A stethoscope draped across a doctor's chest is as classic an image of
medicine as a white coat or a wooden tongue depressor.
But the stethoscope is an old-fashioned device that has outlived its
usefulness and should be replaced in the very near future, a pair of prominent
New York City cardiologists contends.
Hand-held ultrasound devices are becoming less expensive and soon will offer
a viable and preferable alternative to the stethoscope, said Dr Jagat Narula,
associate dean for global affairs at Mount Sinai School of Medicine and
editor-in-chief of the journal Global Heart. His editorial outlining the
argument was published recently in the journal.
Doctors of the future will tote a small ultrasound device around in their
pocket and use it to peek at a person's internal organs, rather than listening
to the organs with a stethoscope, Narula wrote with his Mount Sinai colleague
Dr Bret Nelson.
Not without a fight
"We should be able to replace the stethoscope with ultrasound,"
Narula said. "Basically the time has come that we need to ascend to a new
era. We have this technology available to us, and we need to use it not only as
an investigational and diagnostic tool but as a basic patient examination
That said, many doctors will not throw away their stethoscopes without a
"I disagree with the author's premise. The stethoscope is as important
as it ever has been," said Dr Charles Cutler, chairman of the American
College of Physicians' Board of Regents. "I understand where the author is
coming from, and as a world we are going more and more toward technology. But I
think in medicine, more is not always better."
The stethoscope dates back to 1816, when it was invented in Paris by the
French physician Rene Laennec. Laennec pioneered its use in diagnosing chest
conditions, and it has since become a standard piece of equipment in basic
Ultrasound technology came along in the 1950s, and has gotten more portable
and more accurate over time, Narula pointed out. Doctors can now purchase a
device not much larger than a deck of cards, with the technology and screen of
As competition arises, these devices will become considerably cheaper within a year or two.
'Seeing' a patient's organs
Ultrasound allows a doctor to actually see a patient's organs, rather than
listening to them for clues of illness, he explained. This will reduce the need
for unnecessary testing, he argued, as doctors will be able to see for
themselves rather than sending a patient for a follow-up CT scan or MRI.
"You can look at almost everything, right there at the bedside or
examination room," Narula said. "Most of the time, the technology
takes you away from the patient. By doing this, we will be bringing back the
relationship between the doctor and the patient."
But Cutler believes the opposite will occur, and more unnecessary tests will
take place because doctors will see many things they can't interpret.
"An ultrasound will turn up things that may not be there," Cutler
said, providing the example of a heart valve that looks a little different on
an ultrasound, leading the doctor to call for a CT scan. "It may be a
false alarm, but now you have ordered the test and you have worried the
patient," he explained.
Another expert pointed out another downside with ultrasound technology.
Adopting ultrasound will also place a huge burden on medical students, who
will have to learn how to properly read ultrasound results on top of their already
packed curriculum, said Dr Robert Bonow, a cardiologist at North-western
Memorial Hospital in Chicago and a spokesman for the American Heart
But Narula believes ultrasound will become more ubiquitous as medical
schools begin teaching use of the technology as a common examination tool.
"I think it has to be a part of culture, and it will become part of
culture when we begin using it in medical school," Narula said.
However, cost will be a deciding factor that keeps ultrasound technology
from replacing the stethoscope anytime soon, Cutler said.
A fraction of the cost
"Why should the
medical system spend millions of dollars on equipment when they don't have to?
They could spend a fraction of the cost on stethoscopes," he said.
Bonow shares Cutler's concerns. He likens ultrasound to the hand-held
medical device used in "Star Trek" that doctors waved over patients.
"I believe that's not going to be science fiction in 30 to 50 years,
but going from here to there is going to take several steps we're going to have
to explore," Bonow said. "Maybe we should give 50% of the medical
students training in this device and see how well they perform relative to the
others. But I don't think we're ready to throw away the stethoscope."