Almost 200 years later, are we living in the final days of the stethoscope?

January 23, 2014

An editorial in this month's edition of Global Heart suggests the world of medicine could be experiencing its final days of the stethoscope, due to the rapid advent of point-of-care ultrasound devices that are becoming increasingly accurate, smaller to the point of being hand-held and less expensive as the years roll by. The editorial is by Professor Jagat Narula, Editor-in-Chief of Global Heart (Mount Sinai School of Medicine, New York, USA) and Associate Professor Bret Nelson, also of Mount Sinai School of Medicine, New York, USA.

Looking at the (invented in 1816) and ultrasound (invented in the 1950s), with the the authors suggest that the stethoscope could soon be exiled to the archives of medical history. They say*: "At the time of this writing several manufacturers offer hand-held ultrasound machines slightly larger than a deck of cards, with technology and screens modelled after modern smartphones." As the minimum size of an ultrasound continued to decrease, concerns about smaller machines having inferior image quality compared to devices many times larger and more expensive were over time outweighed by evidence that rapid diagnostic decisions could be made with portable machines. Today, more than 20 medical specialties include use of point-of-care ultrasound as a core skill, and that mounting evidence suggests that compared with the stethoscope ultrasound technology can reduce complications, assist in emergency procedures and improve .

The authors say: "Thus, many experts have argued that ultrasound has become the stethoscope of the 21st century. Why then, do we not see ultrasound machines in the coat pocket of every clinician? Several factors play a role. The ultrasound machines are expensive, and even clinicians enamored with the promise of point-of-care ultrasound must make a financial decision weighing the increased diagnostic accuracy against increased cost. In addition, point-of-care ultrasound is still a new field relative to traditional imaging. Many older clinicians completed training long before ultrasound use was part of standard practice for their specialty."

Additionally, while the cheapest available stethoscopes are literally disposable (though many can cost hundreds of dollars), the cost of the cheapest ultrasound devices is still several thousand dollars, making roll-out, especially in developing nations, much more difficult. Yet the authors believe all the evidence shows that ultrasound can diagnose heart, lung, and other problems with much more accuracy than the 200-year-old stethoscope.

The authors conclude*: "Certainly the stage is set for disruption; as LPs were replaced by cassettes, then CDs and .mp3s, so too might the stethoscope yield to ultrasound. Medical students will train with portable devices during their preclinical years, and witness living anatomy and physiology previously only available through simulation. Their mentors will increasingly use point-of-care ultrasound in clinical environments to diagnose illness and guide procedures. They will see more efficient use of comprehensive, consultative as well- guided by focused sonography and not limited by physical examination alone. And as they take on leadership roles themselves they may realise an even broader potential of a technology we are only beginning to fully utilize. At that point will the "modern" stethoscope earn a careful cleaning, tagging, and white-glove placement in the vault next to the artifacts of Laënnec, Golding Bird, George Cammann, and David Littmann? Or, as some audiophiles still maintain the phonograph provides the truest sound, will some clinicians yet cling to the analog acoustics of the stethoscope?"

Explore further: Evidence rapidly building on utility of ultrasound in areas other than cardiology

Related Stories

Evidence rapidly building on utility of ultrasound in areas other than cardiology

January 23, 2014
A paper in this month's edition of Global Heart (the journal of the World Heart Federation) says there is mounting evidence regarding the utility of ultrasound in areas outside its traditional field of cardiology, with increasing ...

Ultrasound training should be implemented early into medical education programs

January 23, 2014
A paper in this month's edition of Global Heart (the journal of the World Heart Federation advocates including ultrasound in medical education programmes to realise the full benefits of the technology as early as possible. ...

Point-of-care ultrasound is more accurate than the stethoscope in diagnosing pneumonia in children

December 10, 2012
Point-of-care ultrasound is more accurate than the traditional method of auscultation by stethoscope in diagnosing pneumonia in children and young adults, and can even detect small pneumonias that a chest x-ray may miss, ...

Radiologists, primary users of non-cardiac ultrasound

November 1, 2011
Although non-radiologist physicians have contributed to the widespread use of point-of-care (POC) ultrasound, radiologists remain the primary users, according to a study in the November issue of the Journal of the American ...

X-rays overused in ICU: Ultrasound safer, just as effective

October 28, 2013
A new study shows that the use of ultrasound testing rather than x-rays or CT scans in the ICU reduces patient radiation exposure and lowers costs of care. The study was presented at CHEST 2013, the annual meeting of the ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.