In my experience, the distance between us and the patient’s bedside has been widening. This is a result not only because of the electronic medical record but also regulatory changes, hospital operational pressures and technologic advances. In today’s paradigm, why should we spend time listening with a stethoscope when we can simply order an echocardiogram?

This was the subject of our recent medical Grand Rounds. The lecture celebrated the 200th anniversary of the stethoscope, a great opportunity to explain why it’s more important than ever to build outstanding clinical skills. During the rounds, Ed Kasper, a master clinician and director of clinical cardiology, took a patient history and then examined the patient so that all watching could learn.

On the large screen, we observed what he saw as he examined the patient’s neck veins. We listened to what he heard as he used a digital stethoscope to auscultate the heart. The audience discussed their impressions and made a diagnosis based on the bedside history and exam.

We then watched as Mary Corretti, medical director of the adult echocardiography lab, interpreted images from an echocardiogram that was performed live in front of the audience. She confirmed the diagnosis already made by exam of pulmonary stenosis. Importantly, it was clear that the echo alone, without the history and exam, would have overestimated the severity of the condition and led to the wrong treatment. 

Instantly, the foundational nature of bedside skills and how technology can supplement—but never replace—clinical skills became apparent to all.

To build these skills into our program, last July, we launched a service dedicated to clinical expertise. Every morning, a seasoned clinician takes the team to the bedside for a 30-minute session to teach a communication or physical examination skill. Brian Garibaldi, curriculum director of the service, showed at our Grand Rounds how this experience has objectively improved our interns’ skills. We are excited to build on these efforts that continue to bring us all back to the bedside.

Sanjay Desai, Director
Osler Medical Residency Training Program