Editor Dan Buckland has been commenting on a post by Iltifat Husain over at iMedicalApps, and thought it worthy of a more in-depth follow-up here.
The one-liner from Iltifat’s short post, which you should read, is:
While there are cases the stethoscope would be useful, especially in regards to certain pulmonary sounds, it’s not outlandish to think mobile ultrasound could be the essential tool physicians carry around, while the stethoscope becomes relegated to PRN use.
This led to some back and forth between him and me in the comments where we discussed the current state of mobile ultrasound and the profile of likely competitors to the GE VScan and Siemens P10. But what I want to respond to is other well put comments, by Picudoc and a Miguel Silva:
Having the title of this story in mind, “Why physicians will use mobile ultrasound instead of stethoscopes in the future”, I wouldn’t say “instead of”, but “along with”. It’s an overstatement considering the limitations of ultrasound in the diagnosis of several respiratory and some cardiac conditions, the yet still high price of the equipment at the moment and for the forseeable future (I doubt that the price of mobile ultrasounds will drop to as low as the price of a stethoscope in the next 10 years). Also, let’s not forget the costly effort, both in terms of time and resources to train every medical student to proficiently use an ultrasound. It takes time and experience.
I will put my limited prognostication credibility on the line here and say that I respectfully disagree with (I’m assuming) Dr. Silva. Ultrasound will be used “instead of” stethoscopes in my working lifetime in the majority of primary-care and cardiac practices in industrialized countries. I may only be halfway done with medical school, but I am hopefully a month away from finishing a PhD thesis where I use portable ultrasound in some pretty non-traditional medical scenarios, so I spend a lot of time thinking and researching the current and future state of the art of ultrasound as a medical imaging modality.
The price of an ultrasound system doesn’t have to compete with a stethoscope because it can tell you much more with similar training. As an example, I’m pretty sure you could train a medical or nursing student how to identify and quantify mitral regurgitation with ultrasound in the same time it took you to teach them to auscultate it (which then has to be followed up with a transthoracic or TEE echo anyway). Auscultation with a stethoscope might be second nature to established MDs, but it still took experience and training to get to that point. I think we could make a reasonable assumption that the “science” of auscultation is mature. On the other hand, with advances in materials science, image analysis, machine vision, and all the tech which makes a smartphone more powerful and capable than the computers on the Apollo spacecraft, ultrasound still has a way to go and will end up much easier to use to get much higher diagnostic reliability.
Finally, as I mention in the original post:
I think the pulmonary exam could be a somewhat trivial fix as well, the ultrasound probe already acts as a microphone for the sound waves it produces. I can envision a “listen only” setting that only transmits the low frequency noises to an audio jack on the device.
If it is determined through peer-review that auscultation is a better diagnostic modality for some conditions, it is already a part of the device. I agree with both Picudoc and Dr. Silva that the current generation of mobile ultrasound is not going to replace stethoscopes and I don’t think that stethoscopes will disappear completely from medical practice, but I do think that mobile ultrasound will replace the role that stethoscopes currently have in medical education and in the skill set a graduating medical student is expected to have. Someday soon, the stereotypical device hanging around an MD’s neck won’t be a stethoscope, it will be an ultrasound probe.
I invite other opinions in the comments.
Original post at iMedicalApps: Why physicians will use mobile ultrasound instead of stethoscopes in the future…