|Year : 2016 | Volume
| Issue : 1 | Page : 6-7
The stethoscope: The iconic medical tool
Om Prakash Gupta
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
|Date of Web Publication||4-Mar-2016|
Om Prakash Gupta
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta OP. The stethoscope: The iconic medical tool. J Mahatma Gandhi Inst Med Sci 2016;21:6-7
It is an irony that while we are celebrating the 201 st birthday of the "Stethoscope" the medical world of 21 st century is talking of its demise! 
The stethoscope, a ubiquitous symbol and identity of a doctor and until date an important, handy, economical instrument to detect and monitor ailments related to heart, lung, vessels and bowels is seen today as "not so useful" and should be jettisoned. However, Dr. Fletcher, a researcher said "If you have a trained, experienced doctor who knows his stethoscope, that's really better than any machine."
Rene-Theophile-Hyacinthe Lennec, a French physician invented a hollow wooden cylinder of 25 cm by 2.5 cm size to listen to the chest events, replacing the traditional direct hearing by placing one's ear over the chest and avoiding the embarrassment. The sounds were amplified, and accuracy of diagnosis was improved.
The original Lennec's diagnostic tool has undergone certain refinement with the time to have the modern stethoscope we use today, having rubber tubing attached to a diaphragm and a bell to listen the sounds having a different pitch and well-fitting ear-pieces. For the last 200 years, it has been used to hear heart sounds, murmurs and scratches, the lung sounds, the bruit over the vessels and the bowel sounds with better precision to diagnose the various ailments.
Technology is all about using the "technical and scientific knowledge to help solve problems and to make life better." The technology is constantly changing. New technology which radically changes the way things have been done in the past is commonly referred to as "disruptive technology." There are many new devices which appear to be providing a better understanding of ongoing alterations in physiology during the illness. The heart sounds can now be transmitted, digitized, amplified, filtered and reproduced into a cell-phone anywhere in the world and included in patients'electronic medical records. The Echocardiogram makes it possible for doctors to look at beating heart in two- or three-dimensions thus having more accuracy in diagnosis.
Heart auscultation plays a key role in the diagnosis of cardiovascular diseases. A recent study comparing the conventional stethoscope and the electronic one with sound amplification and noise filtering observed better detection of low-frequency sounds with the electronic device. 
Heart Buds is a small device with an app and a Smartphone. The sounds can be recorded, stored and shared. In a study where four different models of stethoscopes were used, it is found that Heart Buds picked up sounds (heart, lungs, and bowel) as well as a top model of stethoscope. Authors also claim the opportunity for bacteria to nest in the earpiece of the stethoscope is eliminated. Cost is also about $10, much less than the traditional stethoscope.  A similar device is developed by a 15-year-old CEO Suman Mulmudi along with his cardiologist father, which is powered by iPhone or Android smartphone. 
The latest device, the EKO Core attaches to standard stethoscope which records the sounds and transmits them to Eko iPhone and iPad app through Bluetooth 4.0. (Eko devices 2600, 10th Street suite 20A, Berkely, CA 94710, USA). The physician can see the wave form on Smartphone and can also hear amplified heart sounds. It allows the clinician to consult and diagnose from a distance and help the patient. This is particularly vital in rural areas, saving the patients travel time and money as well. Its cost is about $200 which can fit in the tubing of any stethoscope or $300 with Ekos' stethoscope. 
The latest technological developments in the field of diagnostics are pocket size, hand held ultrasound unit with dual transducers producing real-time images. It is most convenient tool to look for heart, lung, and abdominal ailments. Two devices recently developed by GE (India) and Philips (India) are, V-scan and the Visiq, respectively. Though cost is less than premium ultrasound units, it is still prohibitive, $10,000-15,000. Moreover, it requires special training to the user.
As far as a stethoscope is concerned it may retain its value for listening to lungs and bowels for clues of disease, experts agree, but for the cardiovascular system, "auscultation is superfluous" since newer devices provide better information. The hand-held device, like Eko Core that charts the cardiac rhythm, sounds, clicks and murmur on one's Smartphone may replace the traditional one.
Embracing change to modern technology is always a slow process more so in the medical field. Every clinician cannot have and use a pocket-size echocardiogram and ultrasound device in very near future, in view of its high and prohibitive cost and need for the training. Adopting the other devices will also take some time particularly in developing countries. For teaching and training of the students in physical examination stethoscope will continue to be an important tool, aided with amplified sounds. Another important aspect form patient point of view is human touch which strengthen the doctor-patient relationship is eliminated due to modern electronic gadgets. A patient has better understanding and satisfaction when the stethoscope is put over the chest. And the stethoscope will remain an essential complement to medicine in developing countries for a long time to come.
| References|| |