The Stethoscope of the 21st Century

Originally published in the November 2015 issue of the Vista View Newsletter.

In 1816, Dr. Rene Theophile Hyacinthe Laennec, a French physician, had a dilemma: the standard technique for listening to a patient’s heart was “immediate auscultation”: placing one ear directly on the chest of the patient. One day, to allay his uneasiness about using this technique on a young woman, he rolled a piece of paper and placed it against her chest. To his surprise, her breath and heart sounded louder and clearer. Technology in medicine took a giant leap forward that day. His discovery that tubes transmitted sounds more efficiently spurred him to develop a monaural wooden tube. In 1851, Dr. Arthur Leared, an Irish physician, developed a binaural version of Laennec’s tube, allowing a physician to listen with both ears. Thus, the modern stethoscope was born.

Today, we are once again aided by the physics of sound and it is just as revolutionary and profound to the everyday practice of medicine as it was to Laennec long ago. That technology I allude to is diagnostic ultrasound, which involves the digital transformation of reflected high frequency sound waves into light, painting digital pictures of the objects being targeted.

As a young medical student in 1972, I attended a presentation about a new modality that could change high frequency sonar waves into a light generated image. These reflected sound waves would create often fuzzy pictures on a screen or printed on heat-sensitive photographic paper. It was like looking at smoky shadows, but I could make out shapes of organs and see movement of internal structures. The ultrasound left a lasting impression on me. The machine, however, was the size of a washer and I knew it was out of my reach. I urged my little hospital to purchase one. While back then, only radiologists could perform ultrasound procedures, in their absence or at night, I began doing my own scans.

Eventually, I was able to afford a machine for my office and we began using it for everything. When a patient had a lump in a breast, I simply scanned it, using that same scanner later to guide a needle for a biopsy. When a female patient was nauseated with abdominal pain, I could check for gallstones, an inflamed appendix, and pregnancy all at once. I could tell whether lumps in the body were cystic, solid, or vascular. The ultrasound allowed us to know the exact age of a baby before birth and to assess any possible complications before or during delivery. It was a great diagnostic tool and saved my patients time and money—and often spared them from more invasive procedures. I became an advocate for an ultrasound in every office, setting up courses and developing curriculum to teach ultrasound techniques.

When I came to RVU, my machine came with me. But with such a large, expensive machine, would teaching medical students this skill be worth the effort to their future goals? In every case, the answer returned a resounding yes. Digital technology later created machines that were smaller and lighter than ever before, making the ultrasound an essential diagnostic tool in every physician’s bag. It became affordable, portable, simple to operate, and produced high fidelity images that aided in diagnosis. When I read of a iPhone-sized ultrasound machine with a relatively modest price, I was certain that RVU should include this modality into our curriculum. Ultrasound was indeed becoming the stethoscope of the 21st century, growing in relevance every day. We would never graduate a student without knowledge of how to use a stethoscope, so how could we graduate students who were not proficient in the use of ultrasound for diagnosis? Most recently, the ultrasound has been judged superior to (as well as less expensive and invasive than) MRI and CT for the diagnosis of joint erosions in arthritis or cartilage tears in the knee. The uses of this modality have become so numerous that it is hard to determine for which condition it is best suited.

RVU is not the first osteopathic medical school to incorporate ultrasound into the curriculum; however, we are one of a few that have developed curriculum extending throughout all four years of study. We know that this important tool will be essential to the physicians of the future. In our goal to produce the best physician possible, developing ultrasound skills seem to be an essential ingredient in that process.