The Stethoscope May Have Reached Retirement Age

2016 marks the 200th anniversary of the invention of one of medicines most iconic instrument, the stethoscope. While it still it in use worldwide a new article in the Journal Lancet argues it may be time for the stethoscope to take retirement. PIC or third of the article is Eric Topol , a cardiologist and director of the scripts translational science Institute in La Jolla. Topol said pocket-sized ultrasound devices can't give doctors a lot more information than the stethoscope provides. Doctor Topol what is wrong with the good old stethoscope? It is good at all, Kenny. It doesn't do anything besides getting found. -- sounds So now that we have handheld ultrasound where you can see any part of the Broady recites the brain on a smart phone with a probe that connects to it. The stethoscope doesn't cut it in terms of what you can do a matter of seconds with a smart phone probe ultrasound high resolution. In what specific ways are these digital devices period to the stethoscope? -- Superior to the stethoscope? The thing is you still don't know too much. You send the patient for other studies like echocardiograms, CT scans, whatnot. That with the handheld ultrasound connected to a in iPhone you do that as part of the physical exam. So it makes the physical exam much more efficient. And you can show the patient the ultrasonic -- ultrasound while you are doing. And you can send them the video loop so they can have it in their video record. And you can share with other doctors for immediate consultation. It sounds like you are saying the new digital ultrasound devices give you a lot more information and accurate information than a stethoscope can? Yes. Even senior cardiologist have been shown to have error rates of 50 percent. That's not very good. So we have to go beyond that. You can get algorithmic determination and you go beyond that now with ultrasound. You see at all and it is just more powerful. How expenses are these devices? And what additional equipment you need to use them? A good quality 200-year-old stethoscope is still about $200. But the ultrasound we are talking about, the handheld is $200 a month but it has unlimited users. So several doctors in a clinic, emergency rooms or other places can use it. It is more expensive but quickly pays for itself because it gets rid of the subsequent unnecessary task. Is that to say you don't need scanners or other equipment with these devices? No. This is self-sufficient. The only other thing is if you pick something up on part of your exam you may need to, in some cases follow up the usual traditional type skin. But it is a great screening tool. As we have published and continue to do studies you can get rid of about 70 percent of what normally do scans are done by having this part of the physical exam. And those are expensive. They run $800 $800-$1000 when you order a formal ultrasound or echocardiogram scanned. So these are great for reduction in costs and increasing the bond between patient and doctor. You talk in your last article about the contrary view that replacing fees stethoscope when he wrote the relationship. It is actually just the opposite. I've argued this and clinic for six years now. What is wonderful is you can show in real-time the pictures you are capturing of the person's heart and you can show them the valve and the function and the thickness. Patients can understand that very quickly. We tend to underrate the capability to patients can see and absorb it. And you can send the patient to live to see it later as well. So it is so much better than the way it is done traditionally today. Used in the patient to the ultrasound lab. They never get to see their study. They don't get the results and they have to call later to try and get the answer. And then it's just the bottom line. Services getting the patient much more actively involve. What about the viability of using smartphone apps to replace the stethoscope? This is, I think, a combination of an apple and a probe. And someday consumers will have this on their own. To scan their own body if need be and then the images to experts or algorithms for interpretations. This is a very smart phone apps story that is not been fully told you. -- Fully told yet. Will kind of pushback have gotten from your fellow doctors about your idea of eliminating the stethoscope? There is no shortage of pushback because there is no reimbursements do this. But then again to doctors get reimbursed using stethoscope? No. It is part of the physical exam. So we feel strongly that it should be part of the routine exam for all doctors and we should not be thinking about additional reimbursement. But it will take training. It will take the willingness of doctors to make the change. Back in 1816 it took 20 years for doctors to accept the original stethoscope. So it may take that long again. Do you believe aspiring doctors still need to be trained on how to use the old stethoscope? That is pretty easy to listen to sounds. So trainees do need to learn a stethoscope at least for now. There will always be some use of this quick, inexpensive device so it will not ever go away. But the problem we have now is making the pivot to having students and trainees to learn hand body ultrasound. It is an amazingly powerful tool and no medical schools except for a couple out of 150 in the United States. Besides you how many other cardiologist are using these devices? We are using them at Scripps but also at Oregon health sciences, Mount Sinai New York, at UC Irvine, at the medical University of South Carolina. So less than 10 around the country where this is becoming routine. I have been speaking with Dr. Eric Topol cardiologist and director of the scripts translational science Institute in La Jolla. I'm Kenny Goldberg.