Bare chest auscultation

My current GP listens over my shirt. Shirt is always off in play exams though.

Bare chested, never a good idea to auscultate over clothing, it can muffle the sound?

Next time you auscultate someone, try listening over clothing, then repeat on a bare chest. You'll be convinced how much clothing degrades what you hear.

@Pollux No experience, but I’ve read auscultation over light clothing attenuates 5-18 dB (that’s significant). Light to moderate pressure eliminates most of this, except at the higher frequencies. No idea what is lost in the evaluation, or how much or how consistent the pressure should be, but it seems pretty simple to loosen clothing and do it on bear skin, while respecting modesty.

My doc routinely listens to my lungs over my shirt without noticeable pressure. Guess she’s just looking for low freq rumbles. Listening to my heart over clothing gives her a pretty good indication that I’ve got one, probably nothing more! When in for surgery or a colonoscopy it’s always been on my skin.

@Rigel , when I learned physical diagnosis we were taught to use the bell of the stethoscope to focus on lower frequency heart and breath sounds. To best use the bell it should be touched very lightly against the skin. Most breath sounds (including rales and rhonchi) are lower frequency, along with heart sounds and murmurs. Just a few murmurs are higher frequency and best heard with a diaphragm. Bowel sounds and bruits are better heard with the diaphragm as well. You can approximate the improved ability to hear higher pitched sounds with the bell by pressing it firmly against the skin which, in effect, stretches the skin under the bell, in effect turning it into a diaphragm. Through clothing, i think you're correct--about all one can discern is rhythm.

I recently went to a cardiologist. I had to strip down to my underwear. I had my pulse and blood pressure taken. Then they listened to my heart and lungs. Then I had an EKG and an echocardiogram (ECG). Everything was done very.

Auscultation has to be always topless. I don't like the idea, the doctor listening ober clothing. If you don't have to take it off completely, at least it should be pulled up.

I can't tell you the last time that a doctor (in real life) has put a stethoscope on my bare skin. In fact, my last two visits - one was a sick visit and one was a physical - the doctor listened over a sweatshirt. Which I just can't believe. I tried to use a stethoscope to listen over a sweatshirt, and I couldn't hear a darn thing!

You are correct that you can’t really hear anything through a sweatshirt or heavy sweater! My opinion as a Respiratory Therapist is that it was just a “token” auscultation and just going through the motions just to make it “look good “. In the physician’s defense, they are now under extreme time management restraints by the supervisors that they don’t really have time for a true assessment!

At the last cardiology visit my wife and I underwent, the doctor had us completely uncover our chests, we were wearing only our underwear.

My shirt is always off for a play exam. For a regular exam, they either do it over my shirt or under it

For a play exam, I like to start fully clothed and be stethed over the shirt, then under. Next I'd lift the shirt so the doc can get better access. Eventually he will ask me to take the shirt off altogether. At my regular doctor, I have had a mix of experiences. He has gone over the shirt and also slipped under, but I prefer to wear a shirt with buttons now so I can undo the shirt and expose my chest. Most recently, he had me undo it all the way to palpate my abdomen, and eventually the shirt came off so he could examine my back. He even had me lay back with the shirt off and listened and palpated again. Hope to have this experience every time.

My doctor (male, early 60’s) will open up my gown and listen to my bare chest. When I see the NP however she listens over the gown.

AllyOTK, I wonder why the female is less intrusive? It is much quicker to listen over the clothes than take the time to listen to the bare skin! Heart sounds and breath sounds are diminished over clothing. What is your opinion?

From early memories to now the stethscope is placed directly on my bare skin; either top pulled up or removed depending on the situation and over years with various others in the family its been the same. Our doctor changed practice depending on gender of patient.