Skip to content

The End of the Stethoscope? I Think Not!

January 28, 2014

I read recently in The Telegraph1 that the days of the stethoscope might be numbered. As they get smaller and more ergonomic, handheld ultrasound devices look set to replace the trusty doctor’s friend, the article reported. Forgive me if I’m not ready to swap my stethoscope for a tricorder just yet.

The invention of the stethoscope is credited to René Laennec, a particularly tuberculous Frenchman in the early 19th century. Concerned by his own infectiousness and the sensitivities of his patients, he created a stiff hollow tube to convey auscultated sounds from the patient’s chest to his ear. The bi-auricular rubber piping incarnation, to be worn with pride around the necks of generations of doctors and medical students, came later.

But the reputation of the stethoscope is hardly spotless. Studies have repeatedly shown that the heads of stethoscopes may harbor staphylococci and other nasties. This source of potential nosocomial infections can be readily decontaminated, but this is rarely done. Compared with the ubiquity of messages and signs advocating hand hygiene, the stethoscope falls under the infection control radar. In a 2013 survey2 of Edinburgh medical students, one in five had never cleaned their stethoscope. In comparison, nearly all cleaned their hands after every patient encounter.

Though, if we are that bad at cleaning our instruments, will we really be much better with ultrasounds?

In the UK, doctors have largely dispensed with the traditional white coats, ostensibly due to similar worries over infection control. We cannot let the stethoscope go the same way because of a laxity of hygiene. Like the white coat, the stethoscope is one of the great symbols of modern medicine. To the students on the cusp of clinical medicine, it is a totem of initiation, cleaving them to the generations of doctors and medical students to go before them. Where is the prestige in carrying an ultrasound device for the first time?

Admittedly, if the stethoscope were to be superseded by some futuristic gizmo, maybe there would be some agreement in what signs the patient actually has. An end to the confusion between coarse and fine inspiratory crackles. Solid ground in the examination instead of the quagmire of heart murmurs for the inexperienced. No more worrying that I have gone deaf as I fumble between bell and diaphragm.

But for all that certainty and accuracy that might be gained in an examination, there is so much more that would be lost. A stethoscope is a valuable substitute for a tendon hammer in a pinch. Will an ultrasound device be able to do that? There’ll never be an app for that. What of the stethoscope’s individuality? Engraved with your name to fend off kleptomaniac registrars or that particular shade of electric pink to accessorise with your favourite smart blouse, or splashing out on the medical bling of a Littman Cardiology III model to show you’ve got money to burn. The possibilities are endless. A stethoscope is as unique to the student as a wand is to a wizard from Harry Potter’s world – Both are equally capable of deep magic.

And can you boldly stride into the hospital canteen with an ultrasound device the way you can with a stethoscope? Slung around the neck, it declares to the world that yes! Everything will be fine now the medical student is here. (Actually, that’s infuriating. Can we all agree to stop doing that?)

Lastly, what of one the greatest uses of the stethoscope? In a hectic emergency room or a busy GP surgery, when the earbuds go in and the diaphragm is laid meaningfully on the chest, the stethoscope ferries the doctor or student to that quiet mental space. There, in silence save for the meditational lub…dub…lub…dub, there is the chance to think. In the rush of the 21st century, amidst the blur of medical calculator apps and e-portfolio proformas, of QOFs and four hour targets, of OSCES and exams, what will become of that little space where the doctor or student can synthesise, diagnose and reflect? Will the next generation of ultrasounds have an app for that?

I’m sure in ten years’ time, the medical students of tomorrow will be striding around with their new ultrasound devices in personalized holsters and I will have been denounced as a Luddite who railed against the innovation and improvement of medicine. That’s fine.

But I’m not ready to give up my stethoscope. Not just yet.

This blog also appears on the Lancet Student.

References

  1. Jasper Copping. Stethoscopes on their way out. The Telegraph. [Online] 24th January 2014. Available from: http://www.telegraph.co.uk/health/healthnews/10592653/Stethoscopes-on-their-way-out.html [Accessed 24th January 2014}.
  2. C. Saunders, L. Hryhorskyj, J. Skinner. Factors Influencing Stethoscope Cleanliness Among Clinical Medical Students. Journal of Hospital Infection [Online] 2013; 84 (3): 242-244. Available from: http://dx.doi.org/10.1016/j.jhin.2013.04.003 [Accessed 24th January 2014].
Advertisements
One Comment leave one →
  1. May 1, 2014 7:56 am

    Hey just wanted to give you a quick heads up.

    The text in your article seem to be running off
    the screen in Opera. I’m not sure if this is a format
    issue or something to do with internet browser compatibility but
    I figured I’d post to let you know. The
    design and style look great though! Hope you get the issue solved soon.
    Cheers

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: