What Exactly Is Your Doctor Listening For?
Why physicians move that stethoscope around your chest and belly, what your body sounds like, and what can be learned from a simple listen.
PCOM primary-care physician Dr. Bidey examines a patient during a routine pediatric visit. / Photograph courtesy of PCOM
“Take a deep breath for me, please.” As patients, we’re used to hearing this request as a primary care physician presses a stethoscope’s cold metal disk to skin.
Newer to the exam room scene? Hearing a doctor say, aloud, “lungs clear to auscultation” or “regular rate and rhythm” — increasingly for the artificial-intelligence note-taking systems that record and transcribe medical appointments. Suddenly, patients are overhearing technical descriptions of their own bodies and wondering: What does that mean? More to the point: What exactly is the doctor hearing?
The seemingly simple stethoscope has been around for about 200 years, but it’s still a mystery to most patients. (The origin story: A male physician in Paris was reluctant to place his ear directly on a young woman’s chest for a routine exam, so he rolled a piece of paper into a tube and could still hear her heart and lungs just fine.) The diagnostic tool may be ubiquitous, but most patients don’t understand how a doctor distinguishes a bodily gurgle from a whoosh — or what those sounds can reveal. That listening part of the exam is interactive, too. As patients, we get to do something, to breathe in, hold, exhale. We’re participating.
“I like the stethoscope because it’s an extension of myself, a connection to the patient,” says Peter Bidey, a primary care physician and Philadelphia College of Osteopathic Medicine’s chief academic officer. “I’m putting something in my ears that connects to my brain that connects me directly to you. It has that physician-patient relationship built into it.”
The medical student’s first tool
Bidey trains students on how to use a stethoscope in their first year of medical school:
A “higher-pitched murmur” during a heart check could signal a valve that’s narrower than typical and a potential for heart failure. The reason for the short hops around your chest with the stethoscope? To listen to each of the four heart valves. Atrial fibrillation, which new research shows is three times more common than once thought, leads to a heart beating very fast and irregularly.
Crackling in the lungs, often called “rales,” can mean pneumonia or congestive heart failure. “I’ve always equated rales to Velcro ripped apart, or Rice Krispies in a bowl of milk,” Bidey says.
A stethoscope pressed to the abdomen lets a doctor hear bowel sounds — which, ideally, are “somewhat rhythmic and sporadic, but following a pattern, not too fast and not too slow.” No bowel sounds at all would be “concerning.”
Atypical sounds usually mean the stethoscope is just the first step on the way to other tests such as an ultrasound or electrocardiogram (EKG).
“Those are amazing, advanced technologies, but you might not have one in your office,” Bidey says. “This is my chance to do my exam and say, ‘I’m actually worried about this, let’s take the next step.’ A hundred years ago, this was all doctors had.”
The next evolution
Technology is coming for the stethoscope, too. Digital versions can record. A recent study found that an AI-enabled digital stethoscope was better at detecting valvular heart disease than the standard physician listen. The potential is significant: Researchers in the United Kingdom are studying whether such a tool can reduce emergency hospitalizations and healthcare costs related to cardiovascular disease.
But Bidey says stethoscope training is still important: “How do you check something if you don’t understand it? As physicians, we should incorporate these technologies to better evaluate and treat our patients. But you need that balance. This is a tool. If you don’t understand how to use your tools, how to confirm what they’re telling you, then you’re not using them to their fullest potential.”
And if during your next appointment, your doctor says something to the invisible note-taker in the room that leaves you puzzled? In the true spirit of the stethoscope, Bidey says it’s all about listening.
“If we use a term you don’t recognize, ask us,” Bidey says. “That kind of exchange allows us to be better at our jobs and hopefully connect more with our patients. We need to make sure you understand what we’re saying, and that we understand what you’re saying. That benefits everybody.”
This primary-care health series is made possible by a generous donation from PCOM.
