The journal of the World Heart Federation suggests that the stethoscope could be experiencing its final days due to the rapid advent of point of care ultrasound devices that are becoming smaller, increasingly accurate and less expensive.
Point of care ultrasound devices can scan for trauma, reduce complications, assist in emergency procedures and improve diagnostic accuracy. A number of air ambulances in the UK now carry and use portable ultrasound devices and the feedback is positive.
A search of reported clinical negligence cases and literature reveals no cases of inappropriate diagnosis arising from the use of a stethoscope. In fact, the largest concern seems to be the risk of infection due to stethoscope use. Claims relating to the incorrect interpretation of imaging are however not infrequent and image interpretation is what is required when using point of care ultrasound devices.
Images have to be interpreted accurately and anomalies can be missed even by a well trained and experienced eye. Furthermore, problems might arise with the performance and suitability of the device itself. Will the screen on a handheld device be big enough for diagnostic purposes?
Awareness of risks
Point of care ultrasound devices are being used more frequently. Consideration needs to be given as to whether images taken can be stored and married up with the medical record for the patient with other scans and radiology.
Clinicians adopting their use will need to be able to evidence the training they have received in using these devices and will have to be used where circumstances deem their use appropriate. They should not be used to replace a more thorough examination where such an examination is required. Detailed maintenance records will need to be kept as well so that it can be demonstrated that the device was fit for purpose when used.
Whilst a stethoscope usually belongs to the individual doctor or healthcare professional handheld ultrasound devices remain costly.
The stethoscope remains a powerful diagnostic tool in the correct hands. Over time and with appropriate training the same will be said for point of care ultrasound devices. In the interim the risks and benefits of adopting the new technology need to be carefully balanced. The stethoscope survives for the time being at least.
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