Sick Stethoscopes Modified and Debugged

To the Editor.— The letter by Drs Orton and Stryker1reveals a sickness that goes beyond the stethoscope to involve our daily work, ie, the failure to perform an adequate physical examination in the proper sequential order (inspection, palpation, percussion, and auscultation). You will notice that the examiner first performed pulmonary auscultation (I am sure he did not mean cardiac auscultation as written) and based on erroneous information provided by the faulty stethoscope immediately ordered a chest roentgenogram. Only when the laboratory data did not match the auscultatory findings was a more complete examination conducted, revealing costochondral tenderness (palpation), equal resonance (percussion), and bilateral breath sounds (auscultation). Had all this been done initially, it is likely that there would have been no confusion, even with a faulty stethoscope. It is regrettable that the good habit of an orderly physical examination is becoming increasingly rare in this age of hasty