For almost 200 years, doctors the world over have relied on the stethoscope to give them insights into the structure and health of their patients’ hearts. The stethoscope is a simple yet extremely effective device. It’s so effective, in fact, that its design has gone largely unchanged since the early 20th century. In the 1970s, Dr. David Littmann of Harvard Medical School made significant improvements to the stethoscope that made it possible to detect the faintest heart murmurs. Researchers the world over are wondering, then, why doctors seem to be leaving the stethoscope out of exams for some patients.
The 2014 European Heart Valve Survey has revealed that more than 50% of those questioned reported that their doctor rarely checks their heart with a stethoscope. This has serious implications because the stethoscope is the first line of defense for several heart conditions. In many cases, heart murmurs are not immediately life threatening, but early detection and intervention is nevertheless key to extending life expectancy.
Even more shocking, the survey revealed that people of retirement age are less likely than the general population to receive a heart exam via stethoscope. This age group is at high risk of death due to heart disease-related events or from complications from stroke that stem from undiagnosed heart conditions. What’s more, plaque buildup in the arteries—a leading cause of cardiac events—can start as early as childhood and can rapidly increase as an individual ages. Valve disease, known as “the silent killer,” results in narrowing of blood flow to the heart and often presents in individuals over 60 years of age. Left untreated, the condition leads to heart failure.
Aortic stenosis, one form of the disease, is characterized by calcification of the arteries, while mitral stenosis is the result of an obstruction in a heart valve. Doctors can readily treat both of these conditions—if they are discovered early. Some analysis of the 2014 survey point out that many physicians may view individuals over the age of 60 with these conditions as beyond help. However, other analysts note that such a complacent attitude is in direct conflict with the Hippocratic Oath. Still, some experts point to a less nefarious cause for the lack of stethoscope examination: superbugs.
A study published in the journal Mayo Clinical Proceedings reveals that most stethoscopes are as filthy as the average person’s hands, and that alcohol alone is not enough to keep them clean. The elderly are at particular risk from antibacterial-resistant bugs as their immune systems are less prepared to mount a defense against an all-out microbial assault. While doctors can and should sanitize their stethoscopes between each use, there is no way to be absolutely sure that their stethoscopes are not contaminated by germs from other patients.
A final potential explanation for the survey’s results is that many doctors feel that patients over the age of 60 would be at risk from any surgery meant to correct a heart defect. While this may explain why some doctors forego examination with a stethoscope in elderly patients, many world health organizations are nevertheless urging doctors to listen in on all of their patient’s hearts.