Tag Archives: Echocardiography

Listen More

My first posting on this blog explained why I chose to name it “Auscultation.”  I wrote that I wanted to promote a conversation, and that listening was essential to doing so. I went on to write: “With an obvious nod to my being a cardiologist, I believe auscultation has long been an act that defines us as physicians and connects us in a profound way with our patients. The act of leaning in, touching the patient, listening, concentrating, and interpreting is a powerful metaphor for the entire clinical encounter: getting close to the patient and listening.”

It is therefore no wonder that I was really pleased to read “The Physical Examination and the Fifth Maneuver” by Thomas Metkus in a recent issue of the Journal of the American College of Cardiology. The piece appeared in the “fellows in training and early career page” in the Journal, which regularly features articles by trainees about their experiences, and was a mature and robust defense of the importance of developing auscultatory skills. Metkus alludes to Osler’s model of physical diagnosis, the first four maneuvers of which are inspection, percussion, palpation and auscultation. The fifth – and arguably most important – is cognition, the intellectual exercise of putting it all together.

Continue reading Listen More

More on Prices

I have been thinking more about the price of health care services. I have already shared some thoughts about this, but this time I have a more personal story to tell.

I recently had an echocardiogram. I would score the indication as “uncertain” (not clearly appropriate or inappropriate) according to professional guidelines.  As a cardiologist myself, however, I would have ordered one in similar circumstances without hesitation. So I did not think the test itself was a problem — until I got the bill. Continue reading More on Prices