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How Skilled Is Your Doctor with the Stethoscope?

Stethoscope-SkillA plethora of recent research has uncovered a troubling truth: many doctors aren’t very skilled at interpreting sounds produced in the chest cavity. While all doctors are trained in the basic use of the stethoscope, accurate diagnosis of heart conditions with the device requires a good deal of experience and a trained ear. Additionally, noisy work environments—like those found in the ER—can make it difficult to make heads or tails of faint heart sounds. This leads to uncertainty, which prompts doctors to order echocardiograms, which are quite costly. Unfortunately, the problem may stem from medical schools themselves.

A study conducted in 1997 found that only around one-third of U.S. internal medicine programs offer structured instruction in detecting heart problems with the stethoscope. These schools instead expect students to learn the art of the stethoscope during internships, where they would have access to real patients. More recently, however, some medical schools, such as Johns Hopkins, have put a renewed focus on teaching the proper use of the stethoscope in hopes that young doctors will be able to diagnose heart issues with greater confidence.

Dr. W. Reid Thompson of Johns Hopkins Children’s Center has stated that most professors who teach the use of the stethoscope went to medical school before the advent of the echocardiogram. Consequently, Thompson says, these professors are concerned that new doctors are relying on ultrasound far too much. Ultrasound is, compared to the analog stethoscope, incredibly expensive, and it is known for creating shadows that can be misconstrued as heart abnormalities. Thompson also stresses that the stethoscope creates an all-important physical connection to patients that won’t be as strong with hand-held ultrasound devices.

Johns Hopkins is also known for its innovative teaching methods, from their extensive database of recorded heart sounds to their use of Harvey, a patient model “dummy” that can simulate many different heart and lung sounds. While your doctor’s alma mater isn’t necessarily an indication of their proficiency with a stethoscope, not all schools are created equally. What’s more, stethoscope proficiency is not tested on medical board exams.

The 1997 study, published in the Journal of the American Medical Association, found that 450 first, second and third year doctors were unable to correctly distinguish between 12 heart sounds at a rate of four out of five times. According to Dr. Salvatore Mangione of Allegheny University, these young doctors showed “little or no” improvement over three years of on-the-job training. The only exception proved to be doctors who had a musical background. These ear-centric individuals scored much higher overall, and Dr. Mangione believes that a trained ear may be required to use the stethoscope proficiently.

Unfortunately, as innovators begin to focus on ultrasound technology, medical schools may spend even less time on the stethoscope. Dr. Jagat Narula, writing in the journal Global Heart, believes that ultrasound technology will completely supplant the stethoscope within 20 years. Dr. Narula believes that medical schools will begin teaching the use of hand-held ultrasound devices even earlier than that. Critics of this point of view, however, point out that the stethoscope—because it uses no power—will always be essential in emergency situations. Consequently, these critics argue, medical schools will always teach its use.

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