Electronic Stethoscope Oddities
Thursday, January 01, 2009
Joshua Schwimmer, MD, FACP, FASN
Happy New Year!
If acoustic stethoscopes — the kind physicians have used for over two hundred years — are the equivalent of typewriters, then electronic stethoscopes are like word processors. Okay, this analogy is non-intuitive, but hear me out. Electronic stethoscopes, like word processors, are newer, more expensive than the previous generation, and are — well — electronic, with all the advantages and disadvantages this implies.
The advantages to electronic stethoscopes are many. As I've written previously in my review of the Littman Electronic Stethoscope Model 3000, it's simply easier to hear heart and lung sounds with an electronic stethoscope than it is with an acoustic stethoscope. (For real-world examples of this, see the previous review.) Plus, some models, like the Littmann 4100 Electronic Stethoscope, allow you to record and playback — think copy and paste — heart and lung sounds for reference or teaching.
But anything electronic is prone to failure, and when electronic stethoscopes fail, they fail spectacularly. Don't misunderstand: I'm a fan of my Littman Model 3000, but it's worth pointing out the oddities you should expect if you decide to purchase one of these things. (Some of these observations are taken from my postings on Twitter.)
First — and this might sound obvious — the electronic stethoscope requires batteries. Eventually, these batteries will die. Unexpectedly. At exactly the wrong moment. Almost certainly, when you're examining a patient. At this time, your electronic stethoscope will make a sad little noise, then — silence. An eerie silence. And unless you're walking around with an extra AA battery in your pocket — which you will suddenly realize is probably a good idea — you will then say, apologetically, "I'm sorry. The battery in my electronic stethoscope just died."
Second, if you carry around an iPhone or a BlackBerry, you will experience intermittently the faint faraway static of your mobile device as you're listening to the heart of a patient. And while this doesn't interfere with your physical exam, it's unnerving.
Finally, if you were planning to place another type of diaphgram on your electronic stethoscope — such as the excellent SafeSeal stethoscope covers by DRG — don't. It will cause unbelievable amounts of feedback. As I learned recently, placing incompatible diaphragms on electronic stethoscopes makes your patients' hearts sound like they're being played by Jimi Hendrix.
If acoustic stethoscopes — the kind physicians have used for over two hundred years — are the equivalent of typewriters, then electronic stethoscopes are like word processors. Okay, this analogy is non-intuitive, but hear me out. Electronic stethoscopes, like word processors, are newer, more expensive than the previous generation, and are — well — electronic, with all the advantages and disadvantages this implies.
The advantages to electronic stethoscopes are many. As I've written previously in my review of the Littman Electronic Stethoscope Model 3000, it's simply easier to hear heart and lung sounds with an electronic stethoscope than it is with an acoustic stethoscope. (For real-world examples of this, see the previous review.) Plus, some models, like the Littmann 4100 Electronic Stethoscope, allow you to record and playback — think copy and paste — heart and lung sounds for reference or teaching.
But anything electronic is prone to failure, and when electronic stethoscopes fail, they fail spectacularly. Don't misunderstand: I'm a fan of my Littman Model 3000, but it's worth pointing out the oddities you should expect if you decide to purchase one of these things. (Some of these observations are taken from my postings on Twitter.)
First — and this might sound obvious — the electronic stethoscope requires batteries. Eventually, these batteries will die. Unexpectedly. At exactly the wrong moment. Almost certainly, when you're examining a patient. At this time, your electronic stethoscope will make a sad little noise, then — silence. An eerie silence. And unless you're walking around with an extra AA battery in your pocket — which you will suddenly realize is probably a good idea — you will then say, apologetically, "I'm sorry. The battery in my electronic stethoscope just died."
Second, if you carry around an iPhone or a BlackBerry, you will experience intermittently the faint faraway static of your mobile device as you're listening to the heart of a patient. And while this doesn't interfere with your physical exam, it's unnerving.
Finally, if you were planning to place another type of diaphgram on your electronic stethoscope — such as the excellent SafeSeal stethoscope covers by DRG — don't. It will cause unbelievable amounts of feedback. As I learned recently, placing incompatible diaphragms on electronic stethoscopes makes your patients' hearts sound like they're being played by Jimi Hendrix.
5 Comments:
At Fri Apr 03, 07:42:00 AM 2009,
Wayne said…
The question I have is why the electronic stethoscope looks exactly like its acoustic ancestor? In the day of Bluetooth connectivity why do we have a tube containing wires to in ear speakers pulling us closer than necessary to the patient and requiring additional hardware to share observations? When will someone design a multifunction sensor (stethoscope, pulse oximeter, possible other functions) that connects wirelessly to a display/headset? I am the only one waiting for this?
At Tue May 19, 02:11:00 AM 2009,
Jessica said…
To Wayne:
While I'm no expert in electronics and wireless gadgets, my guess would be an increase in interference or changes in the sound quality. The basic idea is seen in the acoustic stethoscopes with longer tubing. While they make it easier to work around large patients (such as a vet working on a obese and woolly pony) the quality of the sound perceived it decreased. Even with our modern gadgets (believe me I live attached to my ipod) a recorded sound is never the same quality as the original sound, and even more of the subtle details are lost each time a sound is transmitted (think of the sound difference from the radio vs. your mp3 player or a live concert). Also, if they are already picking up stray signals from personal electronic devices, can you imagine the world of sounds you'd get with a wireless headset? I agree with you that it would be exceptionally useful to have such a wireless device, especially for those of us with patients that weigh over 1,000 pounds and can send you flying over a fence with a flick of one leg, if it could be proven to produce the same quality of sound.
At Wed May 20, 07:51:00 AM 2009,
Wayne said…
Jessica-
We already have electronic stethoscopes that deal with the concerns you raised using ambient noise suppression, selective amplification, and other technologies to make them superior to the old acoustic models. The ability to record what is heard, share the information with others, and even analyze the signals is available. Rather than losing information, the data is actually enhanced.
The issue I am trying to get people to think about (and perhaps find someone with more knowledge and time than I possess) and consider re-designing the electronic scope using wireless tech, starting with a blank page instead of trying to emulate the old acoustic design.
Wayne
At Thu May 21, 03:43:00 AM 2009,
Jessica said…
Wayne-
The interference I was referring to wasn't from ambient sounds within the environment but rather from and with other electronic equipment. A wireless signal transmitted within an environment filled with electronic machines and undoubtedly a blackberry or two could encounter interference with signal transmission OR could disrupt the function of the electronic equipment. While I realize this may not be a highly likely event, the potential risks associated with it would have to be carefully considered before introducing such a product to a hospital environment. There already are limits on the use of personal electronic devices, particularly those with wireless capabilities, aboard airplanes for this exact reason.
I agree with you that it would be most convenient for both patient and doctor to be able to simply place an electronic sensor on the patient's chest and have the sound sent to a wireless device such as an ear piece (it would certainly make my job safer) but they may be having trouble designing one that would be 100% safe within a hospital.
Jessica
At Sat Jun 20, 01:17:00 AM 2009,
Anonymous said…
Wayne, I absolutely agree. Electronic stethoscopes are rediculous, like some steampunk fetish for modern technology in the shell of outdated forms. Even if it can't be wireless, why can't 3M make an iPhone attachment microphone / software so I can see a wave form of what I'm hearing, record, slow down... and listen through eShure earbuds or noise canceling Bose headphones instead of painful, hard stethoscope earpieces? If the stethoscope microphone attachment could do a pulse ox reading and calculate the heart rate for me, I'd pay three to four hundred dollars out of my pocket for that.
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