Blog | Monday, April 14, 2014

Are the days of the stethoscope numbered?

This seemingly uncomplicated device has been a symbol of the medical profession for 2 centuries. Dr. Rene Laennec probably had no idea how his idea would take off when he first invented the simple wooden tube in Paris back in 1816. After a few modifications over the course of the next several decades, it evolved into what we know today.

A central part of the physical examination, the stethoscope currently gives doctors priceless information about the cardiac and respiratory status of their patients. The world over, it’s this auscultation that provides the first inclination about the patient’s heart sounds and whether their lungs are clear. I remember as a medical student in the United Kingdom, the moment when we could “wear our stethoscopes around our necks” was usually the proud moment that we graduated as doctors. (This may seem odd to people in the United States, but in many medical schools in the UK, students typically carried their stethoscopes in their white coat pockets. Not only did graduation mean you could wear your stethoscope differently, but also that you lost the white coat!)

The stethoscope is quite simply the most basic and recognized tool that a doctor uses, which is surprising for such an elementary piece of equipment in the modern technological age. And as technology rapidly progresses, it seems inevitable that the stethoscope as we know it is soon to be cast aside. What will replace it? Highly likely, our smart devices. If you believe this sounds far-fetched, think back just 5 or 6 years when nobody had a smartphone. Fast forward to today, and they are so ubiquitous that if you look around any public place, it’s highly likely half the people will be glued to their devices! This isn’t because smartphones only act as phones. It’s because our smartphones now do almost anything possible—from reading a map to playing our favorite movie.

The next big area of smart technology development, which has actually already started, will be using them for health care. Only this week there were news stories about a smartphone application that will monitor the users’ pulse and blood pressure. Although this may be imperfect at first, it will undoubtedly improve over time to an accuracy level that will be acceptable to the medical profession. Other technologies that look set to be released include real-time blood sugar and hydration monitors. There’s even the biomedical sensor that can help predict certain cancers based on distinct odors. Truly incredible stuff.

Here’s my prediction for doctors: in the not too distant future we will be waving our iPhones or tablets over our patients’ chests, to not only get instantaneous information about their heart rate and blood pressure, but also their valvular function and whether there’s any pathology in their lungs such as fluid or infection. This will soon be to a level that reciprocates an echocardiogram. What’s more, patients themselves will be able to do this and then relay the data back to their doctor. The pictures, video and sound can be analyzed and acted upon.

Should the medical profession be concerned about this? Absolutely not. The “electronic smartphone stethoscope” of the future will be a lot more accurate and less prone to variation than using today’s regular stethoscope. It will still need to be supplemented by some sort of physical assessment, but will give us the information we need quicker. From the educational perspective, this doesn’t mean that medical students and doctors learning the profession get to bypass the knowledge and theory, never needing to perform a cardiac or respiratory examination, but it will provide a valuable tool to aid the diagnosis.

Let’s remember that when the stethoscope was first introduced, many physicians dismissed it as an outrage! Change and new developments are always a bit rattling, especially when they happen fast. But the more technology helps us with a fast and accurate diagnosis, the better it will be for our patients. When one reads about the history of the medical profession and how painstakingly slow the progress has been over mankind’s history, we realize how blessed we are to be living today. My question with any new technological or other medical development is: will this benefit the patient, tell us what’s wrong with them, and help alleviate suffering? If the answer is yes, it’s got to be a good thing for medicine.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.