Occasionally, while teaching a large class, I ask nurses and students to raise their hands if they see staff nurses wearing stethoscopes around their necks or actively using them to assess heart and lung sounds. Very few hands would go up, accompanied by a knowing chuckle that they’re maybe guilty of an assessment sin by omission. For the past two decades, clinicians have noted the decline of the auscultatory element of physical exam—less use of the stethoscope. This trend persists despite the advent of technologically advanced models equipped with Bluetooth connectivity and AI-assisted murmur detection.
René Laennec, a French physician, invented the stethoscope in 1816. He created it—a simple wooden tube—because he needed a noninvasive way to listen to a patient’s chest without direct contact, which was considered improper at the time. Over the years, the stethoscope evolved into the modern, flexible rubber tubing design seen today.
What murmur?
A 2001 study published in the American Journal of Medicine assessed the cardiac auscultation skills of 314 internal medicine residents from Canada, the United Kingdom, and the United States. Participants listened to 12 prerecorded cardiac sounds and completed a multiple-choice questionnaire. The results revealed consistently low proficiency, with mean identification scores of 22% for U.S. residents, 26% for Canadians, and 20% for their British counterparts. This raises the question: How would bedside nurses and nurse practitioners perform in comparison?
One of the most anxiety-inducing experiences for prelicensure nursing students is demonstrating manual blood pressure measurement and performing a textbook head-to-toe assessment for evaluation, only to rarely or almost never use these skills in clinical practice as staff nurses. This is just one example of the persistent disconnect between nursing education and real-world practice.
Until the 1950s, tasks such as conducting physical exams, performing 12-lead ECGs, taking vital signs, drawing blood, and administering injections were exclusively performed by physicians. However, shifts in healthcare dynamics—including advancements in medical knowledge and technology, workforce demands, physician shortages, and the professional evolution of nursing—led to the delegation of these responsibilities to nurses. As job roles continued to evolve, various tasks that nurses inherited from physicians were bequeathed to unlicensed assistive personnel. No wonder, nurses and physicians are rarely observed using René Laennec’s invention, at the expense of the patient’s overall experience satisfaction.
“Clear to auscultation” and other lies
If clinicians don’t carry a stethoscope, how can they accurately document that a patient’s lung sounds are “clear to auscultation”? Years ago, an assistant nurse manager in the ICU where I worked jokingly remarked that many clinicians will surely end up in hell for the “epic” lies in their documentation—such as charting “AM care done” when it was actually completed after lunch. In clinical practice, white lies are frequent parts of patient interactions, whether it’s assuring a patient, “You look great” despite visible signs of illness or asking, “May I help you?” while internally dreading the next task. Hyperbole aside, I believe nurses and doctors practice with integrity. When they document “WNL” in their notes, they genuinely mean “within normal limits” to the best of their knowledge—not “we never looked.”
What you’ll hear when you truly listen
The stethoscope and physical exam are fast becoming arcane curiosities in the art of medical diagnosis. Their disappearance speaks to another loss in healthcare—the art of listening. I once read that if you listen to your patients long enough, they’ll tell you the diagnosis.
In fast-paced clinical settings, clinicians rely on real-time diagnostic imaging over traditional auscultation. The pulse oximeter has largely replaced the stethoscope in informing the nurse’s clinical decision. By the same token, the clinician’s ability to recognize heart rhythm irregularity continues to wane because almost no one feels for the patient’s pulse, even for 15 seconds! As the stethoscope gathers dust, the real loss isn’t just the occasional missed diagnosis; it’s the missed opportunity to spend time with the patient—heart to heart.
Years ago, as a clinical instructor, I asked a patient with aortic stenosis if my students could listen to her heart murmur. She kindly agreed. One by one, the students placed the bell of their stethoscopes over the aortic area, intent on hearing the distinct murmur. They listened carefully, but they didn’t truly see the patient. No one introduced themselves or placed a reassuring hand on her shoulder while listening to her heart. Only a couple made brief eye contact. One student muttered “awesome” to no one in particular.
After everyone had taken their turn, I asked the patient if she’d like to listen to her own heart. Her face lit up. “I would love to! I’ve never heard my own heartbeat.” I gently guided the earpieces into her ears and let her listen to my heart first. “What do you hear?” I asked. With a smile, she mimicked the rhythm: “ba-bum, ba-bum.” Then, I placed the bell of the stethoscope over her second intercostal space at the right sternal border as she leaned forward. “Now, what do you hear?” I asked. With puckered lips, she murmured back, “Whoosh-whoosh, whoosh-whoosh.”
Twenty minutes later, the students and I were still gathered at the bedside. What had begun as a clinical demonstration had transformed into something far more meaningful—a shared moment of connection. We were no longer listening through our stethoscopes but with our full attention, as the patient opened up about her life, sharing personal stories that had nothing to do with heart sounds yet everything to do with the human experience.
I can only hope that clinicians will continue to wear and use their stethoscopes—not just as a tool of the trade, but as a symbol. A reminder that medicine isn’t just about diagnosis and treatment, but about presence, about truly seeing and hearing those in our care. Let it be an amulet, not just against clinical ennui, but against forgetting the simple, powerful act of human connection
Fidelindo Lim, DNP, CCRN, FAAN is a Clinical Associate Professor at New York University Meyers College of Nursing
