Handheld ultrasound: A replacement for the stethoscope?

Is the stethoscope going the way of the dodo--to be replaced by handheld ultrasound?

In a recent article in the New England Journal of Medicine, Scott D. Solomon, M.D., and Fidencio Saldana, M.D., of Brigham and Women's Hospital and Harvard Medical School in Boston, suggested that physicians will have to be "trained to view this technology as an extension of their senses, just as many generations have viewed the stethoscope."

Still, while the stethoscope continues to be used by most physicians, many also now argue that the power and convenience of ultrasound improves diagnosis.

"People like to compare ultrasound to the stethoscope, but ultrasound is actually a much more powerful tool when used well," Christopher L. Moore, M.D., associate professor of emergency medicine at Yale University School of Medicine, said in an article in Medscape Medical News. "Like the stethoscope, the contribution to diagnosis is directly related to the skill of the operator."

There has been research demonstrating the advantages of ultrasound compared to the stethoscope. For instance, a study out of Mount Sinai hospital in 2012 found that point-of-care ultrasound is more accurate than auscultation by stethoscope in diagnosing pneumonia in children.

What's more, Jagat Narula, M.D., a professor of cardiology at Mount Sinai, in December co-authored an editorial published in Global Heart that maintained that ultrasound now can diagnose heart, lung and other problems more accurately than traditional stethoscopes. "With ultrasound devices, one can not only look at the heart, but all of the organs in the body," Narula said.

Despite these advantages, handheld ultrasound is not quite ready yet to replace the stethoscope, Solomon and Saldana said. For starters, the devices need to get smaller. They also must be better designed ergonomically, and have added functionality.

Other barriers to the widespread adoption of hand-held ultrasound, according to the Medscape Medical News article, could include issues regarding medical records and billing, and false-negatives and false-positives.

To learn more:
- read the commentary in NEJM
- see the article in Medscape Medical News
- check out this announcement from Mount Sinai
- read Narula's editorial (registration required)

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