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Imaging? Try What’s Around Your Neck First

March 12, 2012
Written by: , Filed in: Cardiac Imaging, Diagnostic Imaging
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Michael Criley, MD, concedes that cardiac imaging has its uses, but he prefers the diagnostic tool that still hangs from the neck of just about every physician: the stethoscope.

Plain old cardiac auscultation can reveal a lot about a heart, says Dr. Criley. He asserted in an interview, as reported by HealthImaging:

If you are not thinking ahead and are just saying, ‘I think I hear a murmur; maybe I should get an echo,’ that is a very wimpy way to go about it.

Dr. Criley, professor emeritus of medicine and radiological sciences at UCLA’s David Geffen School of Medicine, is world-renowned for his contributions to cardiology and to the education of physicians in physical examination. He bemoans what he sees as a decline in auscultation training among all physicians, including cardiologists.

He has participated in studies documenting the decline. Most recently, he was senior author of a study of cardiologists’ cardiac examination (CE) skills that appeared in Clinical Cardiology (published online in December 2010).

The conclusion: “Cardiac examination test scores appear to diminish with more recently trained faculty, raising the troublesome prospect that CE skills in medicine will continue to decline as the older generation of master clinicians retires and is replaced by more poorly trained physicians.”

Bedside examination skills, Dr. Criley notes, are not tested on board exams for internal medicine and cardiology. “It’s not going to be on the test,” he said, “so why study it?”

Dr. Criley doesn’t dislike technology. He’s just passionate about the art of examining a patient and feels that it is “something that you should take some pleasure in learning.”

In his view, a skilled physician uses a physical examination as the primary diagnostic tool. “When two-dimensional echocardiography bcame available in the mid-1970s,” he said, “it could have, and should have, provided a noninvasive way of seeing what the heart chambers and valves were doing when extra sounds or murmurs were created, but instead replaced bedside auscultation.”

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Emergency department use of imaging varies widely by individual physician, with no age or gender pattern, finds a new study. For details, see our Facebook page.

Related seminar: Cardiovascular & Pulmonary Imaging

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