We had a patient on the unit with a murmur last week.
"I want you guys all to go listen to his murmur," our attending told us on rounds. "Then tomorrow, we'll talk about it and decide what kind of murmur he has."

This patient had already had a transthroacic echocardiogram showing a narrowing of the aortic valve. But, we all dutifully listened anyway - our prior knowledge of what the patient had helping us to form a meaningful story about the faint swishing sounds we were hearing over his chest. It's probably a better characterization of what we were actually doing to say that, rather than listening to his heart, we were placing our stethoscopes on the patient's chest and recalling what aortic stenosis is supposed to sound like.

We are greeted by critical care attending the next day. "So what did you hear?"

"I heard a crecendo-decrecendo murmur that was loudest over the right, second intercostal space, radiating towards the neck." If my response sounded as if I was quoting the textbook, it was because I was.

"Can you draw it for me?" I copied the diagram illustrating aortic stenosis from my physical exam text. We talked for several more minutes about the subtle findings one can use to assess the severity of disease in someone's aortic valve using only a stethoscope. It was an underwhelming discussion.

When there is a much more sophisticated method of assessing someone's heart valves that is relatively cheap and easy, why do we continue to care what we find using the stethoscope? I'm beginning to wonder why I still carry the damn thing around my neck all day! Why would you bother trying to move a 15 ton pile of dirt with a shovel when you have a bulldozer readily available? Today, there are very few clinical decisions that it is still appropriate to make based solely on what you find using a stethoscope. There are a few conditions for which it continues to be of some use in making diagnoses - asthma, pneumonia or congestive heart failure, for example. But, please don't ask me draw a diagram of someone's heart murmur. I can't imagine any responsible surgeon making the decision to replace a heart valve based on my pencil markings.