Many Doctors Cannot “Sound the Chest” Properly

As a medical student (many, many years ago) I spent a lot of time actually using my stethoscope, rather than draping it round my neck. We were expected to be able to reach a bedside diagnosis based on the patient’s symptoms and physical signs, without benefit of lab tests and X-rays, which took forever. A major part of the physical exam was ‘sounding the chest’, with the emphasis on the functioning of the heart and lungs.

A new report in the Archives of Internal Medicine tells us that much of the skill involved in sounding the chest has been lost (or never taught). Cardiac examination skills were compared between medical students, residents, cardiac fellows and faculty, and family practitioners. None of these groups reached the expected level of skill; cardiac fellows did best, but still fell below what the targeted standard. Family practitioners did no better than 3^rd and 4^th year students.

Last time you had an exam did your doctor sound your chest with more than perfunctory attention? And I very much doubt that they removed your undershirt and actually undertook percussion of the chest.

With the ready availability today of ECG, X-ray, and lab test facilities, it’s clear that there’s less demand for auscultative skills. But this also means that the time spent with the doctor is greatly reduced, and the patient doesn’t have the same opportunity to bring up something forgotten in the first minutes of consultation.