The first stethoscope, invented by the French physician René Laennec, was a hollow wooden or ebony tube. Its name came from the Greek roots “stethos” (chest) and “skopein” (to observe). Unlike the stethoscope so familiar to us today the original device was a simple tube. But since its invention 200 years ago as it underwent refinements it also became the unique identifier for medical practitioners. The “traditional stethoscope” we see wrapped now around the collar of a white-coat medico symbolizes the profession like no other gadget. But with the advent of smarter technology (that enables doctors to diagnose patients even from a distance) “the traditional stethoscope’s” death seems imminent.
A typical model of stethoscope we use routinely has a flat, round chest piece covered by a thin, tightly stretched skin of plastic called a diaphragm. The diaphragm vibrates when a sound occurs. These sound waves travel up the hollow plastic tubing into hollow metal earpieces and to the doctor’s ears. The stethoscope enables physicians to record and analyze heart sounds to make relevant diagnostic decisions.
But soothsayers are already predicting the demise of the “traditional stethoscope” as attempts are on to replace it with “handheld ultrasound devices” and “smartphones”. The latest “portable ultrasound machines” produce images that are almost the same quality as that of the “larger machines” and they are easy to use, durable, and cost effective. Therefore, doctors in all sorts of fields are starting to use them. Also, with a growing body of literature supporting their use in the developing world, the World Health Organization now recommends them as a primary diagnostic tool in low resource environments.
Some medical schools in the USA have already started giving their students “handheld ultrasound devices” that are a little bigger than a cell phone but can generate real-time images of the heart at the bedside. So, why put an effort and rely on a doctor’s relative skill to interpret auscultation with a “traditional stethoscope” if you can have a hand-held Echocardiograph to get a real-time image of the heart to achieve a diagnosis? There is more good news. A 15-year-old boy of Indian origin has developed a working stethoscope that is powered by “iPhone” or “Android smartphone”. The iPhone is fitted into a case with a diaphragm, similar to that of a regular stethoscope and captures the sounds of the beating heart. The sound is routed through a channel that directs it to the iPhone’s microphone. An associated app can then record the heart sounds and display the individual heartbeats on the smartphone’s display which can be further stored and analyzed. The “digital stethoscope” is yet another welcome addition. It records the sounds of a patient’s heart and transmits the data to an app and the clip that is stored can be transferred for a second opinion anywhere in the world. This device has already been approved for clinical use.
We know that interpreting auscultation through a “traditional stethoscope” depends largely on the skill of the examining physician and there is no universally accepted protocol that leads to a definite diagnosis. This may be a drawback. Thus, using “special stethoscopes” and that too with devices that receive infrared signals from a computer, cardiac diagnosis has been facilitated in a manner never seen before. In US, two young doctors and a medical student placed at different points were made to listen with “special stethoscopes” to the recorded sounds of a teenage athlete who was experiencing unexplained trouble keeping up on the soccer field. All three accurately diagnosed the athlete as suffering from a “choked aortic valve” which was later replaced with a mechanical valve. A shining example of how a concerted application of skill and technology of telediagnosis can work in improving patient care.
Cutting edge physicians are leaning today towards these technologies that enable them to achieve greater diagnostic accuracy saving the patient time by eliminating superfluous tests and medication. However, there is another school of thought which feels that Apps and automated devices cannot be 100% accurate. According to them good history-taking and listening to a patient directly with a “traditional stethoscope” can never be substituted. If the new gadgets miss for instance even one clue the diagnosis could be erroneous, whereas personal intervention based on the logical approach of a trained physician can correct any accidental error in making a diagnosis. This is the reason why any digitally fabricated contraption always comes with a disclaimer! What is more, the new technology comes at a huge cost which is a concern for countries like India. For example, an app requires, at least, a Rs 5,000 “smartphone” and a “portable ultrasound scanner” costs Rs 5 lakhs whereas a “regular stethoscope” costs just between Rs 500 to Rs 2000.
As for me, I fully concur with those physicians who feel that the “traditional stethoscope “will never become obsolete. Besides other known advantages, our time-honoured best friend, helps establish an inalienable patient-doctor psychological bond which is sadly on the wane nowadays. As long as God permits my “Processor” in the gray matter to function without a hitch I, for one, shall never ever part with my “traditional Littmann stetho” of many years which I cherish like gold. And most of my colleagues will bear me out.
(Dr. Francisco Colaço is a seniormost consulting
physician.)
