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 He told me that these devices tell him vastly more than listening to out-of-date sounds via a long rubber tube attached to his ear.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 wonder Continue reading

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The Lost Arts of Listening, Touching, Seeing . . . The Depersonalization of Medicine

As Clifton Meador’s observes in “Unheard Hearts,” these days most doctors rarely listen to a patient’s heart.

 “Physicians do carry stethoscopes and it certainly is a badge that shows they are a physician, but the sad thing is a large percentage of them don’t know how to use it and use it improperly when they do,” says Michael Criley, professor emeritus of medicine and radiological sciences and the University of California, Los Angeles’ David Geffen School of Medicine.

In a recent interview with Cardiovascular Business, Criley explains: “When two-dimensional echocardiography became available in the mid-1970s it could have, and should have, provided a noninvasive way of seeing what the heart chambers and valves were doing when extra sounds or murmurs were created, but instead replaced bedside auscultation [listening to the heart].

Reading what Criley had to say, and thinking about Meador’s piece, it struck me that this is all part of what some call “the depersonalization of medicine.”

By and large, 21st century doctors do not lay hands on their patients. As psychiatry resident Christine Montross pointed out in a New York Times op-ed: a few years ago:  ”Today’s doctors rarely do thorough physical exams.” Instead, they rely on “diagnostic tests and imaging studies.”

Meanwhile, in medical schools, Montross  reveals, “virtual gross anatomy” lets students avoid the “messy” business of dissecting a real body. “This is a mistake,” says Montross.

                                    Listening to the Heart                        

Criley’s theory that the stethoscope has become little more than a badge of honor is based on a study of physicians’ cardiac examinations.. . Criley was the lead author on a study that investigated these exams, published in the the December 2010 issue of Clinical Cardiology. Continue reading

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