Since its invention by a French doctor 200 years ago, this device has become the unique identifier for clinical practitioners. A stethoscope wrapped around the collar of a white-coat medico tethers the patients easily to them. However, the tether is reportedly being frayed. Let us get into the most happening discussion of the time among clinical fraternity about the possible demise of the unmatched clinical tool called stethoscope. The advent of smarter and handy technology has enabled the patient to be diagnosed even from a distance that is out of reach for a stethoscope. This article will try to find out whether the pulse of a stethoscope is really fading with the pressure of newer and smarter devices. Before going into the depth of this discussion, we must understand how a stethoscope works. It is one of the simplest devices ever invented with a huge impact in diagnostic decisions. A stethoscope enhances body sounds (Heart, bowel, lung etc) and transmits those sounds to our ears. A typical model 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. A stethoscope is even used with a sphygmomanometer to record the blood pressure. Recent advances have enabled physicians to record and analyze the sound heard by stethoscope to make a better diagnostic decision. Futurist has started murmuring the death tune for the modern medicine’s primary diagnostic tool saying it is on the way to being replaced by handheld ultrasound devices and smartphones. Let us have a look at the devices that are supposed to replace the need of stethoscope among clinicians. A portable ultrasound Scanner A latest portable ultrasound machine produces 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, and 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 its students hand-held ultrasound devices that are little bigger than a cell phone but can generate real-time images of the heart right at the bedside. So, why putting an effort and relying on the relative skill set to interpret “auscultation”, if you can have a hand-held Echocardiograph to get a real-time image of the heart to achieve a diagnosis. Smartphone and apps to analyze the sound 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 on a regular stethoscope, that captures the sounds of a beating heart. The sound is routed through a channel that directs it to the iPhone’s microphone. An associated app can then record the heartbeat sounds and display the individual heartbeats on the smartphone’s display which can be further stored and analyzed. Digital Stethoscope There is another addition of digital stethoscope that records the sounds of a patient’s heart and transmits the data to an app and the clip stored in the cloud can be transferred for a second opinion anywhere in the world. This device is already marketed as an FDA-approved digital device for clinical use. Some stethoscope apps help doctors by delivering snap diagnoses by applying algorithms to match the patient’s recordings with a pre-programmed index of common sounds detected in auscultation. Stethoscope versus modern technology 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. Therefore, it is evident interpreting auscultation depends largely on the skillset of the examining physician. It has no universally accepted protocol that leads to a definite diagnosis. On the contrary, two young doctors and a medical student in Baltimore listened intently to the recorded sounds of a heart coming through special stethoscopes, which receive an infrared signal from a computer. The “patient” was a teenage athlete who was suddenly having trouble keeping up on the soccer field. All three opined that there was perhaps a hole in the wall that separates the heart’s top two chambers. This condition, known as an atrial septal defect, was indeed the correct diagnosis. Such example shows how a concerted application of skill and technology of telediagnosis can improve patient care. A professor from the same medical school has already started a database of heart sounds called MurmurLab for training and listening practice to improve the skill of the clinical professionals of interpreting auscultation. Digital accuracy or a personal diagnostic skill: a tenuous tether between patient and doctor Therefore cutting edge physicians are leaning towards technologies that enable them to achieve greater diagnostic accuracy, real-time results and streamlined treatment that saves the patient time and money by eliminating superfluous tests and medication. However, another school of doctors still thinks, Apps and automated devices cannot be 100% accurate. Good history-taking, and listening to a patient can never be substituted. If the machine misses even one sign, the diagnosis could be erroneous whereas personal intervention based on the logical approach of trained physician can correct any accidental error in making a diagnosis. That is why any digitally fabricated result always comes with a disclaimer to clinically correlate the findings. They insisted, digital debutants can help in storage and analysis of data to some extent but cannot match the importance of personal intervention in diagnosis. A study in NEJM further speculates that with the regression in the use of stethoscope the tethering of patient to a doctor will be affected, which itself has an undoubted healing effect for many patients. Economic and demographic constraint There are several more hurdles to launching such smart devices in a country like India where 80% of the population is treated in the rural area where a steady power source itself is a luxury. It is also important that the device must initially be introduced in medical schools before it is launched in the market. The price of such apps or digital device is also a concern for countries like India, for example, an app requires, at least, a ₹5,000 smartphone, and portable ultrasound scanner costs ₹ 5 lakhs. Whereas, a stethoscope costs anywhere between ₹ 500 to ₹2000. In a country with the steep imbalance in doctor-patient ratio, faster and more efficient tools with telemedicine capabilities is an unmet need of the doctor’s community. However, keeping aside the debate of the old versus new school, it is worthwhile to remember that a conventional stethoscope may not relay images, store or analyze data, but it has always had the best processor attached to it via the earpiece–the human brain. Sources: New England Journal of Medicine, BMJ, NZ Herald, TNN Do you think the emerging smart digital devices can successfully rep
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