Ultrasound vs. Stethoscope

CNN.com – Ultrasound may mean end to classic stethoscope – Aug. 27, 2003
In an article that has to have been written by an ultrasound rep, CNN says:

Handheld ultrasound is the tool of choice for some doctors who think it’s time to replace the stethoscope, which has seen little change since a French physician invented it in the early 1800s.

Ultrasound (US) is a tool, no more, no less. Emergency Physicians (EP) use US daily in the evaluation and management of a variety of disorders that come to the ED, from trauma to abdominal pain to vaginal bleeding. I use US frequently, to answer very specific questions about my patients.

To quote a lecturer in ED US, “it’s going to answer a question, it’s not a Tricorder to scan for disease.” That’s how EP’s use it: my most common use is the FAST Scan, the Focused Abdominal Sonogram for Trauma, a noninvasive way to quickly and efficiently evaluate trauma patients for scute, life threatening emergencies.

Now, when you think US, do you think EP? No, you think radiologist (or Obstetricians and Cardiologists, both of whom use US, and both groups still carry and use their stethoscopes).. Not too surprisingly, radiologists (who virtually never do their own ultrasounds but read the films developed by the sonographers) know a turf battle when they see it, and aren’t shy about protecting their income turf.

“There’s a specialty in ultrasound,” says Dr. Michael Hill of the American College of Radiology. “It’s a technical skill that’s hard to learn to be good.”

Hill says he’s worried that if untrained doctors use a tool like ultrasound, they will both misdiagnose and think they see problems where there aren’t any. This could mean patients end up having unnecessary procedures.

Let’s not kid ourselves, this isn’t altruism about patients possibly getting unnecessary procedures, it’s about income protection. (Well, that’s a little harsh, but not very. I have seen the radiologist proposals for ED US, and they’re ridiculous). Not surprisingly, other specialities have decided what they need, and have made their own decisions about US.

In my opinion, there will always be a need for stethoscopes, and US will be an adjunct to diagnosis for many gruops of physicians.

Links to some Emergency Medicine Ultrasound resources:
ACEP Section of Emergency Ultrasound
AAEM Performance of Emergency Screening Ultrasound Examinations


Comments

  1. FAST exams where I practice are growing in popularity, and we have avoided the turf battles because we get credentials through the department of surgery.
    However, where I trained, the battles were severe. The radiologists would not let us use a hand-held machine (we had to drag a big one from the department), a tech had to do the study (not us, and often the tech had to come from home), and the radiologists STILL insisted on a CT. These limitations severly diminished the utility of the FAST exam. It was so much trouble that we just stopped doing them, and I wasn’t able to get my numbers while a resident.

  2. Bill Shields says:

    The blogger is wrong . This is a qulity, not turf, issue. In any event, if hand-held ultrasoung does replace the stethescope, remember that no one gets paid anything extra for using a stethescope.