It's out there. It makes a cool picture, but I wonder how many medical students realize how unimportant apps like this have become to today's cardiovascular care. Don't get me wrong, it's good to hear the difference between a systolic and diastolic murmur, or for the really talented, a diastolic rumble on physical exam. Recognizing the difference between mild and severe aortic stenosis is also very helpful. After all, the physical exam remains the most cost-effective instrument in medicine.
But graphics to show the murmur that requires an electronic stethoscope and preamplifier to connect them to your iPhone? How much money do you want to waste on these toys?
The best way I know how to learn is get off the computer and get to the bedside. Look, listen, and feel the precordium a thousand times over. Only by doing will you learn. You really don't need an expensive stethoscope (but it does helps the auditorially challenged). I admit that I've stopped using super-expensive stethoscopes because I always lose them when I change into scrubs or round on too many different wards (or they're often stolen).
Honestly, by the time I'm asked to see a patient, the echocardiogram is already done, so for me, listening to the lung sounds and measuring blood pressures (especially orthostatics for patients with syncope) remains the most important reason I still carry (or borrow) an the old, cheesy, analog version of the stethoscope.
-Wes
h/t: Dr. Joseph Kim via Twitter.
I couldn't agree more. The subjective assessment of hearts sounds has been found to be statistically too inaccurate in this day and age of a multitude of other studies. That said, in this day and age of doctors crouching over computer screens instead of looking their patients in the eye, it does give reason to look, touch, interact. I think that, now, is the highest use of the stethoscope.
ReplyDeleteCould not agree more with your sentiments.
ReplyDeleteI have cheap stethoscopes all over the place.
There are still some uses, like after AF ablation, but for diagnostic purposes I do not trust myself with out the "shadows."
Hopefully, my old teachers who likely have even more grey hair now are not reading.
JMM
For a cardiologist, diagnosis with a stethoscope maybe outdated. I wouldn't go that far for an FP or Internist though. Although you may get a lot of false negatives, it only takes a few positives in otherwise asymptomatic patients being seen for something else to understand the value of a talented ear.
ReplyDeleteAs for cheap vs expensive, I go for the ones that have interchangeable ear tips, but other than that don't care.
You ask "How much money do you want to waste on these toys?" Honestly, as much as I can afford. As a current medical student, I expect my future patients to be very tech savvy and to insist upon being more involved in the diagnostic and therapeutic techniques. Having a audio/visual representation of the heart sounds would not only provide for interactive patient education, it also allows the physician to maintain an electronic copy of the patients heart sounds within the EMR.
ReplyDeleteCertainly echo technology has yet to reach its heyday and while it seems to becomes the diagnostic test of choice for another disease daily, this modern day addition to the stethoscope provides a more objective component to this essential part of the physical exam without sacrificing the art of medicine. Moreover, a medical blogger/reader can't go a day without reading how the iPhone can improve one's practice.
Personally, I will always auscultate for heart and lung sounds (and bruits, thank you lawyers) just as I will always palpate for a pulse. And when I begin rotations in a few months I would love to make the diagnosis with my iPhone and electronic stethoscope before the patients is sent to the echo lab. That is unless it means getting pimped on sound waves too.
BFD, M2