Unheard Hearts – A Metaphor, by Clifton K. Meador

Below, a guest-post by Dr. Clifton. Meador.

Many  HealthBeatt readers  know Meador as the author of a popular HealthBeat guest-post “The Art of Diagnosis,” drawn from his book True Medical Detective Stories  (“A Young Doctor and a Coal Miner’s Wife.”)

Long-term readers will recognize Meador both as one of the stars in  the film,, Money-Driven Medicine,  and as the author of well-known satirical writings on the excesses in our  medical system. They  include “The Art and Science of Nondisease (the New England Journal of Medicine, 1965) and  “The Last Well Person,” an essay he published as an “Occasional Note” in NEJM  in 1994. 

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Unheard Hearts – A Metaphor 

                                                      Clifton K. Meador, M.D

A few months ago, a young cardiologist told me that he rarely listens to hearts anymore. In a strange way, I was not surprised.

He went on to tell me that he gets all the information he needs from echocardiograms, EKGs, MRIs, and catherizations. In the ICU, he can even measure cardiac output within seconds. He told me that these devices tell him vastly more than listening to out-of-date sounds via a long rubber tube attached to his ear.

There was even an element of disdain. He said, “There is absolutely nothing that listening to hearts can tell me that I don’t already know from technology. I have no need to listen. So I don’t do it much anymore.”

I began to wonderI called my longtime friend and colleague, also a cardiologist. I knew him to be one of the best heart listeners. I asked him if he still listens to hearts. He answered, “Of course I do. I could not practice medicine if I didn’t. But you know every week, several patients tell me when I listen to their hearts that I am the first doctor ever to do that. Can you imagine that?”

Playing the devil’s advocate, I challenged my friend to tell me what he learned from listening to hearts.

He answered, “How could anyone not want to hear those murmurs, sometimes ever so soft, like whispers? Murmurs from the heart, even very faint ones, are trying to tell us significant things. Some sounds are very localized, even hidden or obscured by layers of air. And then there is the rhythm and the beat and the cadence that you cannot hear on the paper strip of the EKG. Also, careful listening is the only way to appreciate the rubs of friction if there are any. The devices are important, but the heart has its own spoken and unspoken language if you know how to listen.

My cardiologist friend continued, “I don’t know how to say it. But something real important happens between me and the patient when I listen. Over a long period of time, I can get to know each heart and its peculiar and individual sounds and rhythms. I do believe if you put a blindfold on me I could tell one heart from another.”

Then I really began to wonder. How many of us no longer listen to hearts? How many hearts go unheard each day? 

And the really big question: what becomes of the unheard heart?

 

 

 

 

 

 

 

 

 

2 thoughts on “Unheard Hearts – A Metaphor, by Clifton K. Meador

  1. I would submit that the physical touch is more important for the patient.( I have many times examined a patient who told me that I was the first to touch him)
    Cardiac auscultation usually is cursory and fulfills the shamanistic role. To evaluate for some problems requires standing and having the patient bend forward. A pcp in our old neighborhood diagnosed idiopathic suaortic stenosis in a young fit boy about to attend a university on a swimming scholarship. Attention to proper auscultation can be valuable
    Topl, Eric in the recent text “The Creative Destruction of Medicine” discusses the V scan a miniature high resolution ultrasound. He indicates” it is one of the most significant advances in medical imaging in decades and is replacing the stethoscope…around since 1816.” p 124. I am sure other than keeping the ear of the chest the stethoscope moved physicians past the period of palpating for a thrill.
    I would contend that most generalists are not qualified to hear the soft sounds, rubs, and whispers his friend can.
    On the other hand a young internist listened tony chest thoroughly when i had some atypical chest pain and noted decreased breath sounds on pectorliloquy. First time I had seen it performed since an intern myself. So there are still young physicians who do physical exams.!

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