Saturday, August 29, 2015

This is the time that doctors' bag content should be changed! Doctors debate need for stethoscope as health care goes high-tech and that turns 200 years old .

Dr. Andrea Leeds, a Bellmore pediatrician, said she never leaves home without hers.
The doctor runs an old-fashioned practice out of her house, just as her father did in Brooklyn a generation earlier.
"I can tell you with 100 percent certainty that not only do I go everywhere with my stethoscope, I use it for every exam.
"I have picked up pneumonia using my stethoscope when the child has come in with a stomachache," Leeds said.
Using a stethoscope, she said, is one of the most important skills doctors acquire.
Chief Medical Officer Dr. Ronald Gulotta of St. Francis Hospital in Flower Hill thinks younger doctors do not know how to use them the way physicians of his father's generation learned to diagnose with them. And Dr. Stephen Gulotta, now retired after more than 50 years in medicine, is certain his son is right.

All of these doctors have an interest in the use and future of the stethoscope, perhaps the best-recognized symbol of the medical profession and a tool that turns 200 years old next year. The instrument's bicentennial arrives at a crossroads, some experts say.
Hank Campbell, president of the American Council on Science and Health in Manhattan, said that while the stethoscope is the instrument that personalized medicine -- bringing the doctor within 8 inches of the patient -- it's on its way out.
He predicts handheld ultrasound devices will replace them in the not-too-distant future.
And Dr. Jagat Narula, chief of cardiology at St. Luke's and Roosevelt Hospitals, divisions of Mount Sinai in Manhattan, is even more succinct: "The stethoscope is dead," Narula said.
That is not welcome news for Leeds, who says she will never give up her stethoscope.
"It's definitely a learned art. You have to know what you're listening to and it takes a lot of practice. I hope it's a skill that we don't lose. Being a doctor is a calling, not a job, and the stethoscope is one of the most important tools of our trade."

"There's a lot of useful information to be gained from using a stethoscope to examine the heart, lungs and abdomen," said Dr. Bruce Polsky, a specialist in infectious diseases at Winthrop-University Hospital in Mineola.
Information gathered through "auscultation," Polsky said of listening to and discerning the meaning of sounds the body makes, provides the basis for further evaluation.

Gulotta, a cardiologist and medical director of St. Francis, thinks technology has lessened the need for the stethoscope compared with its use in 1958, when his father graduated from medical school.
"I graduated from medical school in 1986 and it's still important," Gulotta said. "As a cardiologist there is still an emphasis on the utility of it. But we have the CT scan and echocardiography. Those technologies really gave us the real structure and anatomy, so when there's a murmur you can actually visualize it."
Gulotta, however, has seen decreasing reliance on stethoscopes among new medical school graduates. And he's saddened, he said, because it means the physical diagnosis of patients is an art in decline.
For his dad, he added, the stethoscope was viewed as gold and central to the physical exam.
"The physical examination of the patient was extremely important and the stethoscope had tremendous utility," Gulotta said. "They spent a lot of time with patients and they were true masters of auscultation."
Abnormal heartbeats; rales in the lungs, which are abnormal rattling or clicking sounds; obstructions in the bowel and in the carotid arteries that run along each side of the neck are some of the sounds the trained ear can hear through a stethoscope, which was invented by René Laennec.
"They would put patients through different maneuvers -- to lie on this side or on that side, stand up, squat, inhale, exhale -- to give them clues about the diagnosis" while listening with a stethoscope, Gulotta said.
"We are starting to lose its importance," he said.

Gulotta's dad, Stephen, who lives in Greenwich, Connecticut, said he spent hours in classes as an intern and resident at Montefiore Hospital in the Bronx mastering the sounds the body makes.
"Most people younger than 50 don't know how to examine the heart," said Gulotta, also a cardiologist who, in 1967, founded the cardiopulmonary department at North Shore University Hospital in Manhasset. He later moved to St. Francis.
During his internship and residency, Gulotta said he used what was called a phonocardiographic machine, which had high-fidelity recordings of various heart sounds, including very subtle ones.
He became so astute at diagnosing heart problems with a stethoscope that even now he can diagnose mild, moderate or severe valvular disease with that instrument alone. He officially retired in December.
"I've seen young cardiologists examining patients in the emergency room and it's a disgrace," Gulotta said. "These are ostensibly good cardiologists. But they'll listen to one spot with a stethoscope for two seconds, then another spot for two seconds and they're finished. I am shocked by it; a lot of old guys are shocked by it."
Campbell, meanwhile, predicts that handheld ultrasound devices are the wave of the future. "Nostalgia and symbolism will give way to increased accuracy," he said. "With anything that's 200 years old there's always a lot of art and a lot less science."

Narula agrees and thinks the $8,000 price tag on handheld ultrasound devices will decline if more doctors adopt the new technology. "The physical examination is becoming less and less popular," he said.
all prefer a device that visualizes patient complaints because it avoids guesswork and ultimately saves money spent on additional tests.
"I believe seeing is believing," Narula said. "Why should I imagine what is there? If I have the ultrasound in my hand, I can look at it."

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