Monday, October 26, 2009

them's fighting words

Auscultation, once thought to be the exclusive province of the physician, is now more important in surgery than it is in medicine. Radiologic examinations, including cardiac catheterization, have relegated auscultation of the heart and lungs to the status of preliminary scanning procedures in medicine. In surgery, however, auscultation of the abdomen and peripheral vessels has become absolutely essential.

The above is from Current Diagnosis and Treatment: Surgery.

Once upon a time, the lovely folks at PagingDr and I had a polite debate about the usefulness of auscultation in the context of how expensive a stethoscope should be purchased.  I still think that auscultation of the heart as part of the daily examination is not particularly useful - the likelihood of developing an abnormality that can be picked up on auscultation is minimal - but I do not believe that auscultation of the lungs is a preliminary scanning procedure;  it is essential in the early diagnosis of fluid overload and pulmonary oedema, much more than the chest radiograph or any other investigation.

Being a ward resident/intern is quite different between medical and surgical teams.  On my medical rotations, I would politely stand and scribe while the registrar examined and dictated.  I would rarely if ever lay hands on the patient;  the ED resident or registrar did the initial examination, and the ward registrar did the daily examination.  On a surgical firm, the ED resident would often not bother documenting a cardiorespiratory exam, and the surgical registrars were never interested in what someone's chest sounded like, front or back.  After the "wave" round at 7am, I would go back between 8-9 and have a listen to the chests (back only).  I would suggest that new interns on surgical teams get into the habit of doing this, and documenting it every day.

I used to listen to the front, but I never picked up a thing.  This may just be a reflection of my (lack of) cardiac auscultation skills.

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