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Updated: March 16, 2014 01:22 IST

Physician and surgeon do need this device

J. S. N. Murthy
Comment (5)   ·   print   ·   T  T  
DELHI, 12/02/2014: FILE PHOTO (for open page) Stethoscope. New Delhi, Wednesday. Photo: Monica Tiwari.
Monica Tiwari DELHI, 12/02/2014: FILE PHOTO (for open page) Stethoscope. New Delhi, Wednesday. Photo: Monica Tiwari.

It was recently reported in the media that the stethoscope could be replaced by ultrasound devices. God forbid. How can they possibly replace stethoscopes? Having lived with them for more than three decades in the field of medicine, I cannot imagine a doctor without a stethoscope.

As a medical student, it was a great feeling to own one. Many of us could afford only locally made ones bought for Rs.25. Some rich classmates had imported Littman stethoscopes, which cost Rs.1,000.

After completing the MBBS course, I was Senior House Officer in the Department of Cardiology at the Southern Railway Hospital at Perambur in Chennai in 1977, working under Dr. T.J. Cherian. Virtually the only appliance we doctors then had was the stethoscope, and we relied on clinical skills imparted by senior cardiologists and cardiac surgeons. Even heads of department like Dr. Cherian and Dr. K.A. Abraham would study the details of each patient and commit the diagnosis.

In southern India, Christian Medical College (CMC) Hospital, Vellore and the Railway Hospital were the premier centres for cardiac surgery in the early-1970s, and both had cardiac catheterisation laboratories. After a detailed examination we would send patients to the ‘cath lab’ for confirmation of the diagnosis. Sometimes the final diagnosis would come only during open-heart surgery.

Dr. Stanley John, Dr. George Cherian and Dr. N. Gopinath of the CMCH, Dr. P. Venugopal and Dr. I.M. Rao of the All India Institute of Medical Sciences, Dr. M.R. Girinath, Dr. K.M. Cherian and Dr. K.A. Abraham of the Railway Hospital, Dr. K.V.Thiruvengadam of the Madras Medical College, Professor P. Krishnan Kutty of the Stanley Medical College, Chennai, Professor T.S. Ramadurai (who was the first to speak about Electrophysiology), Dr. K.P. Mishra (who made ECG familiar to physicians and students), all were giants in cardiology and cardiovascular surgery known particularly for their clinical skills, still in the era of the stethoscope.

Ultrasound techniques were unknown then. Through clinical examination they would arrive at reasonably good conclusions. Fairly accurate diagnosis was made by the bedside by means of physical examination, auscultation, X-ray and ECG.

One day at the Railway Hospital a small gadget arrived, and Dr. Cherian announced India’s first cardiac ultrasound device. That was probably the start of the ultrasound era in India in cardiology.

Today we have powerful ultrasound systems that can give accurate details of cardiac anomalies. Newer technologies are available to do intravascular ultrasound, 3D echocardiogram and intra-cardiac echo. But will any or all of these devices replace the stethoscope?

A stethoscope can assess heart function and any obstruction and leakage of its valves. It can predict and follow-up the effects of treatment of heart failure. Most birth defects involving the heart can be diagnosed fairly well by the use of the stethoscope, besides ECG, X-ray and echocardiogram.

Doctors can detect cardiac complications such as Papillary Muscle Rupture and Ventricular Septal Rupture with the stethoscope. It could help accurately evaluate valve function and the functioning of artificial valves. It could help assess lungs and lung diseases. The ultrasound is of no use in most of these cases.

An obstetrician can listen to foetal heartbeat during advanced pregnancy with a fair amount of accuracy with a simple foetoscope and predict foetal distress.

Can you imagine an anaesthetist without a stethoscope? He or she needs it to know if a patient’s endotracheal tube is in the wind pipe or in the food pipe. He needs to check if he is bellowing both lungs properly.

Imagine an intensivist in the intensive care unit without a stethoscope. He has to continuously monitor the heart, lungs and abdomen. The general surgeon uses a stethoscope to listen to bowel sounds during the post-operative period. What a marvellous piece of invention the stethoscope really is.

Today ultrasound is a part of the armamentarium for the medical man and woman. We do need it. Let it serve the purpose as an additional investigation tool for a specific purpose, and not as a routine test. Mind you, it will also add to the cost to the patient. An ultrasound device just cannot replace a stethoscope, which costs the patient nothing.

And in any case, the most important part of the stethoscope is the medical professional’s brain situated between the two ear-pieces. It gives immense confidence to both the patient and the doctor. It will serve the purpose for which it is invented by great clinician with great clinical knowledge.

(Professor J.S.N. Murthy is now Vice-Chancellor and Professor of Cardiology, Sri Ramachandra University & Sri Ramachandra Medical Centre, Chennai. drjsnm@gmail.com)

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One day,Dr. Rene'Theophile Laennec, a devout catholic, had a pretty
buxom young woman in his consulting room whose chest had to be
examined.In stead of putting his ear to her chest which was widely
practiced by doctors all over, he rolled up a quire of sheets lying on
his table into a cylinder and put one end of it on her chest and at
the other end put his ear to hear the chest. To his surprise and
relief, he found that he could hear the chest much more clearly than
by putting his ear on the chest itself. Thus was the stethoscope
invented that became an excellent diagnostic tool in the hands of
excellent physicians and surgeons all over the world. Thanks for the
highly informative article that highlights what a simple tool like
the humble stethoscope can do in the hands and ears of a skilled
medical practitioner!

from:  DR. M. S. FRANK
Posted on: Mar 18, 2014 at 13:34 IST

Thanks for alerting this reader to this troubling development. It will indeed be a
setback for patient if doctors become so dependent on an ultrasound that they lose touch with the stethoscope and the skills required to use it effectively.
"And in any case, the most important part of the stethoscope is the medical professional’s brain situated between the two ear-pieces. "
Well said.

from:  Aravinda Pillalamarri
Posted on: Mar 18, 2014 at 11:21 IST

It is a bitter truth in these days of corporatisation of health care. The humble ophthalmoscope that we ophthalmologists use is also going the way of the stethoscope. New upcoming specialists don't think twice before ordering a costly test before using these humble instruments

from:  Rajesh Radhakrishnan
Posted on: Mar 17, 2014 at 09:48 IST

Umm thanks for giving us a history lesson on the awesome hospitals where you worked and for dropping names of all the famous people whom you have worked with. You have not provided any evidence or substantial argument for why a doctor still needs a stethoscope. I am an anesthesiologist and I can't remember the last time I actually used one. I think I do a pretty good job and have not killed anyone because of not using a stethoscope. I would encourage you to to step into the field of modern medicine and open your eyes to the new devices and techniques. Drop that antiquated stethoscope which probably spends more time around your neck, transmitting germs from one patient to another.

from:  Narayan
Posted on: Mar 16, 2014 at 19:54 IST

A very apt and true ending of the article.
Today we have very few doctors in medical colleges who emphasize on
developing the clinical skills of the aspiring doctors.They are more
focused on being "tech savvy" and finding the shortest,easiest and to
an extent money oriented route for diagnosis.
Though technological advancements in medical field have been a
boon,they've definitely come in with a bit of a heavy price we've had
to pay in terms of clinical skills.
Articles of this kind remind us of what our patients need most,and
that is the psychological satisfaction of the doctor actually
"hearing" them and also what we know as the "Healer's Touch".
Though my time in the field of medicine has been less than a decade, I
think being trained to become a good doctor on the basis of good
history and clinical examination has served as a blessing to grow in
this field.
Cheers to the author for reminding us what being grounded actually
serves.

from:  DR.MITHILA V
Posted on: Mar 16, 2014 at 11:43 IST
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