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December 3, 1997

Cardiac Auscultation Skills of Physicians in Training

JAMA. 1997;278(21):1739-1740. doi:10.1001/jama.1997.03550210037023

To the Editor.  —I read with sadness about the waning skills of cardiac auscultation among medical trainees as reported by Drs Mangione and Nieman.1 The stethoscope, one of medicine's bedrock diagnostic instruments, was invented nearly 180 years ago by Laënnec, who, because he was too shy to put his ear to the chest of a woman patient, rolled a piece of cardboard into a cylinder instead and was so astonished by the chest sounds he could hear that he soon published a book on his findings.2The use of a stethoscope is an art of medicine that is being lost amid growing reliance on laboratory tests and computerized imaging equipment. The instrument weighs less than a pound; does not need an electrical outlet, a cardiac catheter, or a video recorder; is not radioactive; has no adverse effects; and fits easily into a coat pocket. It is one of the most effective ways of detecting important medical problems or giving instantaneous assurance to patients with worrisome, yet insignificant, symptoms. The findings of Mangione and Nieman are particularly disturbing as the increase of managed care and ambulatory-based medicine shifts more responsibility for diagnosis and treatment of some diseases onto the shoulders of internists and primary care physicians.