Hand-held Ultrasound and the Stethoscope

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The stethoscope was invented in the early 19th century. It is now the most readily recognized tool of the physician and healthcare worker, yet its demise has been wrongly but repeatedly foretold over the years. This usually occurs when other diagnostic tools are invented and gain popularity. There is an old tale of an early 20th-century radiologist who placed a stethoscope prominently for all to see in a coffin-shaped display case. It was his mistaken belief that X-ray of the heart would shortly render the stethoscope obsolete.

More recently, and the point of this article, a small ultrasound machine is being hailed as the new stethoscope.This is bolstered by recent medical literature bemoaning the loss of auscultation skills by the latest generation of doctors. Physician reliance on the stethoscope has indeed decreased. A 21st-century medical student is initially exposed to cardiac auscultation with inspiring lectures that often incorporate innovative electronic teaching techniques of heart sounds. This usually spurs their enthusiasm for the stethoscope. After all, it is the symbol of their chosen profession. This shortlived enthusiasm for auscultation is evident during their rotations in the clinical third and fourth years, where they examine real patients with a stethoscope. Unfortunately, soon afterwards, when time becomes precious during their internship and residency, they seem to come to the inevitable conclusion that the ultrasound machine is much more expeditious and accurate in establishing a cardiac diagnosis. Their interest in further learning the fine points and nuances of using a stethoscope wanes. This is especially true if there is no knowledgeable mentor available to teach them the fine art of honing their still immature auscultation skills. Auscultation role models are hard to find. It becomes more practical to order an ultrasound study than to spend time listening to the heart.

Over the last 30 years, cardiac ultrasound (usually referred to as echocardiography) has emerged as a powerful diagnostic tool for patients with heart disease. It has dramatically altered the diagnostic approach in children with congenital heart disease. Echocardiography has virtually replaced cardiac catheterization as the primary diagnostic tool in most of pediatric cardiology. In adult cardiology, echocardiography has emerged as a convenient and reliable first-line method of testing in most cardiac disorders. At the same time, the scientific literature on echocardiography has validated its extensive diagnostic capabilities.