The year 2016 will mark the 200th anniversary of the stethoscope, but an editorial featured in this month’s Global Heart — the journal of the World Heart Federation — predicts this out of date medical device will be obsolete pretty soon.  Editor in chief at Global Heart, Professor Jagat Narula and his colleague, Associate Professor Bret Nelson, both from the Mount Sinai School of Medicine in New York, say the improved accuracy of ultrasound devices and their ease-of-use has led to the end of the stethoscope.

"At the time of this writing, several manufacturers offer hand-held ultrasound machines slightly larger than a deck of cards, with technology and screens modelled after modern smartphones," the authors wrote. "Certainly the stage is set for disruption; as LPs were replaced by cassettes, then CDs and .mp3s, so too might the stethoscope yield to ultrasound.”

Invented in 1816 by French doctor René Théophile Hyacinthe Laënnec, the stethoscope was used to make auscultation, the act of listening to the body’s sounds to determine a person’s ailment, easier. Prior to its invention, doctors would implore what’s known as immediate auscultation or putting their ear directly on the patient’s body. Laënnec remedied this slightly ineffective and awkward practice by rolling up a piece of paper to amplify his patient’s heart rhythm.

According to Narula and Nelson, current ultrasound devices are increasingly more accurate in diagnosing heart, lung, and other organ complications. Even though the cheapest ultrasound on today’s market can cost upward of several thousand dollars compared to a disposable stethoscope at $20, the advent of point-of-care ultrasounds are making ultrasonography cheaper, easier, and more accurate. Using state of the art imaging technology that can facilitate either a symptom-based examination or surgical image-guidance, point-of-care ultrasounds offer quick and easy exams that can be performed by the patient’s bedside.

"Many experts have argued that ultrasound has become the stethoscope of the 21st century,” the authors continued. “Why, then, do we not see ultrasound machines in the coat pocket of every clinician? Several factors play a role. The ultrasound machines are expensive, and even clinicians enamored with the promise of point-of-care ultrasound must make a financial decision weighing the increased diagnostic accuracy against increased cost.”

The authors did note that some physicians argue the “analog acoustics of the stethoscope” provide the “truest sound” for examining the internal condition of a patient’s organs. However, as mentoring physicians increase their use of point-of-care ultrasounds for patient diagnosis and surgery guidance, future doctors will be exposed to a more applicable and comprehensive use of sonography that does not rest solely on physical examination.

“Medical students will train with portable devices during their preclinical years, and witness living anatomy and physiology previously only available through simulation. And as they take on leadership roles themselves they may realise an even broader potential of a technology we are only beginning to fully utilize. At that point will the "modern" stethoscope earn a careful cleaning, tagging, and white-glove placement in the vault next to the artifacts of Laënnec, Golding Bird, George Cammann, and David Littmann?”

 

 

Source: Narula J, Nelson B. How Relevant Is Point-of-Care Ultrasound in LMIC? Global Heart. 2014.