Why the stethoscope still has value as a modern-day medical tool

THE QUESTION

I was recently in a hospital for a medical appointment and noticed some doctors with stethoscopes around their necks. Then I read an article in the newspaper that said the stethoscope was invented 200 years ago. I find it strange that doctors are still relying on them. Isn't there something better?

THE ANSWER

It's true that doctors have been using the stethoscope for two centuries to assess the hearts, lungs and bowels of patients by listening to the internal sounds of their bodies.

The first stethoscope – an improvised hollow tube – was developed in 1816 by a French physician, René Laënnec, who essentially felt embarrassed about putting his ear on a woman's chest to hear her beating heart.

Since then, the stethoscope – with its disc-shaped resonator and two tubes connected to earpieces – has become a symbol of the medical profession.

But in recent years there have been calls for doctors to ditch the stethoscope and adopt high-tech devices.

Eric Topol, director of the Scripps Translational Science Institute in La Jolla, Calif., is one of the leading proponents of the "digital" health revolution, which promises to put personal health information directly into the hands of patients.

Dr. Topol calls the stethoscope a "relic," noting that pocket-size ultrasound scanners can now provide detailed images of the heart. Other devices that connect to smartphones can amplify heartbeats, help with diagnosis, and the data can be sent wirelessly to patients' electronic medical records.

These advances certainly seem impressive and there's little doubt that medicine is heading down the high-tech highway.

However, there are still occasions when low tech can be good tech, says Donald Redelmeier, a staff physician at Sunnybrook Health Sciences Centre and a professor of medicine at the University of Toronto.

"The stethoscope isn't perfect, but it isn't completely ready for the rubbish heap," says Dr. Redelmeier, who has a reputation for challenging conventional medical wisdom.

He can think of several examples where the old-fashioned stethoscope is more than sufficient to do the job. These include:

• Assessing pregnant women who are short of breath: These patients usually don’t like getting chest X-rays or CT scans, Dr. Redelmeier notes. A stethoscope can help determine if things such as a flare-up of asthma or pneumonia is causing the breathing difficulties because the sounds vary with the condition. “It is convenient. It’s rapid. And it’s safe – no radiation.”
• Declaring a patient dead: Death is not like in the movies – “there is not necessarily a death rattle.” In fact, sometimes it is not obvious the patient has died, especially when there’s been a slow, steady decline. The stethoscope can provide an answer. “You lay the stethoscope on the chest and it is absolutely silent,” he says. “Conversely, if there is the occasional thump, thump, thump going on” then the patient is still alive.
• Checking heart rate: Many patients have a heart rate that’s too fast. Doctors will often prescribe medications to bring the heart rate down to a more normal range. But checking the heart rate by putting two fingers on the wrist can sometimes give a misleading measurement because not every pulse can be felt with this approach. However, if the stethoscope is placed on the chest at the same time, it’s obvious when a heartbeat is not getting through to the wrist.
• Measuring blood pressure: There are now many electronic devices that automatically measure blood pressure. But they “sometimes get out of whack or break down,” Dr. Redelmeier says. The stethoscope, combined with a sphygmomanometer (inflatable cuff), is a handy backup when the electronic devices crash.
• Detecting heart problems: Before starting an operation, doctors usually want to know if a patient has a pre-existing heart problem that could lead to surgical complications. A definitive diagnosis can be made with an echocardiogram test. But that takes time. By contrast, the stethoscope can help quickly identify cardiac conditions in patients in need of urgent surgery, such as a senior who has fallen and broken a hip. “The advantage of a stethoscope is that you can do it in five seconds whereas an echocardiogram might take five hours or longer to get the results in the middle of the night,” he says.
• Gauging recovery from surgery: The anesthetic used in surgery tends to slow down the bowels. By using a stethoscope to listen to the belly, the doctor can often get an indication of the patient’s stage of recovery. “When bowel sounds have come back … it can be a sign that the patient is turning the corner.”

In each of these cases, Dr. Redelmeier says a "more ideal, more exact and more elaborate assessment" can be done. But sometimes the trusty stethoscope is the practical and preferable choice.

Paul Taylor is a Patient Navigation Advisor at Sunnybrook Health Sciences Centre. He is a former Health Editor of The Globe and Mail. You can find him on Twitter @epaultaylor and online at Sunnybrook's Your Health Matters.