Listening to Our Patients

When was the last time any of us used a stethoscope and felt it made a difference either to clinch a diagnosis or to change the management of a sick patient?
Diagnostic Tool or Neckwear?
How many of us have had a patient with a history of hypertension, diabetes or myocardial infarction (MI), who presented with complaints of chest pain and shortness of breath?
On exam, he might have been anxious and diaphoretic, with a heart rate of 130, respirations of 24, blood pressure of 190/110, bilateral pedal edema, oxygen saturation (SpO2) of 89% and 12-lead ECGs showing ST-elevation.
Then you put your scope on his chest and said, "Wow, this guy has crackles two-thirds of the way up. Good thing I checked, otherwise I never would've guessed he was in pulmonary edema."
Or, "Gosh, that three pack-a-day smoker with a productive cough, green sputum, a temperature of 103, an SpO2 of 92% and respiratory rate of 32 has crackles in her right lung. She must have pneumonia!"
When you got these patients to the hospital, things might not have gotten much better.
With the use of increasingly sophisticated technology and imaging modalities, some of the tools of our trade, like the stethoscope, have been relegated to near museum status.
Several years ago, the chairman of radiology at a teaching hospital asked what I thought about their emergency medicine residency. I said I thought it was good but also bemoaned the fact that their residents would often throw the pat...

Source: JEMS Patient Care - August 2, 2017 Category: Emergency Medicine Authors: Neal Richmond, MD Tags: Patient Care Columns Source Type: news