Stethoscope envy

MrCreosote

Maybe this would be better on "Ranting and Raving" but I'm getting a bit cheesed off with all the flash Litmanns around. Personally I went for the standard and cheapest model and it has served me well for 10+ years. I mean if I can't hear it is it really worth hearing. Do I need to hear fixed splitting of the second heart sound or say if a murmur if grade 2 or 3??

Now everybody has a cardiology stethoscopy, or the one with the massive heads, or the ones that can record the fraking sound!

It's like having a flash car- obviously compensating for something!:D

Vorsprung

Jealous?!

MrCreosote

Only a little.

A Neurotic

According to one of my lecturers, stethoscopes are fairly inaccurate/unreliable/obsolete by today's standards. Is this true?

MrCreosote

I think the bell side is pretty useless anyway. Never use it myself.

You could argue that clinical examination as a whole is of little benefit with the odd exception.

daithi1986

Do you not have one of those ones that does a 3 lead ECG while your listening to the chest, now that is extravagance!

mardybumbum

MrCreosote wrote: »

You could argue that clinical examination as a whole is of little benefit with the odd exception.

What? :eek:
Is that something you would argue yourself?
Surely a clinical examination is of huge importance in any diagnosis.

ergo

mardybumbum wrote: »

What? :eek:
Is that something you would argue yourself?
Surely a clinical examination is of huge importance in any diagnosis.

imaging ie. in this case echocardiography has taken over massively, many cardiology consultants will verify this.

For other systems CT/MRI/Ultrasound have replaced the need for clinical exam to be accurate or have reduced the emphasis on clinical exam as scans will be done anyway

for the above that is regarding hospital-based diagnosis. In GP-land where you have no diagnostic imaging available immediately like that the clinical exam is obviously essential

people can argue all of the above either way, it's been the focus of much debate, I don't have time to go into detail or to point to published articles regarding this but they are out there

MrCreosote

mardybumbum wrote: »

What? :eek:
Is that something you would argue yourself?
Surely a clinical examination is of huge importance in any diagnosis.

History is by far the most important since it establishes the probability of a particular diagnosis- the pretest probability.

Examination and diagnostic tests simply alter this probability, and diagnostic tests are usually more accurate.

There are always going to be exceptions of course, and as ergo says the access to these tests is important too.

Jessibelle

Would an exam be an important factor psychologically to the patient too? Help cemment the idea that they were being looked after? I know personally, even if it's just checking my blood pressure, I feel more 'looked after' and reassured if some form of check is performed physically rather than just a chat about previous symptoms?

Vorsprung

I'd agree that examination has diminished somewhat in it's importance, but it's still important in guiding your investigations. I've seen loads of people come through ED with generally sore abdomens - you get their pain under control and have another feel and the tenderness/pain localises to the RUQ/LLQ, so you go for USS or CT as appropriate.

tech77

A good neuro exam (when indicated) is very valuable surely (for things like Stroke, Parkinson's).

Ironically, it's arguably the most neglected/poorly performed exam.

DubMedic

The old stethoscope is still useful in some cases..more so from the pre-hospital care aspect, seeing as the advanced lads can intubate on the roadside it's handy for checking tube placement.

I have a steth but it's nothing fancy, just a bog standard. It stays in my pocket most of the time.

.

DrIndy

I have 2 littmans stethoscopes!

One of them is the cardiology master!

But in fairness - its the ears that listen which really make a difference, not the equipment used. Bad workman and tools et al......