It’s the art of listening to the sounds that the body makes – usually through a device such as a stethoscope. It is a skill that all physicians and nurses are expected to master as part of their training. To be fair, some of us become quite skilled at it while others frankly suck. Most do a passable job, I think.
In my day, a high-quality stethoscope was a Sprague-Rappaport. I purchased one in our medical school bookstore when I was a first-year student. The Litman company gave everyone in my class a free stethoscope. I liked my Sprague better; it was shorter and had interchangeable diaphragms suited for cardiac auscultation, lung examination and pediatric work. But in fairness, the Litman scopes were quite serviceable. I used my Sprague ‘scope the entirety of my clinical carrier. At under $100 in the mid-70s, it was a wise investment.
These days, stethoscopes do digital signal processing of their acoustic inputs, and some even have built-in EKG capabilities. What do I think of this? Allow me to recount something that a friend asked me back in 1986 when Star Trek IV hit the screen. There is a scene in that movie where Bones (Dr. McCoy) gives an elderly woman lying on a gurney a few pills. She had said that she was on dialysis; Dr. McCoy’s pills allowed her to grow a new kidney. My friend, Jerry Chamkis (RIP, good friend), asked me, “What did you think of that scene?”
I remember that moment fondly. “I would be most disappointed if such improvements had not been achieved in the 23rd Century,” I replied. Don’t get me wrong, I look back on my years of practice and am thankful that I had the opportunity to work in medicine those years. I do not romanticize it. I do not think of that period as the good ole days. I am not a MAGA moron who looks back to a past that is a fiction of my imagination. I look back at it and wonder how much more good my colleagues and I could have done had we known what physicians know today – if we had the medicines, imaging modalities, vaccines, therapeutic interventions of today. Hell, even a fancier stethoscope would have been great!
I’m going on about this for several reasons. For one, I miss my old stethoscope that was lost during a mission of mercy. I bought another of similar design, but it isn’t the same. For another, I miss my brilliant and eccentric friend Jerry. And for another, I read an article today about the use of AI in cardiology.
Back in the early 1980s, Susan and I attended a CME session at our medical alma mater – Baylor College of Medicine in Houston. The program was a cardiology program hosted by Professor Proctor Harvey – a legend in cardiac auscultation. Dr. Harvey died just a few years later, so it was a privilege for us attend his lecture and demonstrations. All the attendees were given wireless stethoscopes, and the seminar was attended by a group of young cardiologists from the Cardiology program of Mexico City. Believe it or not, Mexican cardiologists were then the world’s best at cardiac auscultation.
Dr. Harvey presented a series of cases by first playing the heart sounds of a patient with some heart abnormality. We each heard those sounds in our wireless stethoscopes. He then played the recording again accompanied by the synchronized EKG that appeared on the auditorium’s screen. He then called upon the Mexican cardiology fellows and professors for a diagnosis. These guys were just amazing; they explained each cardiac abnormality with incredible accuracy – valvular stenosis and insufficiency were trivial exercises. They identified patent ductus arteriosus, atrial and ventricular septal defects, pulmonary hypertension, hypertrophic cardiomyopathy, and all manner of abnormality that I had never even heard in a living patient. It was a display of auscultatory pyrotechnics! If I recall correctly, Dr. Harvey then displayed the patient’s echocardiogram so that the audience could verify the accuracy of the cardiologist’s diagnosis. The point was ear training – not unlike that which musicians get.
So, today’s article on AI in cardiology was a Medscape item. It reported that a new stethoscope and smartphone app could send a patient’s heart sounds to a server that would identify heart murmurs due to valvular heart disease with greater diagnostic accuracy than a group of Primary Care Physicians (PCPs). Am I surprised? No! I am gratified, and I look forward to that AI reaching the level of cardiac auscultatory accuracy that would be the match of the revered Dr. Proctor Harvey and the cardiologists of the cardiology program in Mexico City.