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Clinical Skills Rediscovered

A recent article in the New York Times features Dr. Abraham Verghese at Stanford University, who is on a mission to save the physical examination in medicine. He was also featured in an NPR piece a few weeks ago, along with Dr. Roman DeSanctis and Dr. Nesli Basgoz at Mass General, who are also focused on teaching clinical skills, especially auscultation.

Since I've been marketing the Thinklabs Digital Stethoscope, I've had conversations with doctors about the value of the stethoscope and the physical exam. I've noticed that over the years, there has been an INCREASE in the number of doctors, and even residents and students, who believe that using a stethoscope and doing a physical exam are indeed useful.

Last year at AHA, I asked physicians if the new GE handheld ultrasound device would rapidly kill off the stethoscope, as had been predicted by Eric Topol. I could not find one cardiologist who agreed with Topol. While they all felt that handheld ultrasound and echo was extremely valuable, every one of them (and I asked dozens of cardiologists) would offer a counter-argument by telling me about a recent case where they detected a problem with a patient purely by listening. In more than one case, they told of ordering an echo and a few weeks later on a follow-up visit hearing something with a stethoscope that had been missed on the echo.

We also have numerous letters from clinicians who tell us stories about detecting a bruit or murmur that other physicians had missed. In one case, a doctor told me of his partner, a surgeon, who had ordered our stethoscope and upon receiving it had listened to her own heart and carotids. The next morning she scheduled herself for needed surgery.

So it's very heartening to see that the media is beginning to pay attention to the medical educators who teach medical students to observe, to listen, to go beyond simply ordering expensive tests.

You may also recognize Dr. Verghese's name as the author of the bestselling and outstanding novel Cutting for Stone.

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