I had a friend who is a nurse tell me that most use of stethoscopes was just because the patient expects it.
For a patient with a normal heart/lungs, it doesn’t tell the doctor much, and for a patient with cardiac problems, other tests/scans give much more detailed & accurate info.
(But the being close, touching the patient can be helpful in diagnosing other problems.)
Ah - but for a patient with non-normal LUNGS, a stethoscope would seem to be a rather quick way of doing some screening. Chest x-rays or whatever might be useful, but a quick listen can tell you right off the bat if the person is moving air, has evidence of gunk in the lungs, etc.
I can’t speak to the OP / chest pain, but for lung issues, I have only ever once had a doctor skip that step (and that was when I saw him for an asthma flare - a rather glaring omission).
Firstly, if you think I’m being deliberately obtuse, call a moderator, or step outside to the pit.
Secondly, I provided a link, knowing that people could make their own judgment if they were interested in doing so.
Thirdly, I linked to your name, so that you could see what I said: at that time, I didn’t intend it as an insult.
Having said that, I restate the observation I made in that thread: diagnosing pulmonary edema by chest auscultation was once a skill taught to beginners, and I note again your description that it required a Specialist to do so.
Assessment of Pulmonary Edema: Principles and Practice - ScienceDirect
The thread title reminded me of an event some years back when I was still new to this area and seeking a PCP. I had done something to cause a fair bit of back pain and being (at the time) in my early 50s, I didn’t want to just blow it off, so I made an appointment at a practice that accepted my insurance. I felt like the doctor who saw me was afraid of me, for some reason.
He held the stethoscope at arm’s length, as if to be as far from me as possible. That alone I could have written off as a quirk, but after I described what had happened and where the pain was, he sat down and wrote a prescription for pain meds. He didn’t have me stand or try to touch my toes or do any sort of examination at all. So I left, tossed the scrip into the garbage, and never went back. Last thing I wanted was someone to throw pills at me.
FWIW, the pain cleared up in a few days, so I guess it was a minor strain or something.
You should not have dragged me falsely into your argument. That’s all I’m going to say on it.
[Moderating]
OK, @Exapno_Mapcase and @Melbourne , cool it off, both of you. Any misconception that might have been present has now been resolved, so let’s everyone drop this digression.
My PCP lays on the stethoscope during some visits but not all. As far as I know, he is always listening to my lungs, not my heart.
In my life, I’ve mostly had the stethoscope for blood pressure measurement. The lungs only when I’m sick, (or for doctor-in-training). ‘Annual Checkup’ isn’t a thing and there’s no TB in Aus.
I routinely use mine to listen to the lungs, which is definitely useful, but almost never listen to the heart.
I’ve often caught new diagnoses of atrial fibrillation and other arrhythmias that need treatment in otherwise asymptomatic/non-complaining patients simply by listening to the heart. I’ve picked up significant lung abnormalities in those types of patients too, just by listening to the lungs. Less commonly but not rarely I’ve uncovered significant carotid artery obstructions by hearing bruits in the necks of asymptomatic patients.
I don’t know why so many primary care practitioners have abandoned such a useful non-invasive tool.
They don’t have the training or knowledge of what they should be listening for? Or it’s probably just easier/faster to order tests of some kind.
If you’ve got the patient in front of you, it takes under a minute to listen to heart, lungs, neck, bowels.
If you’re a surgeon, you can listen to heart, lungs, bowels just by putting your stethoscope right on the xiphoid process (physician humor). ;-D
I mostly listen to the side of the neck to evaluate upper airway stridor in croupy kids or people having allergic reactions and other types of obstructions.
In kids, because they’re so close together, it can help differentiate between fluid in the bases and nasoharyngeal snottiness.
One value of listening to people who aren’t sick is that you know what normal is, descriptions in a book are only a starting point.
My annual physical “exams”, which are now simply called a “wellness check” by Medicare, are profoundly perfunctory and have been for many many years. I’ve assumed that Medicare dictates what these “exams” cover and it’s a very short list.
But most primary care patients are not on Medicare.
Is this true? I’m on Medicare. I notice when I go for my annual ‘exam’ (to get my prescriptions renewed, mostly) - well, I have a phobia of doctors and turn down any offers of tests and mammograms and so on. (If I’m ill, of course, I speak up!) Maybe that’s why I get a shrug and nothing else except blood pressure, ear exam, and a going over with a stethoscope before being kicked loose, 5 minutes tops. He spends more time typing on his computer than talking to me.
The documentation demands placed on physicians and nurses for reimbursement reasons are abominable. The EMR is a huge barrier to practitioner/patient relationships. NOT the great hope of improving medical which it had been touted to be.
In Aus, a medical consultation must take 3 minutes not including typing. The enforcement is, if you are doing 50 consultations in a 4 hour shift, the medical insurance system will assume that you are cheating. (There is more to it than that, and it’s part of a more complex system, but it’s a comparison.)
“3 minute medicine” is a pejorative term doctors use to describe other doctors in Aus.
True.
I’ve seen evidence of both! Not only are medicinal leeches bred for that use, but medicinal maggots are too, for wound care. Goes without saying that neither is used unless less drastic measures have failed, not because they’re painful but due to the gross-out factor.