Heart Murmurs

When you get to a certain age, you begin to sometimes wonder what it will be like to need medical treatment for a serious disease. You may wonder even more if you are a member of the medical profession yourself. Reading that “the stethoscope is in the midst of a debate with respect to its utility in healthcare”[1] did not exactly put my troubled mind at ease.

Only a few days before, I had listened to the story of a lithe, well-trained vegetarian who had suffered two angiocardiographies within 3 months, the second one surprisingly showing no progress of the nonexistent coronary heart disease documented by the first. His symptoms? Three syncopes.

A brief application of a hopefully MRSA-free stethoscope to the muscular chest of this patient would have revealed a loud systolic murmur, pronounced at the second intercostal space on the right. I leave it to you to come to a diagnosis. Suffice it to say, hardly a week after aortic valve replacement, he reported a marked improvement upon exertion, climbing the stairs of the hospital to his fifth-floor ward.

It is a sobering experience when patients keep telling you that “you are the first doctor who listened to my heart” upon admittance to undergo cardiac surgery. This is also very sad because what can give you a more intimate patient contact than a physical examination? This closeness is something the patients crave but the doctor does not get paid for. According to the German reimbursement system for private (!) patients (GOÄ, Zif. 7), the COMPLETE physical examination of AT LEAST one organ system comprises for the organs of the chest: auscultation AND percussion (remember that?) of heart AND lungs AND measuring the blood pressure. For this chest-all-inclusive, a princely amount of €9.33 is granted. Under special circumstances requiring such exotic settings like the necessity of examining even more than one organ system, this can be increased by a factor of 2.3 or (exceptionally) 3.5, harvesting the impressive sums of €21.45 or €32.64. These excesses must be well-founded in writing. After an average day in the office, this does easily enable the physician to finally order a new Porsche Panamera. After all, the old one shows signs of wear after 2 years, and the taillights look so much better now.

With so much substantiated motivation, it should be simple to keep teaching our medical students, and thus the people who are likely to treat us in the future, the art and fun and plain logic (!) of auscultation and percussion. It is rather banal to state that “this century has seen the introduction of much more advanced diagnostic tools and ultrasound imaging.”[1] One can only hope that the human being handling them is still a doctor, not a technician.

• Reference

• 1 The Death of the Stethoscope? Heart Doctors Have Their Say. https://healthmanagement.org/c/cardio/post/the-death-of-the-stethoscope-heart-doctors-have-their-say . Accessed July 4, 2018