“The stethoscope is dying.” That’s the word on the wards.
Clunky and less precise than what modern technological advances allow, many say it will soon find itself useful as only a historical artifact of 19th and 20th-century medicine. While it may pain many clinicians, it’s tough to argue the stethoscope’s immunity to Moore’s law.
As technology allows us to make better, more accurate tools, we embrace them as a society. For good reason, too. They tend to make us efficient, usually without sacrificing quality of work. From the internet to the automation of production lines, technology just makes our lives better.
Isn’t it the same in medicine?
Maybe. Replacing the stethoscope with a pocket ultrasound may be a useful addition to the tool sets of attending physicians who have sharpened their skills through years of training.
But for medical students, the stethoscope can’t die. It’s a fundamental part of clinical skill development. Forcing us out of the comfort zone of our regular life, it helps us develop the finely tuned senses we need to make it through the most challenging cases.
Recognize that in the present day, we have to do very little to keep ourselves afloat. With advances in technology come advances in passivity. For just about any decision or task we face, “there’s an app for that.”
One to get you directions.
One to find a ride.
One to tell you the weather.
One to tell you what music you might like listening to.
One to find the best food nearby.
There are even apps that tell you what your mood is.
Anyone, if he/she so chooses, can go through an entire day doing very little processing of the surrounding environment. And the people most likely to rely on technology are wearing short white coats.
Yes, I’m talking ‘bout my generation.
Now, I’ll be the first to admit that I love that luxury. But in medicine, that passivity is seldom a part of the practice.
In fact, that has been perhaps the most intimidating pill for me to swallow in medical school thus far; that at times, I will be taking a final stand with few other resources beyond the insights my own skills allowed me to obtain. Skills that won’t feel sharp enough until I am years into practice.
In other words, there’s not an app for physical diagnosis.
A great clinician builds his diagnosis using his senses. The more fine tuned these senses are, the better one can pick up on the subtleties of a case.
Now, many will argue that the tools replacing the stethoscope will make those subtleties more apparent. No longer will a physician have to strain to hear a murmur of aortic stenosis. Instead, she will be able to see a clear picture of a stenotic valve. For a case with a basic presentation, that’s a breakthrough in efficiency and accuracy that we ought to embrace.
But let’s also recognize that, if a patient presentation weren’t so obvious, her training would also have given her the astute clinical skills to effectively dig deeper and catch the subtle findings that might arise.
We medical students have yet to develop those skills. Furthermore, if history is any predictor of the future, giving us a tool that will let us often bypass the need to utilize those skills is a great way to keep us from developing them at all.
How many people born after 1990 can read a map well? Exactly.
The same way that we have come to rely on technology to help us find our way, I worry that if the stethoscope dies, we will learn to rely on technology to tell us what’s going on in our patient. In the process, we skip the development of the skills that come in handy when technology alone can’t get the job done.
The times in which we need to mix the art of medicine with the science of it.
One of the most enjoyable aspects of medical education has been hearing clinicians discuss their proudest diagnoses. If there’s one thing that permeates each of these stories, it’s the presence of a heightened skill set, not a technological tool.
Whether it be uncovering Cushing’s disease by noticing the slightest change in a patient’s affect, or using some savvy observational skills to discover the root cause of aortic insufficiency as tertiary syphilis, there are aspects of medicine require heightened senses.
As I sit here typing this, preparing for clinical rotations, I am nowhere near that level. But, because these past two years have put me in situations where I have nothing to rely on but my own senses, I am closer than I was when I first took the Hippocratic Oath. Closer than I would be if I had the option to derive diagnostic confidence from technology, rather than my own skills.
One day, I will possess the clinical acumen to let modern advances supplement my medical practice. Until then, the stethoscope can’t die. For as a student, I have not yet earned the right to bury it.
Jack Penner is a medical student.
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