Ask any doctor and it’s likely they’ll remember it – the weight of it, the colour, the pride of wearing it for the first time. The day a medical student gets their first stethoscope is the day they first feel like a doctor.
200 years since its invention in a French chest clinic, the doctor’s listening device remains the most visible symbol of the medical profession.
But might the days of the “stetho” be numbered? According to two top doctors at New York’s Mount Sinai Hospital, the old tool of the trade may soon be consigned to the museum, as the advent of new, hand-held ultrasound technology, which is more accurate than a stethoscope and a good ear ever could, gradually renders the stethoscope obsolete.
“Certainly, the stage is set for disruption,” say Professors Jagat Narula and Bret Nelson. “As LPs were replaced by cassettes, then CDs and MP3s, so too might the stethoscope yield to ultrasound.”
In an editorial for Global Heart, the journal of the World Heart Federation, they chart the rise of the new technology that threatens the stethoscope’s place, close to the hearts of every physician, and question whether the modern device will “earn a careful cleaning, tagging, and white-glove placement in the vault” next to the other artifacts of medical history.
Its possible replacement, ultrasound, is probably most familiar as a technology for scanning pregnant woman, but is also used across the medical spectrum, to look at hearts, lungs and other organs. It has been around since the 1950s, but in its early years it could only be performed by a machine the size of refrigerator. Gradually though, as with televisions, computers and mobile phones, the technology has been reduced to smaller and smaller sizes.
Devices like GE Healthcare’s VScan are already in use in the NHS hospitals. A pocket-sized device which resembles a smartphone, the gadget delivers a real time ultrasound image of the patient’s insides, on a screen that can be held in the palm of the hand.
The stethoscope meanwhile, has a slightly older pedigree.
It was invented in 1816 by the French physicist René Laennec, a pioneer in the emerging field of auscultation – in other words, listening to the inner workings of a patient’s body to diagnose their condition. In Dr Laennec’s day, the best a doctor could do was to press his ear firmly against the part of the body he wanted to listen to.
When one day a large female patient arrived at Dr Laennec’s chest clinic at the Hôpital Necker in Paris, he was left with the somewhat delicate dilemma of being unable to hear her lung sounds through her over-large bosom. His solution was to use a rolled up piece of paper. Pressing one end to the patient’s chest and putting his ear to the other, he found that the tube magnified the sound. He soon refined his invention into a hollow wooden tube, which he called the stethoscope.
By the 1850s it had become one of the essential tools of a physician’s trade. The modern stethoscope, made of rubber and later plastic, with a bell-like end that is placed on the patient, emerged in the 1890s and since then doctors have rarely been seen without them.
The favourite manufacturer is Littmann, and doctors usually buy their own. Sophistication and cost vary but a junior doctor today can expect to spend around £80 for theirs. Some personalise with an engraved name or initials and they can be bought in more or less every colour – including pink.
“Your first stethoscope, although I have a terrible habit of losing them, is a special moment,” said Dr Andrew Collier, a psychiatry trainee and chair of the British Medical Association’s junior doctor committee. “It is your first tangible grip on the medical profession. You hold it quite dear. I still have the first one.”
However, Dr Collier said, doctors would always be willing to move with the times in the wake of new technology.
By contrast to the relatively cheap stetho, GE Healthcare’s hand-held ultrasound device currently costs just under £5,000. Petros Nihoyannopoulos, professor of cardiology at Imperial College London and Hammersmith Hospital, was the first to acquire some for his staff back in 2010. Consultants were “hooked” on the new gadgets, he said, which revolutionised the way heart patients could be tested in hospital and in out-patient clinics.
However, the high cost means it could be many years before the ultrasound can be standard issue to all doctors, in the way that a stethoscope is. Even if that day comes, Professor Nihoyannopoulos hopes that the old tool of the trade will not be consigned to the museum.
“I think it will take many years, decades even. The sounds of the heart are important – I don’t think this will change,” he said.
However in some places, over-reliance on technology is becoming a problem for doctors who are losing some of the basic skills of diagnosis and examination. Dr Andrew Elder, a consultant geriatrician at the Western General Hospital in Edinburgh, spent time at Stanford University Medical School, where there was a worry traditional skills were dying out.
“Rumours of the death of the stethoscope are premature,” he said. “It shouldn’t be a case of whether ultrasound is better than the stethoscope. You should be using everything at your disposal to help the patient. Sometimes you’ll get better result with ultrasound, sometimes you can do just as much with a stethoscope. Sometimes you need both of them. We shouldn’t be pitting the old against the new.
“I could envisage that we get to a point where there are no more stethoscopes, but there’s a long way to go.”
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