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Study: Most new doctors can't use stethoscope


Only 20 percent 'hear' common heart problems

September 2, 1997
Web posted at: 11:43 p.m. EST (0443 GMT)

ATLANTA (CNN) -- U.S. researchers say many new doctors don't know how to use a stethoscope properly.

The findings, released Tuesday in this week's Journal of the American Medical Association, were based on a study involving more than 450 first-, second- and third-year internal medicine and family practice residents. They were asked to detect 12 different heart problems by listening with a stethoscope to cardiac rhythms played on a high-fidelity tape.

vxtreme CNN's Dr. Steve Salvatore reports

"On average, they were wrong four out of five times," said Dr. Salvatore Mangione of Allegheny University of Health Sciences in Philadelphia. "There was very little or no improvement over the three years of training. And, in addition, there was basically no difference between residents and a group of medical students."

Dr. Salvatore Mangione

There was one exception, however.

Physicians with musical training are generally better equipped to get the most out of the instrument once considered the cornerstone of their profession.

"A trained ear, whatever the reason for its training, may be a prerequisite for achieving proficiency in this skill," the researchers concluded.

Results 'disturbingly low'

Overall, the study found, residents recognized only 20 percent of common heart problems that usually can be diagnosed with a stethoscope, a rate the authors of the study called "disturbingly low."

Part of the problem lies in training, according to the study.

An EKG monitor

"While directors of internal medicine programs consider this to be an essential skill for every practicing physician and would like more time to be devoted to its teaching," it said, "fewer than one-third of all internal medicine programs offer any structured teaching of cardiac auscultation (detecting heart problems with a stethoscope)."

The other problem is major advances in hi-tech diagnostic tools such as echocardiograms.

One young doctor explained: "there is the constant temptation to think 'let's not totally concentrate on this heart murmur because we can always get an (echocardiogram)'."

Tip of the iceberg?

Mangione is out to change the way residents learn about stethoscope skills. In his class, trainees actually listen to the heart sounds as they learn about them, tying the words and the sounds together.

"We've got all this technology out there, but we've still got to rely on what you can touch and hear and smell and see," said another resident.

Of further concern, researchers say, is that these findings may be just the tip of the iceberg. They say that deficiencies found in the heart exam might also be found in other aspects of the physical exam.

They say "an even worse situation exists" for detecting for lung problems.

Correspondent Dr. Steve Salvatore and Reuters contributed to this report.

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