Saturday, March 5, 2016

Stethoscope versus ultrasound

“I am astounded at the things I’ll find with my stethoscope,” said Allison Rhodes, a third-year student at the Perelman School of Medicine. “I had a patient who had pneumonia, and it was really wonderful to be able to listen to her and say, ‘This is what I think it is.’ And then, later, see on the chest X-ray that, that was exactly what it was.”
But some argue that the stethoscope is becoming less useful in this digital age. Dr. Bret Nelson, an emergency medicine physician at Mt. Sinai Hospital in New York, said clinicians now get a lot more information from newer technology.
An ultrasound, for example, turns sound waves into moving images of blood pumping and heart valves clicking open and shut; those visual cues are easier to interpret than muffled murmurs and may produce a more accurate diagnosis, Nelson said.
He admits the stethoscope is an icon, but doesn’t buy the argument that if you lose the stethoscope, you lose the tradition of “healing touch.”
“Pulling an ultrasound machine out of my pocket, or wheeling the cart over next to the patient [and] talking through with them exactly what I’m looking for and how I’m looking for it — the fact that they can see the same image on the screen that I’m seeing, strengthens that bond more than anything in the last 50 years,” Nelson said.
Nelson is 42 years old and graduated from medical school 16 years ago. He teaches medical students and said it’s helpful to show new learners what “lies beneath.” At Mt. Sinai, when medical students are taught to examine a heart, they learn how to use the stethoscope and an ultrasound machine on the same day.
“They know how to feel it, they know how to listen to it, and they know how to look at it,” Nelson said.
Still, obstetrician George Davis wants to keep the stethoscope around for a while. High-tech machines and imaging scans are great backup resources, he said, but his stethoscope helps him figure out which patients actually need additional testing.
“How much do those ultrasound machines cost?” Davis asked. “I can get a good stethoscope for less than $20. We are not going to sit there and do an echocardiogram on every patient who walks through the door.”
Davis worries that a whole generation of doctors is learning to rely too much on technology; he wants to hold on to first-line tools that are safe, effective and cheaper.
“Shouldn’t we be using what is low-tech and practical?” he asked.
Nelson counters that point-of-care imaging is becoming less expensive every day. Twenty years ago, he says, an ultrasound machine was as big as a refrigerator and cost $400,000. Today, a handheld, portable device plugs into a computer tablet, and costs less than $10,000.
Many care providers in the community may even have an ultrasound in their pocket one day soon, he says, combined in a single device with, “a slide rule, a calculator, a flashlight, a phone, a computer terminal and 36 video games.” In other words: on their smartphone.

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