Topol on the Icons of Medicine: Time to Retire the Relics?


March 25, 2014

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This is Eric Topol, Medscape Editor-in-Chief. The topic at hand today is icons of medicine and how they may be changing.

The icon I like to harp on is the stethoscope, and that inclination has been reinforced recently by an editorial from a group at Mount Sinai saying, "Rest in peace, stethoscope."[1] In fact, at the Mount Sinai Medical School in New York City, as well as at the University of South Carolina, they are giving medical students the modern version of the stethoscope -- namely high-resolution hand-held ultrasound devices -- because the old stethoscope, which has been around for almost 200 years, is now considered a relic, at least by some.

A health system in Minnesota is training primary care physicians to perform a head-to-toe ultrasound exam and to not even use the old stethoscope -- which, by the way, was not really a stethoscope; it was a stethophone. It did not scope or look at anything. The use of ultrasound in this way is an interesting trend and perhaps what we will have as a new icon of medicine.

Another icon is the white coat. An interesting New York Times article[2] questioned whether white coats will be around much longer. There have been concerns that the white coat is a reservoir of bacteria and pathogens and may be making nosocomial infections worse. Moreover, it has always been something that created distance between the patient and physician -- part of the whole theme of medical paternalism.

Other suggestions are to wear white coats with short sleeves or to abandon white coats, similar to the recommendation that male physicians stop wearing ties because they also are a known potential carrier of pathogens.

We are in a time of medicine with a lot of turbulence, a lot of change, which leads us to question some of the most revered and time-honored icons, such as the stethoscope and the white coat. Whether they will ever completely go away remains to be seen, but they are at least certainly being challenged.

I believe that challenging prevailing dogma and ritual use of certain things is always a good thing. Thank you.


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