Computer based USMLE has had multimedia features for some time now. These features include heart sounds. If you look beyond the stress of the exam itself, these multimedia features are quite cool actually! Only tough part is, preparing for these multimedia tests. For example, getting used to listening to and deciphering heart sounds on a computer as opposed to a stethoscope can be a bit challenging in itself. We recently came across this fairly sophisticated “Virtual trainer” at the 3M website – makers of the famed Littman stethoscopes! Check it out.
I remember meeting Proctor Harvey, M.D. (feel free to google him) 25 years ago on an rotation at Georgetown. He was famed internationally for his cardiac diagnostic skills. He heard and understood and explained sounds that others couldn’t fathom. These skills, and other physician diagnostic skills, have been diminished as they have been supplanted by technology. Can you compare how we examine an abdomen today compared to physicians from decades ago?
I really enjoy your writings Dr. Kirsch. MDWhistleblower is one of my favorite “reads”! More power to you!
My reply is greatly delayed, but sometimes Life has a tendency to rearrange schedules without consulting first! Hopefully this little corner of the web will be more prompt in the future.
It must be obvious from this blog that I went to medical school in another country. We experienced first hand the science (and art) of history taking and physical exam – the kind that’s becoming obsolete, it seems. Physical exams HAD to be done in the Inspection-Palpation-Percussion-Auscultation format. I still (almost) remember the more than a dozen points involved in just the inspection of a lump! During rounds, if you were brave enough to suggest getting a CT scan, you better have a darn good reason to justify it, or risk being massively humiliated! Although I didn’t have the privilege of meeting Dr. Harvey, it was my good fortune to learn from some excellent physicians of similar abilities and I know exactly what you are talking about.
Technology has indeed abbreviated the physical exam and sometimes even the history. I suppose the reasoning goes along the lines of “why bother disturbing my peacefully resting neurons about this abdominal tenderness when I can just have it scanned”. But a lot more common scenario would be “I think this is just gastritis, but let me get a CT scan just to be sure I’m not missing something else”.
Its a sad sad state of affairs but technology has supplanted the clinical skills in some cases while in other cases, its just a lot of defensive medicine. Add to it the pressure of seeing more and more patients just to keep up and its not at all surprising that the art is not widely practiced any more.