Vital Times 2017 - 55

ENGINEERING AND TECHNOLOGY

Point of Care Ultrasound:
The Next Physical
Exam Tool
By	Davinder	Ramsingh,	MD

P

erhaps the most important aspect of a physician's role
is our diagnostic capabilities. If we cannot identify
and diagnose a patient's pathology, with reasonable
accuracy, we cannot effectively treat them and may even
cause greater harm.
Let's go back in time to 1816 and imagine that we are
physicians evaluating a patient with shortness of breath.
The common practice of the time was direct auscultation
by placement of the practitioner's ear on the patient's
chest. At the time, many criticized this technique as
providing little insight in the patient's condition as well
being out of normal social standards.
That year, French physician, Dr. Rene Laennec, invented
the stethoscope, which dramatically improved the clarity
of the auscultation exam. He spent the remainder of
his career correlating how the stethoscope could detect
various chest pathologies, and educating the others
on the utility of this technology on improving bedside
assessment. The accumulation of his works resides in his
text De l'Auscultation M├ędiate, which is one of the most
widely translated medical texts in history.
Now, just over 200 years later, it is incredible to think that
this technology has not been disrupted, especially when
you compare the advances mankind has made in other
areas. We have gone from the horse and carriage to cars
that can practically drive themselves; from the notepad
to the iPad, and can now communicate anywhere on the
globe irrespective of language or distance.

In healthcare as well, we have drastically altered our
ability to monitor and treat our patients.
Yet despite all our technologic advances, the stethoscope
remains the primary tool used at the bedside for the
physical exam. This is despite of the widely known
inaccuracies produced by the stethoscope guided
physical exam. For example, studies have demonstrated
dismal results regarding the ability of the stethoscope to
detect common cardiac events, with a reported accuracy
of 20 to 40 percent.1,2 Even among cardiologists the
accuracy of the stethoscope is poor.3
Acceptance of this concept is key for us to innovate. One
simply needs to ask themselves: How do you tell the
difference between rhonchi or rales? What section of the
lung did you hear diminished breath sounds? Or, where
is that heart murmur emitted from and what pathology
does it represent to realize the severe limitations of the
stethoscope?
Moreover, when you compare the scrutiny that we
require all modern medical monitors to achieve for their
accuracy (no one would use a pulse oximeter that had
only a 40 percent accuracy rate), why do we not seek
a similar level of accuracy when we discuss the tools
we use for our physical exam? Fortunately, technologic
advances have recently allowed for new technology to be
evaluated as an adjunct for our physical exam - point of
care ultrasound (POCUS).
(continued)

Annual	Publication	2017	|	 	55



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