Amazing Devices 4

“I’ve seen it, Curmudge. I’ve seen how your reading and writing about amazing devices has awakened the long-dormant scientist in you.”

"You’re right, Jaded Julie. As they say, ‘If you don’t use it, you lose it,’ and I’ve lost it. A whole new world of communication technology has passed me by. Those devices in Dr. Topol’s video that we saw last week went by pretty fast, so I decided to mosey through the literature and learn more about them. Before our readers have these things strapped onto their chest or put in their shoe, they are likely to encounter them in their doctor’s office; so let’s focus on that venue.“

“Can we begin with the humble stethoscope that we mentioned on August 5? I’ve continued to be amazed that it has remained virtually unchanged for almost 200 years.”

“Most of those you see around necks or in pockets are the old kind, but with the advent of the electronic stethoscope (Littmann 3200), the changes are dramatic. It looks similar to the classic design, except on the back of the chestpiece there is a handle and LCD display through which the features of the device are controlled. Variable sound amplification can adjust for the clinician’s hearing acuity or the patient’s obesity. Onboard recording can be played back through the eartubes.”

“Even with your hearing problem, Curmudge, you could use one of these.”

“Sure, although it would require medical education for me to understand what I was listening to. But Julie, there’s a lot more to these things than amplification. Bluetooth technology can be used to wirelessly transfer sounds to your computer for further analysis. This requires a USB wireless adapter inserted into the PC on which proprietary software has been installed. The software allows one to visualize what has been heard in a wave file format, save it in the patient’s record, or send it via the Internet across the world for further consultation.”

“Gosh Curmudge, with that perhaps I could be a cardiologist in my spare time.”

“That would indeed be a stretch, Julie. Let’s start our next topic with a trivia quiz. What is an ER doc’s first question to himself when he sees a patient with no visible trauma?”

“I’ve got it, Curmudge. He looks at the patient and asks, ‘What’s going on in there?’ Then he attempts to find out with history and physical, lab tests, and an armamentarium (see, I remember the word) of increasingly complex tests and procedures.”

“Great answer! However, one powerful procedure is noninvasive and fairly easy to perform, but it requires a trained eye to interpret. It is ultrasound, and it’s what we’re going to talk about next.”

“Hey, Curmudge, one of those tests was done on me several years ago in the ultrasound lab. I looked at the readout, and I appeared to be a confusing mass of angry storm clouds inside.”

“As I said, Julie, a trained eye is needed. A notable innovation is that now we have handheld ultrasound units that can be carried in one’s pocket (1). When not being used on a patient, the scanner (viewer) and probe sit on a docking station connected with a USB cable to a PC. Handheld ultrasound is being promoted for use by cardiologists, obstetricians, primary care physicians, in the ER, and probably everywhere a physician is asking himself, ’What’s going on in there?’ They might become as ubiquitous as the stethoscope.”

“(Ubiquitous? I’ll know what he means when I see them everywhere.) Okay, Wizened Wizard, give me an idea of some of the things that can be diagnosed by ultrasound.”

“With the handheld ultrasound and electronic stethoscope, a cardiologist might be able to avoid ordering a traditional and expensive echocardiogram. In a primary care physician’s office or an Emergency Department, an abdominal ultrasound might reveal an abdominal aortic aneurysm, gallstones, hydronephrosis, kidney stones… An ultrasound of the leg should be the easiest way to detect a blood clot (deep vein thrombosis). These ailments are not uncommon. Each has afflicted one or another of my acquaintances.”

“That, Curmudge, is because your contemporaries are so old. Aside from that, however, the beauty of these in-the-office diagnostic tools is that they can enhance the physician’s communication with the patient. The hand-held ultrasound can provide visual reinforcement of exam findings in real time. The patient can leave the office or the ED with a diagnosis and plan of care—not a schedule of additional tests. So, senior savant, although it should be obvious, what do you see as the lesson for today?”

“Lesson #1 is obvious, Jaded Julie. Advances in technology continue to make the practice of medicine more efficient and effective. However, unless these devices are used in an efficient environment, their effectiveness will not be fully realized. That’s Lesson #2. Here are some examples: an MRI machine that is used only five days per week, a Da Vinci robot on which few surgeons are trained, the report of a CT scan that is misplaced on its way back to the ordering physician.”

“I think what you are saying is that a hospital or clinic needs to have a Lean culture in order to get the most out of its technology.”

“You’ve got that right, Julie.”

Affinity’s Kaizen Curmudgeon

(1) Another handheld ultrasound system is the ACUSON P10.