Is the stethoscope dying? High-tech rivalspose a threat23 October 2019, by Lindsey Tanner

In this 1915-1923 photo made available by the Library ofCongress, a doctor examines a child with a stethoscope,accompanied by a nurse, in the United States. Twocenturies after its invention, the stethoscope—the verysymbol of the medical profession—is facing an uncertainprognosis. It is threatened by hand-held devices that arealso pressed against the chest but rely on ultrasoundtechnology, artificial intelligence and smartphone appsinstead of doctors' ears to help detect leaks, murmurs,abnormal rhythms and other problems in the heart, lungsand elsewhere. (Harris & Ewing/Library of Congress viaAP)

Two centuries after its invention, thestethoscope—the very symbol of the medicalprofession—is facing an uncertain prognosis.

It is threatened by hand-held devices that are alsopressed against the chest but rely on ultrasoundtechnology, artificial intelligence and smartphoneapps instead of doctors' ears to help detect leaks,murmurs, abnormal rhythms and other problems inthe heart, lungs and elsewhere. Some of theseinstruments can yield images of the beating heartor create electrocardiogram graphs.

Dr. Eric Topol, a world-renowned cardiologist,

considers the stethoscope obsolete, nothing morethan a pair of "rubber tubes."

It "was OK for 200 years," Topol said. But "we needto go beyond that. We can do better."

In a longstanding tradition, nearly every U.S.medical school presents incoming students with awhite coat and stethoscope to launch their careers.It's more than symbolic—stethoscope skills are stilltaught, and proficiency is required for doctors to gettheir licenses.

Over the last decade, though, the tech industry hasdownsized ultrasound scanners into devicesresembling TV remotes. It has also created digitalstethoscopes that can be paired with smartphonesto create moving pictures and readouts.

In this Monday, July 8, 2019 photo, James Thomas, acardiologist at Northwestern Hospital in Chicagoexamines Dennis Calling, a retired Chicago inspector.With medical advances and competing devices over thepast few decades, "the old stethoscope is kind of fallingon hard times in terms of rigorous training," saysThomas. "Some recent studies have shown thatgraduates in internal medicine and emergency medicinemay miss as many of half of (heart) murmurs using astethoscope."(AP Photo/Amr Alfiky)

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Proponents say these devices are nearly as easy touse as stethoscopes and allow doctors to watch thebody in motion and actually see things such asleaky valves. "There's no reason you would listen tosounds when you can see everything," Topol said.

At many medical schools, it's the newer devicesthat really get students' hearts pumping.

"Wow!" ''Whoa!" ''This is awesome," IndianaUniversity medical students exclaimed in a recentclass as they learned how to use a hand-heldultrasound device on a classmate, watching imagesof his lub-dubbing heart on a tablet screen.

The Butterfly iQ device, made by Guilford,Connecticut-based Butterfly Network Inc., went onthe market last year. An update will include artificialintelligence to help users position the probe andinterpret the images.

Students at the Indianapolis-based medical school,one of the nation's largest, learn stethoscope skillsbut also get training in hand-held ultrasound in aprogram launched there last year by Dr. PaulWallach, an executive associate dean. He createda similar program five years ago at the MedicalCollege of Georgia and predicts that within the nextdecade, hand-held ultrasound devices will becomepart of the routine physical exam, just like the reflexhammer.

In this Monday, July 8, 2019 photo, James Thomas, a

cardiologist at Northwestern Hospital in Chicagoexamines Dennis Calling, a retired Chicago inspectorusing Eko Duo, a new device for cardiovascularscreening. Northwestern is involved in a study testing thenew artificial intelligence technology which combines astethoscope with an electrocardiogram. To improvedetection of heart murmurs the system uses an algorithmbased on recordings of thousands of heartbeats. (APPhoto/Amr Alfiky)

The devices advance "our ability to take peek underthe skin into the body," he said. But Wallach addedthat, unlike some of his colleagues, he isn't ready todeclare the stethoscope dead. He envisions thenext generation of physicians wearing "astethoscope around the neck and an ultrasound inthe pocket."

Modern-day stethoscopes bear little resemblanceto the first stethoscope, invented in the early 1800sby Frenchman Rene Laennec, but they workessentially the same way.

Laennec's creation was a hollow tube of wood,almost a foot long, that made it easier to hear heartand lung sounds than pressing an ear against thechest. Rubber tubes, earpieces and the often coldmetal attachment that is placed against the chestcame later, helping to amplify the sounds.

When the stethoscope is pressed against the body,sound waves make the diaphragm—the flat metaldisc part of the device—and the bell-shapedunderside vibrate. That channels the sound wavesup through the tubes to the ears. Conventionalstethoscopes typically cost under $200, comparedwith at least a few thousand dollars for some of thehigh-tech devices.

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This image made available by the U.S. National Libraryof Medicine shows a page from a 1869 catalog ofinstruments and medical supplies with diagrams ofvarious models of stethoscopes. Two centuries after itsinvention, the stethoscope—the very symbol of themedical profession—is facing an uncertain prognosis. It isthreatened by hand-held devices that are also pressedagainst the chest but rely on ultrasound technology,artificial intelligence and smartphone apps instead ofdoctors' ears to help detect leaks, murmurs, abnormalrhythms and other problems in the heart, lungs andelsewhere. (National Library of Medicine via AP)

But picking up and interpreting body sounds issubjective and requires a sensitive ear—and atrained one.

With medical advances and competing devicesover the past few decades, "the old stethoscope iskind of falling on hard times in terms of rigoroustraining," said Dr. James Thomas, a cardiologist at

Northwestern Medicine in Chicago. "Some recentstudies have shown that graduates in internalmedicine and emergency medicine may miss asmany of half of murmurs using a stethoscope."

Northwestern is involved in testing new technologycreated by Eko, a Berkeley, California-based makerof smart stethoscopes. To improve detection ofheart murmurs, Eko is developing artificialintelligence algorithms for its devices, usingrecordings of thousands of heartbeats. The devicesproduce a screen message telling the doctorwhether the heart sounds are normal or if murmursare present.

Dennis Callinan, a retired Chicago city employeewith heart disease, is among the study participants.At age 70, he has had plenty of stethoscope examsbut said he feels no nostalgia for the devices.

This image made available by the University of Michiganshows the 1960 painting "Laennec and the Stethoscope"by Robert Thom, depicting Dr. Theophile Laennecexamining a young patient at Necker Hospital in Paris,France, in 1816. Laennec's invention made it easier tohear heart and lung sounds than pressing an ear againstthe chest. Rubber tubes, earpieces and the often coldmetal attachment that is placed against the chest camelater, helping to amplify the sounds. (From the collectionof Michigan Medicine, University of Michigan, Gift ofPfizer Inc. via AP)

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This Aug. 2, 2019 photo shows a Butterfly iQ handheldultrasound device attached to a tablet on a bed at theIndiana University medical school in Indianapolis. Thedevice shows instant images of the heart and otherorgans, helping doctors diagnose a range of ailments.(AP Photo/Lindsey Tanner)

In this Aug. 2, 2019 photo, students practice with eachother using a Butterfly iQ handheld ultrasound deviceattached to a tablet during a class at Indiana Universitymedical school in Indianapolis. The device shows instantimages of the heart and other organs, helping doctorsdiagnose a range of ailments. (AP Photo/Lindsey Tanner)

In this Tuesday, Oct. 30, 2012 photo, a doctor whostarted practicing medicine in 1955 wears a stethoscopearound his neck as he tends to patients in his office inIllinois. Two centuries after its invention, thestethoscope—the very symbol of the medicalprofession—is facing an uncertain prognosis. It isthreatened by hand-held devices that are also pressedagainst the chest but rely on ultrasound technology,artificial intelligence and smartphone apps instead ofdoctors' ears to help detect leaks, murmurs, abnormalrhythms and other problems in the heart, lungs andelsewhere. (AP Photo/Jeff Roberson)

"If they can get a better reading using the newtechnology, great," Callinan said.

Chicago pediatrician Dr. Dave Drelicharz has beenin practice for just over a decade and knows theallure of newer devices. But until the price comesdown, the old stalwart "is still your best tool,"Drelicharz said. Once you learn to use thestethoscope, he said, it "becomes second nature."

"During my work hours in my office, if I don't have itaround my shoulders," he said, "it's as though I wasfeeling almost naked."

© 2019 The Associated Press. All rights reserved.

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APA citation: Is the stethoscope dying? High-tech rivals pose a threat (2019, October 23) retrieved 21March 2022 from https://medicalxpress.com/news/2019-10-stethoscope-dying-high-tech-rivals-pose.html

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