Stop auscultating and listen carefully instead: the new era of respiratory medicine

Editor – I still vividly remember the first second that I got my hands on my first-ever shiny stethoscope back in medical school. That day, I recall auscultating tirelessly every single patient in the premises – respiratory or not! It was that art and skill combined that drew me into respiratory medicine in the first place.

Fast-forward to 20 years later, I'm sitting in my office after finishing another ward round on the COVID-19 ward, during which (once again) I did not auscultate at all. My stethoscope has been left in the drawer since the first ‘peak’ of the pandemic, no longer decorating my neck, losing even the last of its recent uses; indicating who in the hospital premises knows how to auscultate a chest properly (hopefully). Furthermore, after completing >350 virtual consultations, so far, for outpatient respiratory follow-ups and new referrals, I still haven't used it. The lack of direct patient contact has bothered me the most, as this magic skill and art of auscultation rapidly fades away, like the bronze finish on my stethoscope, unused, still in the drawer, banned by the coronavirus.

However, all is not lost. We still have our ears, even without our trusted ‘tubing and bell’ attached to them, which, for a respiratory consultant, has been a ‘mandatory artificial appendage’ for so many years. I now rely on listening carefully to what my patients tell me about their symptoms and concerns, concentrating more on their needs, rather than on my own former need to auscultate before offering my pearls of wisdom. It has not hindered any of my investigations or treatment plans, and none of the patients so far has expressed any concerns about the ‘lack of auscultation’; however, you can find plenty of complaints around NHS trusts about ‘lack of listening’.

I am not sure when (or if) I will actually use my stethoscope again, as for the rest of my clinical encounters, I rely on real-time imaging (ultrasound) as well. I don't know if the pandemic will signal the end of the stethoscope, however, I certainly hope it will signal a new beginning, with a new breed of doctors who listen, even though they don't have a stethoscope around their necks. This is, and always have been, the fundamental art of medicine itself. I guess this is one of the things I've relearned during the pandemic.