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Sick Stethoscopes Modified and Debugged-Reply

Dale Orton, MD; Robert Stryker, MD
JAMA. 1987;257(10):1332. doi:10.1001/jama.1987.03390100069024.
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In Reply.—  Of course, pulmonary auscultation rather than cardiac auscultation is what we intended, and we thank Dr Ciferri for spotting this error. A pertinent history and a proper physical examination are still the clinician's best tools for diagnosis, and we continue to stress this to our students and residents. However, even in today's environment of cost containment and gatekeeper theory, a 38-year-old man who complains of fairly rapid onset of pleuritic chest pain deserves a chest roentgenogram and an electrocardiogram in an emergency department setting, even if the results of the cardiopulmonary examination are normal. We agree that the proper sequential order of examining the cardiopulmonary systems is preferred; however, this is not always feasible. We wonder if, perhaps in haste, Dr Ciferri has ever laid a stethoscope on a patient's chest before inspecting, palpating, and percussing it.We have heard from other clinicians who have had problems with


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