It was 200 years ago that a French doctor spared a female patient embarrassment by rolling up sheets of paper and placing them to her heart instead of putting his ear to her chest, as was the practice of examination then. This single act of propriety gave birth to that universal marker of medical practice — the stethoscope. Over two centuries the device has travelled wide — to film and TV sets (remember ER’s George Clooney with a stethoscope slung around his covetable shoulders?), S&M shops, toy stores, and of course, the medical exam room.
Unfortunately on its 200th birthday instead of celebrations, there’s talk of dispatching the old stetho to the morgue. Last week, Jagat Narula, a cardiologist at Mount Sinai Hospital in New York, provocatively claimed “the stethoscope is dead”.
The futurists singing dirges for modern medicine’s primary diagnostic tool say it’s on the way to being replaced by handheld ultrasound devices and smartphones.
In 2014, Indian-origin 15-year-old Suman Mulumudi invented the Steth IO in Seattle, essentially an iPhone case that amplifies heart and lung sounds and converts them into a spectrogram, which can be annotated and stored for future reference. The device is in the market. Others have cited GE Healthcare’s VScan — a portable ultrasound machine — as a possible successor.
Then there’s the Eko Core, an FDA approved digital stethoscope that records the sounds of a patient’s heart and transmits the data to an app. The clip stored in the cloud can be transferred for a second opinion anywhere in the world.
Some stethoscope apps play doctor and deliver snap diagnoses by applying algorithms to match the patient’s recordings with a pre-programmed index of common sounds detected in auscultation — the clinical term for listening to internal sounds of the body.
The gains, experts say, are greater diagnostic accuracy, real-time results and streamlined treatment that saves the patient time and money by eliminating superfluous tests and medication. A compelling argument for new technology. Not all Indian medics are convinced. Dr Vanita Arora, a cardiologist at Max Healthcare, maintains what technology tells you is what you tell technology. “Apps can’t be 100% accurate. Good history-taking, and listening to a patient can never be substituted. If the machine misses even one sign, the diagnosis could be incorrect. Which is why some apps suggest you clinically correlate their findings,” she points out. Dr CT Deshmukh, professor of pediatrics at Mumbai’s Seth GS Medical College, agrees. “Ninety per cent of doctors can’t do without a stetho,” he says, adding that digital debutants will mainly contribute to storage and sharing of patient records.
But some point out that doctors themselves could miss vital signs. (Not deliberately, like a noted doctor who’d examine his patients in a government hospital with the stetho’s eartips around his neck instead of in his ears.) Overreliance on CT Scans and cardiograms has reportedly blunted the doctor’s diagnostic skills.
Some say stetho stand-ins won’t penetrate the Indian market until the new digital devices are introduced to students right at medical school. “When you go to tech conferences you realize that stethoscopes are going out because apps and mobile devices are more accurate and tell you more,” confirms Dr Neelesh Bhandari, co-founder of Healtho5 Solutions, a healthcare service startup that uses technology to cover the distance between doctor and patient.
Steth IO or Eko, Pradeep Chawla isn’t afraid of what’s to come, because this manufacturer of steel stethoscopes knows at Rs 500 (going up to Rs 2,000), his devices are a bargain. “Even though electronic stethos have been available here for several years, you’ll seldom come across one in use. I doubt doctors will switch any time soon,” says Chawla, whose company, Lifeline Medical Devices, makes 17 models of stethoscopes, including a gold-plated specimen.
The economics of owning and operating next gen stethoscopes — an app requires at least a Rs 5,000 smartphone, and GE’s VScan costs Rs 5 lakh) — may prove to be a hurdle in India. Logically, the steep imbalance in doctor-patient ratio — 6 doctors to every 10,000 people — could suppose that quicker, more efficient tools with tele-medicine capabilities would have sped up diagnosis. But then again 80% of the population is treated in rural India where steady electricity itself is a luxury.
Which is why doctors like Dr. G Lakshmipathi believe it’s not yet time for the stethoscope to exit, although he believes that day will undoubtedly come. The Coimbatore-based cardiologist sets great store by the ‘placebo effect’ of the stetho. “It’s suggestive of the doctor’s authority. When a patient sees an individual with a stethoscope, they’re reassured that they’re in capable hands, and on the way to recovery — this confidence itself can aid recovery. If you take away the symbol, you take away from the placebo effect of the doctor,” says Dr Lakshmipathi.
Finally, in the debate for old versus new school, it’s worthwhile to remember that a conventional stetho may not relay images, store or transfer data or have voice capabilities, but it has always had a processor — between the eartips.