necks.
"The stethoscope is dead," said Jagat Narula, a cardiologist and associate dean for global health at the Icahn School of Medicine at Mount Sinai Hospital in New York.
"The time for the stethoscope is gone," Narula said.
Starting in 2012, Mount Sinai began giving its students hand-held ultrasound devices that are little bigger than a cellphone but can generate real-time images of the heart right at the bedside. Several other schools will join the experiment in the coming months, the report said.
Stethoscopes retain their value for listening to lungs and bowels for clues of disease, experts say.
But for the cardiovascular system, "auscultation is superfluous. We are wasting [students'] time," Narula said.
"Why should I not have an echocardiogram in my hand if it's as small as the stethoscope?"
Not so, counters W. Reid Thompson, an associate professor of pediatrics at Johns Hopkins University School of Medicine.
"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. "It is valuable," he said.
One thing on which both sides agree, however, is that doctors are not very good at using stethoscopes and have not been for a long while, the report said.
In 1997, researchers examined how well 453 physicians in training and 88 medical students interpreted the information obtained via stethoscope. According to their study, "both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events."
19 years later, another team tried to determine when doctors stopped improving at "auscultation" the art of listening to the body to detect disease. The answer: after the third year of medical school.
French physician Rene Laennec had invented the stethoscope in 1816.
In 2016, the stethoscope remains one of the last instruments that health-care providers use to infer the nature of a problem, rather than viewing it directly.
Doctors "are the most conservative people on earth," said Sanjiv Kaul, head of the division of cardiovascular medicine at the Oregon Health and Science University. "Once they have learned something, they don't want to learn something else."
The stethoscope is also an icon, of course. Yet it carries more than symbolic value. It narrows the physical distance between doctor and patient. It compels human touch.
For now, that device is utilised most commonly in emergency rooms, where speed is critical. Its quality, said Thompson, is not yet good enough for routine use in other clinical settings.
But a 2014 study in the Journal of American Cardiological Imaging suggests the hand-held instruments are at least superior to physical examination. Cardiologists using them accurately identified 82 per cent of patients with heart abnormalities, while cardiologists using physical examination caught 47 per cent.
"It is time to discard the inaccurate, albeit iconic, stethoscope and join the rest of mankind in the technology revolution," Kaul, one of the researchers, wrote in an editorial for the Knight Cardiovascular Institute at Oregon Health and Science University.
Others wonder what might be lost when doctors stop placing that round, often cold disc against a patient's skin.
In an essay last month in the New England Journal of Medicine, Elazer Edelman pointed out that a stethoscope exam is an opportunity to create a bond between doctor and patient.
"The link between patient and physician .?.?. is unlike any other relationship between two non-related people," Edelman, a doctor who teaches at both Harvard Medical School and the Massachusetts Institute of Technology, said.
"When one physically moves oneself farther and farther away, that link is either frayed or is torn.
"You can't trust someone who won't touch you," Edelman said.
