SMARTPHONE WILL SOON BE THE STETHOSCOPE?
As medicine's most
recognisable device hits 200, it may be time to say happy birthday, and happy
retirement
It was 200 years ago that a
French doctor spared a female patient embarrassment by rolling up sheets of
paper and placing them to her heart instead of putting his ear to her chest, as
was the practice of examination then. This single act of propriety gave birth
to that universal marker of medical practice -the stethoscope.Over two
centuries the device has travelled wide -to film and TV sets (remember ER's
George Clooney with a stethoscope slung around his covetable shoulders?),
S&M shops, toy stores, and of course, the medical exam room.
Unfortunately on its 200th
birthday instead of celebrations, there's talk of dispatching the old stetho to
the morgue. Last week, Jagat Narula, a cardiologist at Mount Sinai Hospital in
New York, provocatively claimed “the stethoscope is dead“.
The futurists singing
dirges for modern medicine's primary diagnostic tool say it's on the way to
being replaced by handheld ultrasound devices and smartphones.
In 2014, Indian-origin
15-year-old Suman Mulumudi invented the Steth IO in Seattle, essentially an
iPhone case that amplifies heart and lung sounds and converts them into a
spectrogram, which can be annotated and stored for future reference. The device
is in the market. Others have cited GE Healthcare's VScan -a portable ultrasound
machine -as a possible successor.
Then there's the Eko Core,
an FDA approved digital stethoscope that records the sounds of a patient's
heart and transmits the data to an app. The clip stored in the cloud can be
transferred for a second opinion anywhere in the world.
Some stethoscope apps play
doctor and deliver snap diagnoses by applying algorithms to match the patient's
recordings with a pre-programmed index of common sounds detected in
auscultation -the clinical term for listening to internal sounds of the body .
The gains, experts say, are
greater diagnostic accuracy, real-time results and streamlined treatment that
saves the patient time and money by elimi nating superfluous tests and
medication. A compelling argument for new technology .
Not all Indian medics are
convinced.Dr Vanita Arora, a cardiologist at Max Healthcare, maintains what
technology tells you is what you tell technology .“Apps can't be 100% accurate.
Good history-taking, and listening to a patient can never be substituted. If
the machine misses even one sign, the diagnosis could be incorrect. Which is
why some apps suggest you clinically correlate their findings,“ she points out.
Dr CT Deshmukh, professor of pediatrics at Mumbai's Seth GS Medical College,
agrees.“Ninety per cent of doctors can't do without a stetho,“ he says, adding
that digital debutants will mainly contribute to storage and sharing of patient
records.
But some point out that
doctors themselves could miss vital signs. (Not deliberately, like a noted
doctor who'd examine his patients in a government hospital with the stetho's
eartips around his neck instead of in his ears.) Overreliance on CT Scans and
cardiograms has reportedly blunted the doctor's diagnostic skills.
Some say stetho stand-ins
won't penetrate the Indian market until the new digital devices are introduced
to students right at medical school. “When you go to tech conferences you
realize that stethoscopes are going out because apps and mobile devices are
more accurate and tell you more,“ confirms Dr Neelesh Bhandari, co-founder of
Healtho5 Solutions, a healthcare service startup that uses technology to cover
the distance between doctor and patient.
Steth IO or Eko, Pradeep
Chawla isn't afraid of what's to come, because this manufacturer of steel
stethoscopes knows at Rs 500 (going up to Rs 2,000), his devices are a bargain.
“Even though electronic stethos have been available here for several years,
you'll seldom come across one in use. I doubt doctors will switch any time
soon,“ says Chawla, whose company, Lifeline Medical Devices, makes 17 models of
stethoscopes, including a gold-plated specimen.
The economics of owning and
operating next gen stethoscopes -an app requires at least a Rs 5,000
smartphone, and GE's VScan costs Rs 5 lakh) -may prove to be a hurdle in India.
Logically , the steep imbalance in doctor-patient ratio -6 doctors to every
10,000 people -could suppose that quicker, more efficient tools with
tele-medicine capabilities would have sped up diagnosis.But then again 80% of
the population is treated in rural India where steady electricity itself is a
luxury .
Which is why doctors like
Dr. G Lakshmipathi believe it's not yet time for the stethoscope to exit,
although he believes that day will undoubtedly come. The Coimbatore-based
cardiologist sets great store by the `placebo effect' of the stetho.“It's
suggestive of the doctor's authority .When a patient sees an individual with a
stethoscope, they're reassured that they're in capable hands, and on the way to
recovery -this confidence itself can aid recovery . If you take away the
symbol, you take away from the placebo effect of the doctor,“ says Dr
Lakshmipathi.
Finally , in the debate for
old versus new school, it's worthwhile to remember that a conventional stetho
may not relay images, store or transfer data or have voice capabilities, but it
has always had a processor -between the eartips.
SOUNDS OF THE FUTURE
The FDA recently approved a
digital model by Silicon Valley startup, Eko Devices, that records sounds of
the heart and transmits them to an app. The sounds can be stored on the cloud
and accessed by doctors anywhere. It costs approximately Rs 13,200 on
conversion Another contender is the GE Healthcare Vscan -a portable device the
size of a smartphone -that delivers a real-time ultrasound image. Price, Rs 5
lakh
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Joeanna Rebello
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TOI10JAN16
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