Stethoscope faces threat from portable hi-tech

The humble stethoscope - the most recognisable symbol of the medical profession for nearly 200 years - may be on its way out, according to researchers, including one of Indian-origin.
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 pass, researchers said.
In an editorial in the journal Global Heart, a brief history of both the stethoscope (invented in 1816) and ultrasound (invented in the 1950s) is given, with the authors suggesting that the stethoscope could soon be exiled to the archives of medical history.

"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," Professor Jagat Narula and Associate Professor Bret Nelson Mount Sinai School of Medicine, New York wrote.
Compared with expensive, bulky, ultrasound machines of the past, the authors say that "Hand-held ultrasound devices introduced an alternative concept of relatively inexpensive, easy-to-use machines which could generate images interpretable by a wider spectrum of clinicians at the point of care."
"Soon concerns about smaller machines having inferior image quality compared to devices many times larger and more expensive were outweighed by evidence that rapid diagnostic decisions could be made with portable machines," they wrote.

The editorial highlights that nowadays, more than 20 medical specialities 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 diagnostic accuracy.

"Thus, many experts have argued that ultrasound has become the stethoscope of the 21st century. While few studies have pitted ultrasound head-to-head against the stethoscope, there is evidence that ultrasound is more accurate even than chest X-ray in the detection of pneumothorax, pleural effusion, and perhaps even pneumonia," the authors say.
"Ultrasound allows visualisation of cardiac valve function, contractility, and pericardial effusions with greater accuracy than listening with the stethoscope.

"And beyond the heart and lungs lie dozens of other organs and structures- well-described in the literature of point of care ultrasound - which are opaque to the abilities of the stethoscope," they say.
Asking why the stethoscope has not yet made way for its more technically advanced counterpart, ultrasound, the authors say that while the cheapest available stethoscopes are literally disposable, the cost of the cheapest ultrasound devices is still several thousand dollars, making roll-out, especially in developing nations, much more difficult.