Doctors Flunk Identification Of Heart Sounds
Doctors who were almost finished with their training for primary care succeeded only 20 percent of the time in identifying major abnormal heart sounds using a stethoscope, a study found.
The findings suggest that generalist doctors - the ones who control many patients’ fate under managed care plans - are losing a valuable skill as they increasingly rely on technology, authors said in today’s issue of The Journal of the American Medical Association.
Dr. Salvatore Mangione and Linda Nieman of Allegheny University of the Health Sciences in Philadelphia, who headed the study, said effective use of the old skills can help save money. A doctor who doesn’t know by listening that a heart murmur is harmless is forced to order tests.
“And so in a sense, the loss of these skills … may lead to increasing reliance on expensive technology,” Mangione said.
That conflicts with the goal of managed care, which relies on the bedside skills of primary care physicians to determine when expensive specialization is needed.
In the study, residents - medical school graduates in training on hospital staffs - were incorrect four out of five times in identifying abnormal sounds and did not improve with years of training, Mangione said.
The study involved 453 residents and 88 medical students from a total of 31 programs in family practice and internal medicine in the mid-Atlantic states.
Subjects listened to 12 types of heart sounds that had been directly recorded from patients and identified them by multiple choice questionnaire.
Two experts not associated with the study said its findings are cause for some concern, but should not alarm patients.
Dr. Marc A. Weinberg, director of cardiac rehabilitation at Huntington (N.Y.) Hospital, said doctors currently get training in using echocardiograms, an ultrasound test that is much more definitive than any stethoscope exam.
He said the risk-free, pain-free test, which costs $250 to $600, is as superior to a stethoscope exam as the automobile is to a horse and buggy.