Monday, May 2, 2011

After Reading Chapter 7: The Heart of the Matter


How do doctors learn the proper use of the stethoscope to hear cardiac heart sounds? Why is this the “tip of the iceberg?” Would you prefer a “diagnostic test” over a “physical exam” for determining whether or not you had some form of heart disease?

26 comments:

  1. doctor learn proper use from practice on real patients, from listening to audio recordings and by making mistakes. this is the tip of the iceberg of the physical exam because it is the most apparent part of the exam and also possibly the most revealing. i would definitely prefer a physical exam first because it could catch some simply problem that isn't a big problem. while an diagnostic test could also catch it the tests costs thousands of dollars so why take one when its not necessary. Diagnostic tests should be a last result or used for verification before a delicate procedure or possibly dangerous medication is prescribed.

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  2. Doctors learn how to hear cardiac heart sounds by practicing on real patients and getting helpful critiques from experienced doctors, not just by reading from a textbook. This is the "tip of the iceberg" because it is the most recognizable, most well-known part of the exam to both patients and doctors alike, and although it may seem simple, it can be the key to revealing a variety of problems. I think I would prefer a physical exam at first, but if my symptoms persisted/I didn't seem to be getting any better, I would go take a diagnostic test.

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  3. It seems as though most doctors learn the proper use of the stethoscope simply by trial and error. Dr. Sanders' personal experience with Susan (the mitral stenosis patient) is an example of the trial and error learning process. However, there are programs that are working on methods to teach medical students how to look for and identify the abnormal sounds a heart may make. By familiarizing students with these abnormal sounds, many will successfully use what they've learned during everyday physical exams.
    It is the "tip of the iceberg" of the physical exam because it is the most revealing part of the exam. It is revealing in many ways; it reveal health issues about the patient, and it reveals the skill of a well-trained physician. The stethoscope seems to represent the physical examination and the role of the doctor.
    I too, think that I would prefer to start off with a physical exam (especially now that I know doctors are being trained more thoroughly for this type of exam than they were before), but if symptoms arise that my doctor cannot properly diagnose, I would be more than willing to pay for the diagnostic tests.

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  4. Doctors learn the proper use of the stethoscope to hear cardiac heart sounds by practicing on real life patients (primarily) and listening to audio recordings. They also learn over time through experience and mistakes. This is "the tip of the iceberg" of the physical exam because it is the most obvious part of the exam and can give the most information (most revealing, such as by revealing health issues and the skill of the physician). I agree with Sormeh and would prefer a physical exam to begin, but if symptoms showed up that my doctors wouldn't diagnose properly, then I would be down for a diagnostic test. Sormeh also mentions how doctors are becoming better trained at physical exams, so that's comforting.

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  5. Doctors learn how to use a stethoscope properly by practicing on patients and learning from their mistakes. Doctors also use audio recordings to help them learn how to recognize cardiac heart sounds. This is only the "tip of the iceberg" because it is the simplest and most revealing part of the exam and can prompt doctors in the right direction.
    I think I would prefer a physical exam first, because with a skilled doctor, this can lead to a quicker diagnosis. However, if symptoms persisted, I think I'd want a diagnostic test to ensure everything turned out alright.

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  6. As others have answered, doctors learn to use a stethoscope by listening to recordings of heart sounds, pracicing on patients, and learning from their mistakes. Also as others have written, a doctor's listening to a patient's heart with a stethoscope is the "tip of the iceberg" of the physical exam because it is the most apparent part of the exam.
    Physical exam or diagnostic test? First, I would want the doctor to listen to my heart with a stethoscope. He/She would do this anyway during a routine physical exam. If there was a possibility that I had some sort of heartproblem, however, I would want a test in addition. The doctors who are BEST at interpreting heart sounds are right 70-90% of the time. These doctors are heart specialists. Primary care physicians would not be as good as these specialists at listening to and interpreting heart sounds. Echocardiograms, on the other hand, are very reliable (correct 95-100% of the time). Additionally, they are noninvasive and do not have any associated risks. (They use soundwaves, not harmful radiation.) I would much rather have this test, which is neither painful nor dangerous, than be misdiagnosed.

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  7. Doctors learn to use a stethoscope two different ways: through experience with patients and from recordings. In the book, the example on the patient was of a woman named susan. With Susan, Dr. Sanders was unable to figure out what was wrong with her as she was still learning how to process the noises the stethoscope produced. The audio recordings were another method in which students learned, and this method has no consequences. However, it seems that it may not be super realistic (or dr. sanders just got a lot better with the stethoscope as i believe the audio was after Susan). The tip of the iceberg is a reference to the use of a stethoscope to listen to hearts as it is the most widely known part of the physical exam by both patients and doctors. I would probably want a physical exam first and a diagnostic test as a backup.

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  8. Doctors learn to use their stethoscopes by listening to patients' hearts and by listening to recordings of what they should hear through stethoscopes. Using the stethoscopes requires a lot of practice, so doctors continually learn new sounds.
    Use of the stethoscope is the "tip of the iceberg" because the stethoscope is a good indicator of how physicians are practicing the physical exam, and it is emblematic of medicine as a whole since it is such a visible symbol of the doctor's diagnostic abilities.
    After reading about how bad modern doctors supposedly have gotten at the physical exam, I would rather have a diagnostic test because diagnostic tests seem much more foolproof. I would not want to have undiagnosed heart problems because an incompetent physician forgot some sound learned decades ago in medical school.

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  9. Doctors learn how to use a stethoscope by first practicing on real patients, and then listening to audio recordings of different heart problems, then being tested on identifying these problems. This is referred to as the "tip of the iceberg" because it is the most revealing part of the physical exam, but also only the beginning of the possible examinations that may be necessary. I would want a physical exam first simply because of the cost of a diagnostic test, especially if there may not be anything wrong. However, once a hypothesis is made from the physical exam I would definitely want a diagnostic test to confirm it.

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  10. Doctors learn to use a stethoscope through real life practice on patients. Making mistakes, and gaining experience from them is simply the best teacher. Doctors also practice by listening to audio recordings. The recognition of the heart sound is only the "tip of the iceberg" because it is the most basic of steps in the process. I would much rather have a diagnostic test than a physical exam just because a diagnostic test is much more reassuring and safe. If I had a serious heart problem, I would not want to risk it going undiagnosed because the doctor accidentally missed the sound.

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  11. Ingrid Adamson-SmithMay 8, 2011 at 10:24 PM

    It seems like doctors learn how to use a stethoscope simply by trial and error, and by using their knowledge about a patient to infer what the problem with their heart might be. This is the "tip of the iceberg" because the knowledge carries great potential to transmit information about a patient when it is used properly.
    While I am not at risk for heart disease, I have had some recent problems with my heart that led me to get an EKG, an ECG, and a slew of tests. Having had all of those tests done, I found myself less reassured that I had hoped, as the tests themselves did not tell the doctors much. While it seems like diagnostic testing is an incredibly valuable tool, I think it is important not to hail it as the ultimate diagnostic tool.

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  12. Abigail SessionsMay 9, 2011 at 9:27 AM

    Doctors learn how to use a stethoscope and recognize abnormal heart sounds both with real patients and with audio recordings. It's a trial and error method that helps them learn to pick up the abnormalities. Its the tip of the iceberg because it has the power to reveal crucial information about a patients health if used correctly, and is also a very basic test that all doctors should be comfortable with.
    I would want a physical exam first, and then a diagnostic test if the physical exam was inconclusive. Might as well do a physical exam first since it's cheaper and easier, and could be just as effective in coming to a diagnosis.

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  13. Emma Vinella-BrusherMay 9, 2011 at 11:02 AM

    Doctors learn the proper use of a stethoscope through not only practicing on real patients, but also listening to audio recordings and attempting to identify the irregular heartbeats. By practicing identifying various abnormalities of the heart, they can learn from their mistakes and be more prepared for when something bad comes along the next time.
    This is considered the "tip of the iceberg" of the physical exam because it hints at the essentiality of the exam, even as the physical exam is coming out of common practice.
    I think that I would want my doctor to start out by giving me a physical exam as a way to catch any initial obvious abnormalities, but I would also want a diagnostic exam to ensure that any heart problems I have are caught. While the diagnostic exam is definitely more expensive and more of a hassle than the physical exam, it's often necessary for catching disease before any obvious signs have shown up and it's become too late to reverse the damage.

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  14. Doctors learn proper technique and the way to use the stethoscope most effectively through examining patients. But they can also learn through listening to audio recordings and examining the sounds they hear.
    This is considered the tip of the iceberg because this demonstrates the need for the physical exam and how it is slowly being phased out of common practice.
    I would want my doctor to give me a physical exam rather than a diagnostic test if it was just another check-up. A diagnostic test would be preferred if I were worried about my cardiac health. Since the machines are still slightly more effective than the cardiologists at catching murmurs and abnormalities in the heart, I'd prefer a machine for catching possible problems in my health.

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  15. It seems that the cardio exam in the considered the "tip of the iceberg" because it the most familiar part of the exam to patients and the most basic skill that doctors need to learn for a physical exam. Doctors learn to give this exam through textbooks, audio files, and most importantly trial and error. Doctors primarily gain this skill through a practical application on patients: with advise of their teachers, doctors learn how to differentiate between sick and healthy hearts by trying their ear on actual patients.
    Personally, I would not conclusively trust a doctor's physical exam findings because it is evident that most doctors are severely lacking in this skill set. Although diagnostic tests are expensive and arduous, if my heart is on the line they're what I would trust.

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  16. Doctors learn to properly use the stethoscope primarily by examining patients and learning from mistakes. Additionally, doctors can use audio recordings to examine. Mangione describes the heart exam as the "tip of the iceberg" because he believes it's the most apparent indicator of a successful physical exam. I would prefer a physical exam initially, assuming I had a physician who could successfully note any irregularities. However, if my condition persisted without diagnosis, then I would resort to a diagnostic test.

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  17. Doctors learn how to properly use the stethoscope to hear cardiac sounds by listening to real patient's hearts and listening to recordings of various heart sounds. They culminate what they have learned by listening to the heart, as well as the mistakes they have made in misidentifying sounds in the heart, and the advice of more experienced doctors to try to truly understand how to use the stethoscope. Examining the heart is the "tip of the iceberg" of the physical exam, because not only is it a simple and basic part of the physical exam, but also is symbolic for both the physician and the patient, and solidifies the doctor's role as "diagnostician and caregiver." Also, this simple exam can be extraordinarily revealing, and shed light on what's happening to the patient, if the physician knows what to look for. I think initially I would be fine with a physical exam of my heart. I realize this puts a lot of faith in the physician who could easily have been properly trained in preforming the heart exam, or not. I think if I head cardiac concerns, or symptoms for something that persisted, then I would definitely get a diagnostic test, but I feel that it's superfluous to get a diagnostic test when only getting a routine check-up.

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  18. Doctors learn to use the stethoscope both by listening to real patients and by listening to recordings to help them learn to diagnose by sound. In a trial-and-error method, they can learn to identify sounds using advise and previous mistakes. It is "tip of the iceburg" because it is so important, and it is so basic and such an important part for the patient to recognize that it was done (like when you go to the doctors office, people expect the stethoscope, and it helps with confidence in the doctor). I think i would trust a diagnostic test more than a doctor, but I would really want to have interaction with a doctor to help me interpret and to think about the diagnosis - so i guess i'd want both a doctor and a test.

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  19. If i was in the process of training to be a doctor, I would definitely want to listen to both audio recordings, and then real patients Not just healthy patients, but also sick ones too. having an experience physician guide me through this eye-opening procedure (the tip of the iceberg since it reveals so much even though it's so simply "out there"). Trial-and-error is the best method to learn how to diagnose because it can really help a person recognize certain signs IF they are paying attention.
    I would prefer to be checked by both. If the cost was twice as much, then so be it. A person's health shouldn't be taken lightly. Honestly though if I had to be given one, I wouldn't know which to take. They are both different and necessary for me to have that peace of mind. I think i might pay for the diagnosis test instead of the physical check up because it seems more thorough to me. I could get away with a physical any day; a diagnosis test would (hopefully) be more revealing if something was wrong with me.

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  20. In to learn proper use for a stethoscope, doctors go through many practice circumstances. Whether they are practicing through audio recordings or real humans. by listening to recordings, students have no consequences if they are unable to detect a fault in the cardiac fault sounds. This process is also more available for students to practice in their free time. Yet practicing with actual patients is necessary as well, so one learns how to use the stethoscope properly not just listen to the noises, such as how our dear friend practices with her patient, Susan. This section of the physical exam is known as the "tip of the iceberg" because it is the most apparent and like an iceberg, exposed part of the physical examination. If I had a problem, I would first consider receiving a simple physical examination, as it is cheaper and can be just as revealing as a diagnostic test. In a worst case scenario, or if symptoms of the thing I have endure, I would most likely go in for a diagnostic test if needed.

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  21. Doctors learn how to hear cardiac sounds through a stethoscope by practicing on patients. Through a process of trial and error on these real live test cases, the doctors learn how to recognize and identify different sounds. This is the “tip of the iceberg” because it is very obvious and very revealing in terms of showing health problems with the patient and the extent of the doctor’s knowledge. I would definitely prefer a physical exam because it is easier and could catch something quickly.

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  22. Doctors learn how to recognize different heart "murmurs" by listening to patients' hearts with a stethoscope. They learn through repetition that any noise aside from the usual "lub-dub" of the muscles contracting is a sign of heart disease. This part of the exam is the "tip of the iceberg" because it is a physical exam in its most raw form, and while a lot more goes into a successful physical, listening to the heart is the part that has come to define the exam. I would prefer a physical exam first over a diagnostic, as they tend to be cheaper, quicker, less invasive, and right about as often. However, diagnostic tests are definitely necessary as a second line should the diagnosis from the physical.

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  23. Doctors learn how to hear the proper cardiac sounds by using their stethoscope and practicing on real patients. Through this method, doctors learn to hear heart murmurs, sounds not usually heard in healthy hearts. In most cases, these murmurs are signs of cardiac problems. This type of exam is the so-called "tip-of-the-iceberg" because is a physical exam is one of its most basic forms, and like other physical exams, can be a crucial aspect of problematic diagnosis.
    I would prefer a physical exam over a diagnostic test. I'm more familiar with physical exams, as, like most people, I have gotten one in every check-up. To me, if you need diagnostic test then there is maybe something wrong with your healthy, and if I needed one, I'd probably fall into a state of anxiety.

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  24. Doctors learn the proper use of the stethoscope to hear cardiac hear sounds by two methods. They practice on real patients and listen to audio recordings to recognize practicing upon real patients. Trial and error is key to this learning process. Listening to the patient’s heart with a stethoscope is known as the “tip of the iceberg” because it is the most revealing and apparent part of the exam. It gives the physician the most information. I would prefer a physical exam to begin with if it were a regular check up. The regular check-ups are often more cheaper, quicker, and are quite accurate. If I was more worried about my cardiac health, then I would have a diagnostic test.

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  25. Mirabella El BazeMay 27, 2011 at 11:15 AM

    Doctors approach learning to use stethoscopes by listening to both real patient's heart beats and recordings of examples of different sounds. The book says that after making mistakes in identifying distinct heart sounds, they are able to combine everything they have learned in addition to advice from repeatable, experienced doctors. The book claims that examining the heart with a stethoscope is the "tip of the iceberg" for the physical exam not only because it is often times crucial to a doctor's understanding of a patient's condition, but also to build the bond between doctor and patient. I think that I would like a physical exam, since many times it can lead to a diagnosis. However, if my symptoms persist or worsen, a diagnostic test could be helpful.

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