Substituting the Stethoscope with a Scan 

 

As a radiologist, I have seen the occasional substitution of the stethoscope with the CT scanner, of the physical exam with the PET scan, of clinical thinking with clinical testing. 

 

I remember working in the emergency department of a university hospital. Commonly, teams of consulting doctors would come to the dark room in which I read films to see their patients' studies and ask for my interpretation.  

 

Reading a chest x-ray, I would say something like, "This opacity in the lung could be due to compressed tissue, pneumonia, or cancer." 

 

To help narrow the diagnosis, I would inquire, "Is this patient having difficulty breathing deeply?" or "Does the patient have a cough or a fever?" or "Any long history of heavy smoking?"

 

The team would hesitate, then someone would quietly offer, "Well, we're not sure -- we haven't seen the patient yet." 

 

I find it interesting that we doctors sometimes see inside our patients before seeing the actual people behind the medical chart or thoroughly listening to their lungs or even to their words in performing a complete history and physical exam. 

 

Testing before examining.

 

The x-ray machine (and often the CT scanner) seems to have supplanted the stethoscope. 

 

The reasons are many, including the pressures and demands of defensive medicine, high patient expectations, and not having enough time. Sometimes the quick approach of resorting to imaging first is needed, as in many cases of trauma and when a history or physical cannot be thoroughly ascertained or performed (when the patient is unconscious, for example).

 

Of course, the unintended consequences of such preemptive imaging in lieu of a focused exam include unnecessarily exposing patients to potentially harmful ionizing radiation and saddling them with bills for tests that fail to send them farther down the path to diagnosis and recovery.

 

As chief medical officer of HealthHelp, I now guide physicians using a network of experts in a collaborative way to the right tests and treatments for their patients at the right times in the realms of diagnostic radiology, radiation oncology, and diagnostic cardiology.  

 

Sometimes the best medicine may be the tincture of time or the "simpler" means of listening and examining instead of immediately scanning.