Re: Commemorating 2 centuries since the death of the inventor of the stethoscope (2)

Thanks to Dr Amir Dolatabadi for the article “Commemorating 2 centuries since the death of the inventor of the stethoscope” [BCMJ 2026;68:93-95,109]. It was an interesting and informative description of René-Théophile-Hyacinthe Laennec’s life and times.

Over my long career as a physician, there have been changes in stethoscope technology and use. First, I was taught that, ideally, a stethoscope should be placed directly on the skin for the most accurate assessment of heart and lung sounds. While listening through thin clothing is possible—especially if the examiner applies firm pressure to negate sound attenuation—it can introduce artifacts and hide subtle, crucial sounds, reducing diagnostic quality. However, it appears that standard practice is now to place a stethoscope over one or sometimes two layers of clothing and to pronounce with confidence: “Your chest is clear.” Single or double layers of light clothing can attenuate sound by 5 to 18 decibels.

Second, in 2000, Dr David Littmann introduced the electronic stethoscope. Electronic stethoscopes are generally considered better for detecting subtle sounds like soft murmurs due to superior amplification and active noise cancellation, especially in loud environments. They offer higher diagnostic accuracy and are advantageous for clinicians with hearing loss, for telehealth, and when assessing obese patients. As an emergency physician, I found an electronic stethoscope very useful in my often noisy surroundings.

I have two questions: (1) Why are doctors not applying stethoscopes to bare skin to maximize diagnostic accuracy? (2) Why are doctors not using electronic stethoscopes for better auditory performance, when so many of them are aging and their personal acoustic apparatus is failing?

Better use of the simple tools of clinical examination might reduce the spiraling costs of unnecessary imaging, speed up patient throughput, and reduce health care costs.
—Murray Trusler, MD, MBA, FCFP, FRRMS
Peachland

This letter was submitted in response to “Commemorating 2 centuries since the death of the inventor of the stethoscope.”