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(Mother Nature Network)   As far as modern doctor's instruments go, the stethoscope is starting to be as useful as leech tongs and clysters   (mnn.com) divider line 48
    More: Interesting, Measuring instrument, stethoscopes, Mount Sinai School of Medicine  
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4397 clicks; posted to Main » on 25 Jan 2014 at 2:19 PM (30 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



48 Comments   (+0 »)
   
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2014-01-25 01:38:32 AM
Unless Medical Students can hang it around their neck to go lunch and get coffee in a 'I'm A FARKEN DOCTOR SEE THE SCOPE" thing.

This might not be popular.
 
2014-01-25 07:17:30 AM
No. It's going to hang around as a vestigial vestment of the profession. Much like gavels for officers of the court.
 
2014-01-25 11:06:38 AM
This article makes my head hurt. The stupid burns.

"Many authors have argued that ultrasound has become the stethoscope of the 21st century," Narula said. However, it is not found in every doctor's pocket because of its price, typically running from $8,000 to $10,000.

 Yeah. A high end, electronic amplification stethoscope that can not only hear a faint grade I murmur, but record it for you to review on your computer is like under 500 bucks.

"Medical students are now using it. We are training them with ultrasounds in the first years of medical school," Narula said.

Why does someone need to break out an ultrasound machine to listen to breath sounds? To confirm tube placement in intubation or NG/OG tube procedures? Why do I need it to confirm that my albuterol/atrovent is working, or that they're moving air well? A doctor doesn't need ultrasound to identify a pneumo/hemo.

Ultrasounds are great for placing a PICC or difficult IV access. They save radiation exposure in babies who have head trauma or are premature and need checked for a bleed. They can be lifesaving in rapid trauma exams.

But to say they'll replace stethoscopes? At the risk of sounding like QA - that's stupid.
 
2014-01-25 12:46:10 PM

hardinparamedic: This article makes my head hurt. The stupid burns.

"Many authors have argued that ultrasound has become the stethoscope of the 21st century," Narula said. However, it is not found in every doctor's pocket because of its price, typically running from $8,000 to $10,000.

 Yeah. A high end, electronic amplification stethoscope that can not only hear a faint grade I murmur, but record it for you to review on your computer is like under 500 bucks.

"Medical students are now using it. We are training them with ultrasounds in the first years of medical school," Narula said.

Why does someone need to break out an ultrasound machine to listen to breath sounds? To confirm tube placement in intubation or NG/OG tube procedures? Why do I need it to confirm that my albuterol/atrovent is working, or that they're moving air well? A doctor doesn't need ultrasound to identify a pneumo/hemo.

Ultrasounds are great for placing a PICC or difficult IV access. They save radiation exposure in babies who have head trauma or are premature and need checked for a bleed. They can be lifesaving in rapid trauma exams.

But to say they'll replace stethoscopes? At the risk of sounding like QA - that's stupid.


billing for an ultrasound procedure > "breathe in .... breathe out"
 
2014-01-25 02:10:04 PM
How else would you get the leeches off the patient?

(NSF the squeamish)
 
2014-01-25 02:23:36 PM
I think there is an app for that
 
2014-01-25 02:28:33 PM
Let's replace a simple, cheap, easy to use technology with one that's expensive, harder to use and requires continuous maintenance.

Sounds like the American Way.
 
2014-01-25 02:29:05 PM
I work at a hospital. Docs I talk to say they can tell a lot about a patient's heart and lungs by listening with a stethoscope.
 
2014-01-25 02:30:48 PM
FTA: s the stethoscope going extinct?

Answer: No.

If the answer to your headline is "No", don't bother writing the article.
 
2014-01-25 02:31:56 PM

stuhayes2010: I work at a hospital. Docs I talk to say they can tell a lot about a patient's heart and lungs by listening with a stethoscope.


But they could tell just as much with a hour long ultrasound analysis using a really costly machine that goes "bing"!
 
2014-01-25 02:32:37 PM

Gyrfalcon: Let's replace a simple, cheap, easy to use technology with one that's expensive, harder to use and requires continuous maintenance.

Sounds like the American Way.


Bingo!  "News" article brought to you by the company that makes the machine that goes, "ping!"

A medical professional can still diagnose plenty with a stethoscope and rule out the need for more expensive test and procedures.  It's called practicing medicine and understanding diagnostics.  It also requires medical professionals to, shudder, touch their patients.
 
2014-01-25 02:36:56 PM
Unless ultrasounds become portable, inexpensive, and uncumbersome enough to put on ambulances, they won't be all that useful as a replacement for stethoscopes for manual blood pressures
 
2014-01-25 02:38:24 PM
Leeches are still used in modern medicine.
 
2014-01-25 02:40:52 PM

Summoner101: Unless ultrasounds become portable, inexpensive, and uncumbersome enough to put on ambulances, they won't be all that useful as a replacement for stethoscopes for manual blood pressures


A doppler is like 100 bucks, and can be used for taking manual blood pressures in hemodynamicaly unstable patients. Hell, most of the cardiac monitors on the ambulance have NIBP systems that work better than humans do.

However, there are places already using prehospital ultrasound, but it's not to replace stethoscopes.

cdn.medgadget.com

Meet GE's VScan system. It's used prehospitally for difficult/circulatory collapse IV placement, PICC/central line placement, and identifying abdominal/pelvic bleeds as well as cardiac tamponade in FAST exams.
 
2014-01-25 02:50:18 PM
Stethoscopes aren't going anywhere. Too simple and useful - it'd be like declaring the hammer obsolete. Sure, there are faster, cooler, and better ways to get the nails where you want them, but hammers still get used.

We rely far too much on the huge infrastructure we've built up in American medicine. Old cardiologists can diagnose stuff with their ears that the younger fellows need ECHO's for. The physical exam skills of a well trained neurologist trying to localize a lesion are nothing short of breathtaking if you know what you're watching. My generation simply orders the MRI. We're not as good as the guys who came before us in terms of examining the patients. Evidence based medicine and the internet and all the hardware and advancing knowledge are good things bringing about better outcomes, but if the power goes out, we're boned.
 
2014-01-25 02:52:28 PM

Oldiron_79: Leeches are still used in modern medicine.


Yeah, they use them to maintain circulation in reattached digits.
 
2014-01-25 02:54:53 PM
One step closer to the Star Trek tricorder!

s17.postimg.org

"He's DEAD, Jim."
 
2014-01-25 03:09:40 PM

whither_apophis: But to say they'll replace stethoscopes? At the risk of sounding like QA - that's stupid.

billing for an ultrasound procedure > "breathe in .... breathe out"


I really like that I have a doctor who a) still knows how to give a goddamn physical (apparently that's not a thing anymore?) and who b) seems to actually use tools and tests appropriately.  Oh, and who c) talks to me like an adult.

Occam's Disposable Razor: Evidence based medicine and the internet and all the hardware and advancing knowledge are good things bringing about better outcomes, but if the power goes out, we're boned.


And if we keep up healthcare the way it's going in this country, not being able to use a stethoscope appropriately - say (guessing) using an ultrasound only for patients with a personal or family history that suggests it might help, and using a stethoscope *well*... anyway, more people medical bills bankrupt etc.

iaazathot: Bingo! "News" article brought to you by the company that makes the machine that goes, "ping!"

A medical professional can still diagnose plenty with a stethoscope and rule out the need for more expensive test and procedures. It's called practicing medicine and understanding diagnostics. It also requires medical professionals to, shudder, touch their patients.


This too.

The health system my Doctor is in keep trying to update things in stupid ways (more often than apparently to facilitate billing... hi, Epic).

The only thing he actually seemed pretty geeked about was a surprisingly decent speech-to-text program, so he can take notes verbally as he's talking to and then examining me.  So ideally nothing is lost that he, say, might've forgotten to write down/type in - and he can quickly look at how things have been progressing over the months or years.  And I can also correct him if say he misheard me describing a symptom as he's speaking that info into my chart.

It's pretty awesome.
 
2014-01-25 03:19:16 PM

cptjeff: stuhayes2010: I work at a hospital. Docs I talk to say they can tell a lot about a patient's heart and lungs by listening with a stethoscope.

But they could tell just as much with a hour long ultrasound analysis using a really costly machine that goes "bing"!


I wouldn't trust any doctor that doesn't have machines that go "bing"!
 
2014-01-25 03:47:57 PM
hardinparamedic: 
A doppler is like 100 bucks, and can be used for taking manual blood pressures in hemodynamicaly u
[cdn.medgadget.com image 468x347]

Meet GE's VScan system. It's used prehospitally for difficult/circulatory collapse IV placement, PICC/central line placement, and identifying abdominal/pelvic bleeds as well as cardiac tamponade in FAST exams.


the promo video for that glosses over the need for gel. they show gel on the patient but completely fail to mention it.
 
2014-01-25 03:58:25 PM
You can take my retinoscope from my cold dead hands
 
2014-01-25 04:02:36 PM

The Life Of Brian: cptjeff: stuhayes2010: I work at a hospital. Docs I talk to say they can tell a lot about a patient's heart and lungs by listening with a stethoscope.

But they could tell just as much with a hour long ultrasound analysis using a really costly machine that goes "bing"!

I wouldn't trust any doctor that doesn't have machines that go "bing"!


Yeah. Google Docs only for the win.
 
2014-01-25 04:03:57 PM
I would love to have one on the ambulance (not to replace the stethoscope) but they are too pricey for the limited use it would get.  I've seen them used on a trauma call where the patient's internal injuries were able to be viewed as soon as we arrived in the trauma room.
 
2014-01-25 04:32:55 PM

Occam's Disposable Razor: Stethoscopes aren't going anywhere. Too simple and useful - it'd be like declaring the hammer obsolete. Sure, there are faster, cooler, and better ways to get the nails where you want them, but hammers still get used.

We rely far too much on the huge infrastructure we've built up in American medicine. Old cardiologists can diagnose stuff with their ears that the younger fellows need ECHO's for. The physical exam skills of a well trained neurologist trying to localize a lesion are nothing short of breathtaking if you know what you're watching. My generation simply orders the MRI. We're not as good as the guys who came before us in terms of examining the patients. Evidence based medicine and the internet and all the hardware and advancing knowledge are good things bringing about better outcomes, but if the power goes out, we're boned.


To be fair, when the power goes out most of medicine, new or old, goes out the window. It's rather hard to treat patients when all of the treatments require electricity. Also, while being able to determine where a lesion is from a physical exam is great, the physical exam doesn't tell you what the lesion is. Is it a stroke, mass, or something else? Let's get that MRI afterall.
 
2014-01-25 04:35:03 PM

Curious: hardinparamedic: 
A doppler is like 100 bucks, and can be used for taking manual blood pressures in hemodynamicaly u
[cdn.medgadget.com image 468x347]

Meet GE's VScan system. It's used prehospitally for difficult/circulatory collapse IV placement, PICC/central line placement, and identifying abdominal/pelvic bleeds as well as cardiac tamponade in FAST exams.

the promo video for that glosses over the need for gel. they show gel on the patient but completely fail to mention it.


You can use the same lubricating gel that you already have on the ambulance for things like NPAs if need be.
 
2014-01-25 04:38:44 PM

JPINFV: You can use the same lubricating gel that you already have on the ambulance for things like NPAs if need be.


We always run out of that on night shift, for some reason.
 
2014-01-25 04:41:53 PM
Hahahahahaha, this article reads like a sales pitch. No, portable ultrasound will not replace stethoscopes. What a joke.
 
2014-01-25 04:51:19 PM

JPINFV: You can use the same lubricating gel that you already have on the ambulance for things like NPAs if need be.


it's the need for gel that bothers me. my cardiologist listened to my chest last visit through my shirt. was this the best possible way to do it? perhaps not but given my current condition (COPD not heart disease) it was sufficient. and a lot quicker and cheaper than my getting half undressed, smeared with gel, ultra wanded, cleaned up and redressed.

i do equipment repair, i'm not using a several hundred dollar diagnostic tool it i can tell using a <$20 multimeter.
 
2014-01-25 04:57:54 PM

Oldiron_79: Leeches are still used in modern medicine.


I had a really bad accident at work (hand caught in a machine), I ended up losing all the soft tissue, breaking all the bones in my hand, my palm burst open, etc. I was in the hospital for over three weeks. One of the many surgeries (15 so far) was what they call a 'flap' surgery, a piece of muscle that was removed from under my arm and attached to the top of my hand. The doctor ordered a large jar of leeches to keep on hand just in case they were needed. Creepy looking things.
 
2014-01-25 05:04:34 PM
bratface: Oldiron_79: Leeches are still used in modern medicine.

I had a really bad accident at work (hand caught in a machine), I ended up losing all the soft tissue, breaking all the bones in my hand, my palm burst open, etc. I was in the hospital for over three weeks. One of the many surgeries (15 so far) was what they call a 'flap' surgery, a piece of muscle that was removed from under my arm and attached to the top of my hand. The doctor ordered a large jar of leeches to keep on hand just in case they were needed. Creepy looking things.


So, the most important question, is it recovered well enough to fap with?
 
2014-01-25 05:25:41 PM

hardinparamedic: JPINFV: You can use the same lubricating gel that you already have on the ambulance for things like NPAs if need be.

We always run out of that on night shift, for some reason.


Curious: JPINFV: You can use the same lubricating gel that you already have on the ambulance for things like NPAs if need be.

it's the need for gel that bothers me. my cardiologist listened to my chest last visit through my shirt. was this the best possible way to do it? perhaps not but given my current condition (COPD not heart disease) it was sufficient. and a lot quicker and cheaper than my getting half undressed, smeared with gel, ultra wanded, cleaned up and redressed.

i do equipment repair, i'm not using a several hundred dollar diagnostic tool it i can tell using a <$20 multimeter.


Oh, I'm not arguing that it isn't silly to replace a steth with portable ultrasound, just that "gel" really isn't a great reason.

Of course not that any of this matters anyways. Even when a patient does have a murmur, we're still getting the echo anyways even if we can tell what it most likely is due to location, quality, and timing of the murmur.
 
2014-01-25 05:27:28 PM
I think it's funny when a doctor uses a stethoscope but moves it from place to place, never leaving it in any one place long enough to actually hear something through it. It's just a bit of medical theater that is trying to make me feel like the doctor is doing his job and gives a damn.
 
2014-01-25 05:29:22 PM

Befuddled: I think it's funny when a doctor uses a stethoscope but moves it from place to place, never leaving it in any one place long enough to actually hear something through it. It's just a bit of medical theater that is trying to make me feel like the doctor is doing his job and gives a damn.


It really doesn't take that long to hear heart sounds when you know what you're listening for. Lung sounds still require an actually breath to hear.
 
2014-01-25 05:44:16 PM
So I think they dip them in liquid helium between patients for sterilization
 
2014-01-25 06:28:21 PM

Oldiron_79: bratface: Oldiron_79: Leeches are still used in modern medicine.

I had a really bad accident at work (hand caught in a machine), I ended up losing all the soft tissue, breaking all the bones in my hand, my palm burst open, etc. I was in the hospital for over three weeks. One of the many surgeries (15 so far) was what they call a 'flap' surgery, a piece of muscle that was removed from under my arm and attached to the top of my hand. The doctor ordered a large jar of leeches to keep on hand just in case they were needed. Creepy looking things.

So, the most important question, is it recovered well enough to fap with?


No. That's what the leaches are for. Very slippery things they are.
 
2014-01-25 07:06:19 PM
ultrasound doesn't detect asthma...stethoscopes do.
 
2014-01-25 07:25:00 PM
I looked up "clyster." It's another word for enema. Those will never go out of style. Manual evacuation though...
 
2014-01-25 07:28:21 PM

Befuddled: I think it's funny when a doctor uses a stethoscope but moves it from place to place, never leaving it in any one place long enough to actually hear something through it. It's just a bit of medical theater that is trying to make me feel like the doctor is doing his job and gives a damn.


You're adorable
 
2014-01-25 08:00:20 PM

Befuddled: I think it's funny when a doctor uses a stethoscope but moves it from place to place, never leaving it in any one place long enough to actually hear something through it. It's just a bit of medical theater that is trying to make me feel like the doctor is doing his job and gives a damn.


You better hope he doesn't leave it in one place. He's not SUPPOSED to be hearing anything, at least nothing that requires a longer listen, you do realize that, right?
 
2014-01-25 08:35:47 PM

The One True TheDavid: I looked up "clyster." It's another word for enema. Those will never go out of style. Manual evacuation though...


Also known as why LPNs keep their nails short.
 
2014-01-25 08:48:20 PM
I've applied and removed leeches before; for some reason, none of the other nurses didn't want to do it. Hell, I didn't want to do it. The worse part is if the leeches get full before you go in there to pull them off, they detach and start wandering around. I've pulled chunks of gray matter off of my scrubs on more than one occasion, but I almost tossed my cookies when I stepped on a blood-bloated leech and it went "pop!" under my shoe. Ugh.

And stethoscopes aren't going anywhere; 50 years from now nurses and doctors are still going to be walking around with our "ears" hanging around our necks.
 
2014-01-26 01:25:42 AM

Occam's Disposable Razor: Stethoscopes aren't going anywhere. Too simple and useful - it'd be like declaring the hammer obsolete. Sure, there are faster, cooler, and better ways to get the nails where you want them, but hammers still get used.

We rely far too much on the huge infrastructure we've built up in American medicine. Old cardiologists can diagnose stuff with their ears that the younger fellows need ECHO's for. The physical exam skills of a well trained neurologist trying to localize a lesion are nothing short of breathtaking if you know what you're watching. My generation simply orders the MRI. We're not as good as the guys who came before us in terms of examining the patients. Evidence based medicine and the internet and all the hardware and advancing knowledge are good things bringing about better outcomes, but if the power goes out, we're boned.


hahahahahahaa you are the MAN! if any medical practitioners are reading, pay attention!!
 
2014-01-26 05:24:25 AM

Day_Old_Dutchie: One step closer to the Star Trek tricorder!

[s17.postimg.org image 300x300]

"He's DEAD, Jim."


That feeling when you want to make a reference to something and you see that someone beat you to it
 
2014-01-26 06:39:20 AM

hardinparamedic: JPINFV: You can use the same lubricating gel that you already have on the ambulance for things like NPAs if need be.

We always run out of that on night shift, for some reason.


;)
 
2014-01-26 06:47:58 AM

smittyrn: I've applied and removed leeches before; for some reason, none of the other nurses didn't want to do it. Hell, I didn't want to do it. The worse part is if the leeches get full before you go in there to pull them off, they detach and start wandering around. I've pulled chunks of gray matter off of my scrubs on more than one occasion, but I almost tossed my cookies when I stepped on a blood-bloated leech and it went "pop!" under my shoe. Ugh.

And stethoscopes aren't going anywhere; 50 years from now nurses and doctors are still going to be walking around with our "ears" hanging around our necks.


I removed a lot of them the two years I worked on a Trauma Ortho ward. A lot of the nurses REALLY didn't want to handle them. Sometimes I would be busy when they were due to be full, or the nurses wouldn't let me know there were some they wanted removed in a timely manner and I'd have to go hunting for them. Once they are full they drop off and wriggle away. They might be in the bedcovers or they might be anywhere on the floor. At least they often leave a bloody trail behind them so you have a clue where to start looking. Sometimes it was hard to guess when they'd be done, some would fill up very quickly, some would really take their time. Nothing like checking on one three times and then coming back and having to hunt for it!

/ Left my stethoscope in my locker tonight, like most nights. My R2 unit has better ears than I do.
 
2014-01-26 07:36:18 AM
The things you learn on Fark - who would ever guess that eating habits vary from leech to leech?
 
2014-01-26 10:37:24 AM
The obvious intermediate here is for the doctor to hold a stethoscope-like cup to the appropriate parts of the chest, but with a sensitive microphone in the stethoscope, which is wired to a computer.  Software can then be used to analyze what is being heard, as well as compare it to sound profiles of heart, lung, and even bowel  problems, to much greater accuracy.

Very inexpensive.  All you need is a cup with a microphone, and a wire with a USB connector.
 
2014-01-26 11:20:32 AM

Gyrfalcon: Befuddled: I think it's funny when a doctor uses a stethoscope but moves it from place to place, never leaving it in any one place long enough to actually hear something through it. It's just a bit of medical theater that is trying to make me feel like the doctor is doing his job and gives a damn.

You better hope he doesn't leave it in one place. He's not SUPPOSED to be hearing anything, at least nothing that requires a longer listen, you do realize that, right?


That is a good point. Tell us lay people what he is supposed to be hearing when the stethoscope is not in contact with the patient. I'm pretty sure Befuddled is not commenting on the doctor listening in one spot as the patient breathes in/out, moving to a new spot and listening to the patient breathe in/out, moving to a new spot and listening to the patient breathe in/out. I'm fairly certain he is making a comment on the technique where the doctor tells the patient to breathe in/out and the only time the stethoscope is in contact with the patient is at the top or bottom of the breath when there is no airflow. That leaves the patient to conclude that the doctor must be hearing something while the patient is breathing and the scope is in midair. We are just curious as to what it is. The other conclusion is that the breathing is not really needed and is busywork the doctor is giving the patient.
 
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