It’s Not Your Father’s Stethoscope

Those rubber and metal tubes are certainly iconic—that device that rests over the shoulders of clinicians.  It’s a badge of authority and honor that commonly identifies the physician before a word is even spoken. Sometimes, you may even be able to decipher the clinical subspecialty if you know enough about the nuances of stethoscopes. But the reality is that the stethoscope is one of the most fundamental and essential tools in the practice of medicine. It allows the user to enhance human capabilities and improve the ability to hear. 

It’s a tool by which we expand the human sensory experience, and very much like today’s sophisticated technology such as the transistor, night vision goggles, and even artificial intelligence and allowed us all to become even “more human.”

It might even be fair to say that the stethoscope was one of the first technologies available to the clinician.  But that technology has seen little change in over 200 years when it was first introduced by the French physician Rene Laennec in 1816.   But like many aspects of medicine, driven by technology, that’s about to change.

In a recent paper in Lancet, a clinical study gives us a look into the future of Laennec’s stethoscope and its utility as more than just a “sound amplifier” but a powerful tool that combines an ECG-enabled stethoscope examination and artificial intelligence to detect low cardiac function or heart failure. In the case of this trial, an ejection fraction under 40%.  The results indicated that, with some variation around device position, that detection was about 90%. The authors concluded:

“A deep learning system applied to single-lead ECGs acquired during a routine examination with an ECG-enabled stethoscope can detect LVEF of 40% or lower. These findings highlight the potential for inexpensive, non-invasive, workflow-adapted, point-of-care screening, for earlier diagnosis and prognostically beneficial treatment.”

The implications are significant—for clinical care and also the evolution of “technologically empowered” tools to enhance care.  And in addition, the direct contact of the device eliminates the need for ears and sounds transfer via air.  The cardiac sounds are digitized and recorded to establish a reproduceable and visual tracing of what used to be those subtle sounds “lub dub”.

It’s actually a classic technological transformation and follows the pattern of digitization that we’ve seen many. Our camera and even our phones were once clunky and hardly optimized for convenience and utility. But once these devices were digitized, they provided a disruptive transformation in the marketplace. Digitization was followed by dematerialization and demonetization. And after that, democratization emerged.

Today, we see almost everyone with smart phones in their pockets and the application of these technologies to life are seemingly endless and transformative in expected and unexpected ways. That similar dynamic is beginning to happen with the stethoscope. It’s been two hundred years and very little has changed with respect to the underlying mechanism. But today the stethoscope is a tool that is enhanced by technology to provide powerful insights for diagnosis and care. But here’s something that is very interesting and rather unusual.

While the stethoscope was generally the domain of the physician, we now see an interesting shift where consumers make use of this tool to enhance their own care. The domain of the stethoscope may expand to include patients and caregivers and provide a simple and accessible tool to evaluate cardiac function in the comfort and convenience of your home.  It’s these new tools that help expand the role of home care and even telemedicine as the path from digitization to democratization becomes a powerful reality.

Here’s the very good news.  The technology isn’t just an idea or abstract prototype. The stethoscope of tomorrow is available today.  EKO Health, the study sponsor, has a range of tools that expands clinical awareness and leverages technology to improved care. 

Rene Laennec would be proud.