By: Jess Goulart
Photo courtesy of Kathea Pinto.
“Seeing is believing.”
So Dr. Jagat Narula, Associate Dean for Global Affairs at Mount Sinai School of Medicine, tells Matt DeMello on this week’s Third Eye Weekly podcast on BTR. Narula and a growing population of his colleagues feel that the introduction of new handheld ultrasound machines make the stethoscope obsolete–or at least will do over the next few years.
Stethoscopes were invented in Paris in the early 1800s by Rene Laennec, who actually created them out of shyness rather than a thirst to improve medicine. Laennec hated placing his ears against his patients’ chests, and thought that a hollowed out piece of wood might allow him to hear their heart and lungs without having to touch them. Voila! The stethoscope was born.
Stethoscopes are an extremely cheap instrument. Even some of the best ones ring in at only $200. No doubt their cost contributes to their wide distribution, especially in medical schools. Nevertheless, Narula argues that the price of ultrasounds will decrease drastically over the next few years.
“The large, regular standard ultrasound machines still cost about $200,000 apiece. The handheld miniaturized version, which are much the size of a flip phone, are approximately $8,000-10,000 at this point. However, other vendors are coming in and it’s likely that there will be competition that will force the price down to around $2,000. If that is so, they would become significantly affordable instruments.”
He goes on to explain that in cost-effectiveness, correctly diagnosing 100 percent of patients using an ultrasound device will ultimately cost less than misdiagnosing even a few patients using only a stethoscope and then ordering unneeded further tests.
The exception to that circumstance would be, again, in medical schools, where funds are scarce. The financial factor is limiting primarily because in order to make ultrasound use a viable method, new doctors must learn to use these tools and go on to develop an expertise with them throughout their careers. Narula says the best way to change the already well-established culture of stethoscopes is to start incorporating the ultrasound technique as an examination tool, rather than a diagnostic tool.
For their part, students seem reluctant to forgo the stethoscope. Student Doctor Johnny Burke, currently studying at the Lutheran Medical School in Brooklyn, New York, says, “in general I can diagnose a person with a stethoscope, meaning an ultrasound is very rarely needed. What’s more, the handheld machines in a trauma setting are terrible, you’d have to really increase the fidelity of those machines to make them viable, and that would be hugely expensive.”
Burke cites doctors he’s studied under who swear by their stethoscopes because their ears have “appreciated” to the sounds to the point where they can distinguish nuances that other technologies simply can’t. He also points out that the stethoscope can now use Bluetooth accessories that allow digital visual components and enhancements.
Still, handheld ultrasound machines are already vastly improving certain rural areas by negating the need for such specialization. Narula tells DeMello about a study in Ghana where midwives are being trained to diagnose high-risk pregnancies using the devices. If they discover a patient with an increased chance of mortality, they send her to the hospital. Otherwise, they deliver the baby at home. According to Narula, this diagnosis requires little training and has a huge success rate for preventing life-threatening situations.
Perhaps the real reason stethoscopes have endured is due in part to their symbolic nature. In the same way that the lab coat and clipboard denote medical expertise to a patient, so the stethoscope serves to create a trust bond between the two parties. One study shows that a patient’s perceived time with a doctor is dependent on a doctor sitting, as opposed to standing, in the consultation room. Another indicates that face-to-face time will directly influence a patient’s satisfaction with their doctor, whether or not they are correctly diagnosed. These studies indicate that a patient’s perception of their doctor factors into their experience and, by extension, their treatment and health. The stethoscope may be an integral part of this perception.
“The old habits die hard,” says Narula, who acknowledges the stethoscope “has been with us for 200 years and it is an ID card for us as much as the lab coat. As part of our toolbox for so long, it will be very difficult to imagine ourselves without them. I’m from India where there is a lot of stress on the physical examination, but even a person like me who is really involved in the physical component feels that the time has come to allow this new technique to take over.”
Burke agrees, to an extent.
“More likely it will not be a phase out and phase in, it will just be a phase in. Everyone loves visual things but I’ve seen very good ultrasound techs who can use it very well and pick up everything, and others who use it poorly and miss huge problems. The benefit of the stethoscope is, in a proper setting, without having to turn on anything, one can immediately diagnose a disease.”
For more from Dr. Narula tune in to his interview with Matt DeMello this week’s Third Eye Weekly podcast.