DundeeChest 3.0

Posts Tagged ‘Auscultation’

Cross posted from my Doc-2-Doc blog.

I did a post take ward round on Monday. The usual mixture of general medicine, with little to excite the respiratory physician. A student commented that I had reviewed a whole bay of patients without the need for a stethoscope. This got me thinking – has the ancient art of auscultation died with my generation of physicians?

Does it matter if we can tell the difference between various murmurs when a portable echo can give us not only qualitative, but quantitative information with one bedside test. We hear fine crackles, an echo an an HRCT tell us what we need to know. 25 years ago our cardiologists taught us how to determine reverse splitting of the second heart sound, and to judge the severity of mitral stenosis from the delay before the opening snap. When was the last time you relied on that kind of clinical finding? Last month I saw a patient with a 5 cm pericardial effusion; there was no clinical indication of that diagnosis at all.
So what’s the point of all this? A senior colleague of mine has long said we should stop teaching our students auscultation, and teach them all bedside ultrasound rom an early stage. I have to agree with him about the ultrasound: we should be definitely be teaching these skills, and I have started teaching all our registrars, and ST grades the basics of thoracic ultrasound. But should we throw away our ‘tubes’? I don’t think so.
Rene Laennec invented the stethoscope on 1816, and it has served us well for nearly 200 years. Although the echocardiogram may have made listening to heard sounds “so last century”, there’s no test to detect bronchospasm, no scan to detect a pleural rub. So as chest physicians, we still need the ‘scope.

A non-physician friend of mine worked with HEMS in the 90’s – he tells me that the real reason we carry stethoscopes is for photo opportunities. What would Laennec say?