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Stethoscope's declining status symbolizes the problem of impersonal medicine

When doctors spend less time with patients, does it lead to more diagnostic errors?

It's a valid question because there are many pressures in medicine today that undercut doctors' ability to spend time actually examining a patient. The availability of so many complex tests and interventions is one factor. Burdensome compliance with new electronic medical records requirements is another. Add in heavy workloads for doctors in organizations striving to cut costs and the result is precious time taken away from doctor/patient interaction.

This is problematic because good diagnosis requires good human judgment, not merely signing off on a computer-recommended solution to someone's symptoms. Such judgment is often lacking in today's medicine, with diagnostic errors surprisingly common. We discussed this in our October 13 post.

In today's post, let's look at how the decline in status of the simple stethoscope symbolizes medicine's increasing inability to acknowledge the human factor involved in effective diagnosis.

The Stethoscope at 200

The origins of the stethoscope can be found 200 years ago, in a culture with strict social codes about acceptable actions between men and women. A French doctor named Rene Laennec needed to listen to a woman's heart in order to gather data for a diagnosis of her medical condition. But he felt it would be too personally intrusive to put his ear against a woman's chest.

Laennec improvised a device that allowed him to listen to amplified sounds through a tube that contained rolled-up sheets of paper. This device eventually evolved into the stethoscope, a tool that came to symbolize an, intimate, face-to-face form of medicine that is now increasingly at odds with a computer-driven medical culture.

The term for listening to and interpreting the sounds of a patient's body is auscultation. Practicing this skill effectively is an art. But it is an art that some doctors now view as rather obsolete, in an era when echocardiograms, an imaging procedure for the heart, are now widely used. And of course there are also now ultrasound devices for getting at what's going on inside the body.

Implications For Diagnosis

The availability of ultrasounds and echocardiograms, however, does not necessarily mean that a stethoscope is like an anachronistic slide rule in an age of ever-more-powerful computers.

For one thing, even critics of using stethoscopes in the diagnosis of heart conditions acknowledge that stethoscopes are still useful in other contexts. In emergency rooms, for example, the need for speed in making decisions still makes the stethoscope a valuable tool. And stethoscopes can also be used effectively to listen to sounds from the lungs and bowels that may be indicators of medical problems.

But stethoscopes also have an important symbolic value. They stand for an approach to medicine that values the doctor/patient relationship and taking the time to make a thorough examination of someone as a unique individual before making a diagnosis. When that intimate connection between doctor and patient is lost, it increases the risk of getting a diagnosis wrong.

Taking Action

If a failure to properly diagnose a condition has harmed you or someone in your family, we encourage you to take action to explore your legal options.

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