Do women usually get less thorough cardiac stething?

All of the women with whom I have played doctor have commented on how thorough I am in listening to their hearts, moreso than their real doctors. One friend told me that, at her annual physical (which lasted about five minutes), the doctor only listened about a minute, listened through her clothes, only listened on her upper chest above her breasts (pulmonary and aortic), and only used the diaphragm side of the chestpiece. When I listen to my patient's heart, I always listen with her topless so as to use the stethoscope on bare skin. I listen all around her heart with first the bell and then the diaphragm and take in all the listening points--aortic, pulmonic, Erb's, inch the steth down the left sternal border from Erb's to tricuspid, lift the left breast, then inch the steth over from the tricuspid to the apex/mitral. I do this first with my patient upright, then repeat it with her lying on her back, then have her roll over onto her left side and listen at the mitral again in that position. My patients tell me that I listen longer to each valve than their real doctors do to their entire hearts, and that I spend more time listening to their hearts than the real doctors spend on the entire exam.

So, what is the experience of the women here? Do you think that female patients get less thorough cardiac stething than male patients? How thoroughly does your doctor steth your heart on a routine exam when you don't have any heart-related symptoms?

Does the doctor listen through clothing/gown or on bare skin? Does the doctor only listen on your upper chest, or does he/she listen down between your breasts and under your left breast?

I agree. My cardiovascular and pulmonary exams don't last nearly as long as I'd like them to. The fetish aside, I think that doctors should be thorough. The sad truth I think is that you can fit in more patients in a day if you cut the exam short. Kind of infuriating but there you are.

This seems to be the case with most women I've talked to. In our wonderful litigious society of today, it seems like doctors err on the side of caution for fear of lawsuits as opposed to doing what is right and thorough for the patient sometimes. If I am in a professional situation with a female patient, and need to become invasive, and/or look or feel or listen somewhere of a "private" nature, I always have a female staff member present as well. I would rather still do what is right and proper for the patient, while at the same time playing a good old fashioned game of "CYA"

Dear Steth,

that's my experience, too. I spend a lot of time stething my playdoc patients. Stething naked chest. Some of my "patients" said, why didn't you become a doctor? You do the exam so carefully and thoroughly, I'ver never experienced that with a real doctor...

(btw: the same goes for gyn exams!)

Well first of all as I say, education is key and one of the most important things I do. Two things that most people seem to over look is that one of the leading causes of death in women is heart disease, and men can and do in fact get breast cancer, and unfortunately for them it's usually discovered late and ends up being a death sentence.

A couple of key points that need to be addressed here is that there are only certain things that can be detected through a scope, and it doesn't take a genious to be able to hear a heart problem. During a regular physical listening to a heart is at best a minute long procedure and really doesn't need to be longer. If a problem is detected, then yes, a longer listen is needed. If what you are hearing is normal, any longer is a waste of both the patients and doctors time. A trained professional knows where to place the scope on the chest to get an accurate listen to all four valves as the blood flows in and out of the respected chambers. A defective valve, a murmmer are both things that are clearly audible, most other heart things require blood work or other tests.

Medicine has come a long way, and while I don't always agree with how some things are handled, others I completely agree with. I do believe at a physical a patient should have every inch of skin examined by sight, and while this doesn't mean a patient has to stand or lay totally naked at one time, all parts need to be given a good looking over. That is just good medicine. However 90 percent of diagnosing is in the history. History taking is a fine art but initially it falls on the patient to be up front and honest with their doctors in the first place.

Back in the day it was commonly thought that when you went to the doctor a full set of vitals and what not was needed, but again this has proven to be a huge waste of time, and not at all needed. Vitals bring almost nothing to the diagnosis process unless a vital sign is related to a diagnosis and or medication. For example, a temp. What does that tell us? Most real medical professionals can tell by looking at you whether or not you have a temp. If it's low grade, we leave it alone, it's your body fighting off an infection. If it's high then it's high and we will treat it accordingly. But if it's 101 or 105 doesn't matter, we are going to treat it the same.

Again yes I understand that some things are needed, but many these days are not. When our patients dictate how we treat them because they think they know their bodies better than we do, or they think they know what's best for them, or they have a degree in Web MD and think they know medicine better than the professionals, then we run into problems like we face today. Most of us don't want to be rushed when treating and caring for our patients, but fact is doctors, especially family practice doctors have been forced to schedule one patient every 5 or 10 minutes so they can make enough money to pay their bills. Most people have the notion that doctors are rich, and maybe they were before our patients were allowed to dictate how we practice medicine, but with the cost of med school, malpractice insurance, office staff, license renewal, board certifications and on and on, more and more doctors are filing chapter 7, 13, or closing their doors.

So remember that the next time you are feeling slighted during an exam. Just sayin.

Mashie

Let me throw my two cents in here. Four years ago during a routine gyn exam, my wife was told she had a murmur. She follwed up as told six months later with her personal physician who only listened briefly and through her clothes. She was then sent for an echo and was given a clean bill of health from a cardiologist that read the echo. On New Year's Day of this year, she had a massive MI which took her life at the young age of 58. No signs, no symptoms and the absolute picture of health. In the state of her passing, at least three causes of death needs to be documented on the death certificate. The cardiologist that treated her listed Coronary Artery Disease, as the main cause of death in addition to sclerosis and a plaque rupture. Heart disease takes years to develop. If she had been healthy four years ago (as idicated by tests and the expert reading by the cardiologist) why did it take her life so suddenly? I rest my case.

Omegaman,

First let me say, I'm very sorry for your loss.

Coronary artery disease and plaque formation doesn't cause murmurs, and isn't something that can be picked up listening with a stethoscope. When a murmur is detected, they look for valve disease, w hich shows up on a color flow echo.

Generally, things like cholesterol levels can give some idea of risk, but even that won't predict a heart attack.

Some of us seriously wish we could predict a heart attack by listening with a scope.

I too am sorry for your loss. Any life cut short at the young age of 58 is very sad.

Unfortunately as Old has stated MI's are not cut and dry and can't always be predicted, nor prevented. The body for the most part is still a huge mystery to science. Even to us medical professionals it still amazes us how and why in this day and age limbs still need to be amputated, babies are still still born, and MI's happen with little or no advance warning. We are working as fast as possible though to find the genes, find the answers and find the cures for what ails us.

I can't even begin to tell you how many people I know who are no longer alive because of heart disease. They too seemed healthy. It is a silent killer you know. Let me ask you this. Was she getting a complete physical every year? Did she continue to see the cardio yearly? She should have been doing both. Was she on any cholosterol meds? Was she getting blood work once or twice a year? She should have been. Was she proactive in her care? She should have been. Was she exercising 3 times a week and eating a healthy diet, drinking pleanty of water? She should have been. What about her family history? Anyone else in her family die of the same? If she was doing everything she should have, taking the meds she should have been taking, and taking care of herself as well as she should have, and yet she still expired anyway, then there really wasn't anything anyone could have done to prevent it. Sometimes our bodies just wear out and all the love and all the medical intervention/prevention can't stop it. No one is to blame, it just happens.

Education is key in a situation like this, also an ounce of prevention is worth a pound of cure.

Mashie

Again, I am sorry for your loss.

Thank-you for the compassion. Please note that she was 58 rather than 68. And yes, she was very proactive in her health care. She was on no lipid meds as levels were always very low and her HDL levels were always very high. I know that a murmur does not indicate heart disease, but do know that she was on one of the leading birth control meds for menopause symptoms (one that is under a lot of scrutiny).

My point is, all combined in a completely healthy female, and the issues caused by her prscribed medication, the follow-up to her minor cardiac issues should have been followed in more detail. I am a paramedic and have attended to literally hundreds of MI patients. It is truly a shock when it is your own loved one.

I am not looking to blame, rather I am hoping to spread the word about women and heart disease and totally support the AHA "Go Red for Women". True, medicine is a science. We throw what we think we know at it and hope for the best. This is the second time I have been widowed; the first time a loss to lung cancer.

I am thrilled by your stance towards women and heart disease. As I have said to a few others here who have been in your position, thank you for helping to educate others. While it will not change or bring back the woman that you loved, it may help others to keep the loved ones they already have.

I pray for the day when our bodies can be better understood, more easily fixed, and suffering and loss miminimized. You are exactly right, medicine is a science and we are all different. That's why no medication works for everyone, no one persons treatment will always be like anothers. We do have to take what we know, throw what we think is best at it, and pray for the most favorable outcome.

So use what you know as fact, teach others, educate others. Take your loses and use them in a positive way so that others behind you may benefit and not have to suffer. The generation before us helped ease our journey, our generation will help the next generation in the same way, and so forth and so on. Pay it foreward.

Mashie

Thanks for the support Mashie.

I can say that women in india are not getting through heart and lung exam.they will not go regularly for their check ups as they are

shy of going to their doctors.so the doctors have to make surethat they are checked thoroughly when they go.how the doctors can listen to their breathing while they are wearing a pallu,inside that there is a blouse,and under it they wear their bra.so when doctor uses stethoscope frontally it is very tough for them to hear anything.it will be much easier for the doctors if they sit in their bra so that the doctor can listen clearly to their breathing.the doctors here should makea rule for women to undress to her bra for the stethoscope exam.the embarassment for women as their breast rise and fall

during their stethoscope exam will not last for long.soon they will know that it isdone for their sake

In australia i find this as well, i havent had my heart listened to by a doctor since i was little, even though i have had many surgeries since then

Cherrypie, that seems unusual that you've had many surgeries but haven't had your heart listened to. The anesthesiologist should have listened to your heart and lungs before putting you to sleep--the anesthesiologist needs to be aware of any heart or respiratory problems going in to surgery so he doesn't get any surprises.

If he did do was when I was already asleep

I've heared that men are more likely to get a heart disease, I'm not sure if it's true.

I would agree with this, when speaking about GPs. In internal medicine, cardiology i would same the exam becomes very thorough.

In modern America (where I have experience), modesty trumps medical necessity outside the emergency room. Men are commonly asked to remove a shirt, women are given a gown and there's reluctance to ask them to remove a bra. All these things take time and time is money.

If the doctor has to work around clothing and foundation garments, they CAN'T do as complete an exam.

I 've always thought women recieved through cardiac exams. I remember growing up I would hear my moms friends talking about getting examined by doctors

One of her friends said every time she went to the doctor She always was received a through stethoscope exam . She was undressed to the waist. Her Bp was checked. She had too lie on her back . Raise her left breast etc. She was also encouraged to quit smoking.

I can't remember a time since I was a kid where I had a thorough stethoscope exam from a real doctor. My regular doctor only listens above my breasts, with my clothes still on. Never listens to mitral or tricuspid. Even when he referred me to a cardiologist because I'd been having frequent PVCs, the cardiologist only listened to pulmonary and aortic, despite having me put in a hideous paper gown. It's a little bit ridiculous. I know I'm young, so there's not a huge risk of me developing heart disease, but there are things like mitral valve prolapse that are decently common even in young people. I swear the cardiologist spent more time listening to my lungs than to my heart.

This is a very interesting but difficult question to answer.

However as women are less like to develop heart disease before the menopause may well be a factor in this topic. Women in the age group of 20-50 are shown to have much less susceptibility to Coronary Heart Disease (CHD) and other atherosclerotic diseases as compared to men. The exact cause of which is not precisely known and estrogen is constantly shown to be associated with this phenomenon. Improvement of serum HDL concentration and improvement of endothelial functions are some of the proposed mechanisms through which estrogen is believed to mediate this effect. These cholesterol-losing effects of estrogen enable women to enjoy freedom from CHD during their reproductive age, as compared to men of comparable age group. However this risk increases substantially postmenopauel.

So I would suspect that with women due to the low or significant reduce risk may at times get a less thorough exam but in my experience I can't say for sure as I have seen both. In all fairness I think its the Doctor's attention to detail that is the key/crucial factor in determining the thoroughness of the exam. In addition there are issues concern with modesty and nudity that come into the equation.

What I have notice is that the GP's, and other specialties are are allocating less and less time for a consultation and exam for both males and females due to time constraints. It is this trend that is worrying to day the least, as I am concerned that they may miss something or misdiagnose something due to their time constraints.