If you walk around most hospitals, you’re likely to find a stethoscope hanging around the neck of a number of medical professionals. It’s probably safe to say that no other instrument has had such a lasting impact on medicine as the stethoscope, and no other single piece of equipment has come to symbolize “physician” quite like it.
The stethoscope first debuted in 1816 in France, when physician Rene-Theophile-Hyacinthe-Laennec rolled a piece of paper into a cylinder and pressed it to the chest of a sick patient. Almost 200 years later, the stethoscope is used by almost every medical provider and has changed minimally from its humble beginnings. In addition to symbolizing the profession of medicine, it has come to represent an intimate part of the physical exam – when is the last time your primary care physician didn’t listen to your heart and lungs?
But as Drs Soloman and Saldana point out in their article in the New England Journal of Medicine, ultrasound may prove to be the new stethoscope of health care. Over the past 50 years, ultrasonography has increasingly worked its way into different parts of medicine. Much like the stethoscope – the ultrasound is employed by a wide variety of physicians; long a standard tool in obstetrics and gynecology, ultrasound has become the most widely used and cost-effective imaging modality for cardiologist. ED physicians use ultrasound to perform basic abdominal, cardiac, and obstetric evaluations, and even surgeons use ultrasound during trauma scenarios. Ultrasound can be used to evaluate the heart, the blood supply, the uterus and ovaries, the liver and biliary systems, and the kidneys. Ultrasound has become the preferred imaging method for investigating intraabdominal pathology in children (such as appendicities) and pregnant women given the lack of radiation, as opposed to xrays and CT scans.
And much like most emerging technology, ultrasound machines have become smaller, more portable, and cheaper over time. I’ve even seen ultrasound apps for smartphones – perfect for use in the field or in developing countries with less medical infrastructure. It’s not too hard to imagine a future where instead of listening to the heart and lungs with a stethoscope, primary care physicians examine the heart with a portable, hand-held ultrasound machine – thus providing a more accurate picture of the patient’s cardiac function as well as a potential billing opportunity and source of income for primary care physicians.
Ultrasound’s advantages – low cost, no radiation, portability – are precisely why the technology has expanded so rapidly in medicine. Yet ultrasound has a few drawbacks to further implementation, the first of which is accurately interpreting the images (a drawback inherent in all imaging modalities). Inherent in in the first drawback is the other drawbacks – ultrasound is a skill that needs to be learned. Currently, ultrasound education occurs mostly during residency, where Emergency Medicine, OB/GYN, surgery and medicine residents learn to use ultrasound targeted toward their own specialties. Surgical residents are taught how to perform ultrasound exams in trauma scenarios and for certain procedures, while OB/GYN residents focus specifically on gynecologic and obstetric procedures. More detailed examination of the heart and vasculature often occurs during fellowship training in cardiology or vascular surgery. And ultrasound technology is extensively taught during residency training in radiology.
In order for ultrasound to become the “new stethoscope” and gain wider implementation, education in the proper use of ultrasonography must begin at the same point where physicians learn how to use a stethoscope – in medical school. Undergraduate medical education must routine incorporate training in ultrasound in order for the technology to become “point of care”. We cannot expect all of our physicians to be facile in using ultrasound if we don’t teach all of our “physicians in training” how to properly use the technology. As Soloman and Saldana point out, a generation of physicians will need to be trained to view ultrasound “technology as an extension of their senses, just as many generations have viewed the stethoscope. That development will require the medical education community to embrace and incorporate the technology throughout the curriculum.”