E4 eZ ee the washington post.tuesday, november 12 , 2019
BY LINDSEY TANNER
Two centuries after its inven-
tion, the stethoscope — the very
symbol of the medical profession
— is facing an uncertain progno-
sis.
It is threatened by handheld
devices that are also pressed
against the chest but rely on ultra-
sound technology, artificial intel-
ligence and smartphone apps in-
stead of doctors’ ears to help de-
tect leaks, murmurs, abnormal
rhythms and other problems in
the heart, lungs and elsewhere.
Some of these instruments can
yield images of the beating heart
or create electrocardiogram
graphs.
Eric Topol, a world-renowned
cardiologist, considers the stetho-
scope obsolete, nothing more
than a pair of “rubber tubes.”
It “was okay for 200 years,” To-
pol said. But “we need to go be-
yond t hat. We c an do better.”
In a long-standing tradition,
nearly every U.S. medical school
presents incoming students with
a white coat and stethoscope to
launch their careers. It’s more
than symbolic — stethoscope
skills are still taught, and profi-
ciency is required for doctors to
get their l icenses.
over the past decade, however,
the tech industry has downsized
ultrasound scanners into devices
resembling TV r emotes. It h as also
created digital stethoscopes that
can be paired with smartphones
to create moving pictures and
readouts.
Proponents say these devices
are nearly as easy to use as stetho-
scopes and allow doctors to watch
the body in motion and actually
see things such as leaky valves.
“There’s no reason you would lis-
ten to sounds when you can see
everything,” Topol said.
At many medical schools, it’s
the newer devices that really get
students’ h earts pumping.
“Wow!” “Whoa!” “This is awe-
some,” Indiana University medi-
cal students exclaimed in a recent
class as they learned how to use a
handheld ultrasound device on a
classmate, watching images of his
lub-dubbing heart on a tablet
screen.
The Butterfly iQ device, madeby Guilford, Conn.-based Butter-
fly Network, went on the market
last year. An update will include
artificial i ntelligence to help users
position the probe and interpret
the images.
Students at the Indianapolis-
based medical school, one of the
nation’s largest, learn stethoscope
skills but a lso get training in hand-
held ultrasound in a program
launched there last year by Paul
Wallach, an executive associate
dean. He created a similar pro-
gram five years ago at t he medical
College of Georgia and predicts
that within the next decade, hand-
held ultrasound devices will be-
come part of the routine physical
exam, just like the r eflex hammer.
The devices advance “our abili-
ty to take peek [a] under the skin
into the body,” he said. But Wal-
lach a dded that, unlike s ome of his
colleagues, he isn’t ready to de-
clare the stethoscope dead. He
envisions the next generation of
physicians wearing “a stetho-
scope around the neck and an
ultrasound in the pocket.”
modern-day stethoscopes bear
little resemblance to the first
stethoscope, invented in the early
1800s by frenchman rené Laen-
nec, but they work essentially the
same way.Laennec’s creation was a hol-
low tube of wood, almost a foot
long, that made it easier to hear
heart and l ung sounds t han press-
ing an ear against the chest. rub-
ber tubes, earpieces and the often
cold metal attachment that is
placed against the chest came lat-
er, helping to amplify the sounds.
When the stethoscope is
pressed against the body, sound
waves make the diaphragm — the
flat metal disc part of the device —
and the bell-shaped underside vi-
brate. That channels the sound
waves up through the tubes to the
ears. Conventional stethoscopes
typically cost under $200, com-
pared with at l east a few thousand
dollars for some of the high-tech
devices.
But picking up and interpret-
ing body sounds is subjective and
requires a sensitive ear — and a
trained one.
With medical advances and
competing devices over the past
few decades, “the old stethoscope
is kind of falling on hard times in
terms of rigorous training,” said
James Thomas, a cardiologist at
Northwestern medicine in Chica-
go. “Some recent studies have
shown that graduates in internal
medicine and emergency medi-
cine may miss as many of half ofmurmurs using a stethoscope.”
Northwestern is involved in
testing new technology created by
Eko, a Berkeley, Calif.-based mak-
er of smart stethoscopes. To im-
prove detection of heart mur-
murs, Eko is developing AI algo-
rithms for its devices, using re-
cordings of thousands of
heartbeats. The devices produce a
screen message telling the doctor
whether t he heart sounds are nor-
mal or if murmurs a re present.
Dennis Callinan, a retired Chi-
cago city employee with h eart dis-
ease, is among the study partici-
pants. At 70, he has had plenty of
stethoscope exams but said he
feels no nostalgia for t he devices.
“If they can get a better reading
using the new technology, great,”
Callinan said.
Chicago pediatrician Dave
Drelicharz has been in practice f or
just over a decade and knows the
allure of newer devices. But until
the price comes down, the old
stalwart “is still your best tool,”
Drelicharz said. once you learn to
use the stethoscope, he said, it
“becomes second nature.”
“During my work hours in my
office, if I don’t have it around my
shoulders,” he said, “it’s as though
I was feeling almost n aked.”
— A ssociated PressHigh-tech rivals pose a threat for the stethoscope
istockHarris & ewing/Library of congress/associated Press
A doctor examines a child with a stethoscope. Observers say new devices are nearly as easy to use as
stethoscopes and allow doctors to watch the body in motion and see ailments, such as leaky valves.question my ability to get
through them.
It is not uncommon for par-
ents to keep a serious diagnosis
such as cancer from their chil-
dren, says Evan Imber-Black,
director of the Center for fami-
lies and Health at the Ackerman
Institute in New York. “I think
parents often think that they
need to protect their children
from this knowledge, that it
would be too upsetting.”
Shame can also play a major
role in why a parent keeps their
illness a secret, as can fear of
facing t he reality o f the s ituation.
for instance, Vered DeLeeuw, a
recipes blogger from San fran-
cisco, believes her father kept his
Parkinson’s from his adult chil-
dren for four years because he
didn’t want to be pitied.
“We tried to respect his obvi-
ous wish not to talk about it,”
DeLeeuw says. “But it was in-
credibly stressful to know that
something was very wrong with
a loved one and not be able to
talk about it or try to offer
support.”
How different cultures view
illness is also a factor in family
secret-keeping.
Jeanny (who preferred not to
disclose her last name for privacy
reasons), a leadership consultant
from Sunnyvale, Calif., says,
based on her experience, it’s
normal in Asian cultures for
parents to keep a serious illness
hidden from their children. Even
though Jeanny was 35, her par-
ents refused to tell their only
daughter that her mother had
breast cancer until the disease
was in remission a year later.
“I felt angry, robbed, betrayed,
unloved, and abandoned,” Jean-
ny says. “Ironically, these were
the common feelings I had grow-
ing up in my traditional Asian
American family, in which emo-
tional displays, connection and
genuine love and care for family
members is not practiced.”
While parents may think
they’re protecting their children
from pain by k eeping them in the
dark, that can actually do more
harm than good — to everyone
involved. Columbia University
researchers studied the effects of
13,000 secrets and found keep-
ing them often led to preoccupa-
tion, decreased trust and re-
duced satisfaction with life.
“When you keep an illness
secret, that adds a layer of com-
plication and confusion for
[young] children,” Imber-Black
says. “Because children are very
good detectives, and they know
when something is being kept
from them.”
When younger kids t hink their
parents a re keeping a secret, they
often imagine the worst-case
s cenario — that a parent is dying
and there’s nothing they can do
about it. Even if that is the case,
not trusting children with the
truth b reeds f ear a nd resentment
rather than love and support,
which can, over time, perma-
secret from e1 nently taint a parent-child rela-
tionship.
musician and writer Adam
Cole’s mother hid her multiple
sclerosis from him for six years,
starting when he was only 12,
which left Cole making terrible
assumptions about her.
“I thought my mother had a
psychosomatic illness, that it was
all in her head, and this unneces-
sarily lowered my r egard f or her,”
says Cole.
Imber-Black says keeping an
illness a secret also isolates the
sick parent, creating a divide
between them and their family.
This was also seen in the results
from a tests performed at C olum-
bia University on secret-keepers
specifically. Such isolation can
lead to emotional and physical
fatigue because hiding some-
thing so significant takes effort.
There is, however, a way to
bridge that gap, and that starts
with the sick parent deciding to
have that first, tough conversa-
tion with their children.
That is easier said than done,
especially if you’re dealing with
preteens, who tend to blow
th ings out of proportion, and
young children, who may need
everything explained simply. It’s
even harder if sick parents have
been withholding t heir d iagnosis
for some time already.
That’s why Imber-Black rec-
ommends seeing a family thera-
pist who has experience working
with people with illnesses. She
has helped parents work up to
telling their kids by having them
role-play without the children
there. When there are two par-
ents, sometimes she’ll have the
sick parent play the child and the
healthy parent play the sick par-
ent to help change-up perspec-
tives. Afterward, they’ll dissect
how it went and make a plan for
the actual telling.
While revealing a diagnosis to
adult children comes with its
own set of challenges, when your
children are still young enough
to live at home, the diagnosis
may affect many aspects of their
day-to-day lives. That’s why Im-
ber-Black stresses that it
shouldn’t be thought of as a
one-time event.
“It’s a process,” she says. “It’s
never one telling. There needs to
be at least occasional conversa-
tions about what’s happening,
what’s the process, where are we
in the p rocess, and watching how
much a child can take in at a
given time. Then stopping and
taking it up another day.”
You want to be careful not to
overwhelm your kids by talking
about the illness too much. It is a
good thing for them to learn that
their parents aren’t invincible,
but it’s also important for them
not to get emotionally burned
out. “You want to help keep life
normal i n an abnormal situation.
[But] stay open to children’s
questions,” I mber-Black says.
finally, while it may feel
strange at first, letting your chil-
dren comfort you i s not only okay
but encouraged.
“Sometimes parents think
that should only go in one direc-
tion,” Imber-Black says. “No, It
should go in both directions.”
Keeping something as life-
changing as a serious illness
from your children can take a
major toll on you and your
family. Sharing it with them,
however, can only strengthen
your bond and help everyone
navigate the journey ahead.
[email protected]
Why hiding your
illness from your
kids is a bad idea
“I felt angry, robbed,
betrayed, unloved, and
abandoned.”
Jeanny, an adult whose parents
kept her in the dark about her
mother’s breast cancer until the
disease was in remissionImagine a
government
program that
would mobilize
volunteers to help
older a dults a cross
the n ation age in
place. one is on t he way.
The Administration for
Community L iving, part of t he
Department of Health and
Human S ervices, is taking steps
to establish a National Volunteer
Care Corps.
If it’s s uccessful, healthy
retirees and young adults w ould
take seniors to doctor
appointments, shop for groceries,
shovel snowy sidewalks, make a
bed o r mop the floor, or simply
visit a few times a week.
older adults would not only g et
a hand w ith h ousehold tasks but
also companionship and relief
from social isolation. And family
caregivers could get a break.
Younger volunteers m ight get
class credit a t a community
college o r small s tipends. older
volunteers could enjoy a
satisfying s ense of purpose.
The n eed is e normous, as the
ranks of t he oldest Americans —
age 85 a nd up, who tend to h ave
multiple chronic illnesses and
difficulty performing daily t asks
— are s et t o swell to 14.6 m illion
in 2040, u p from more than
6 million now.
Who w ill care for these
seniors? To day, m ore than
34 million unpaid family
caregivers shoulder t hat
responsibility, a long with
3.3 million paid personal care and
home health aides. ( medicare
does not pay for long-term care
services or nonmedical services in
the h ome.)
According to the B ureau of
Labor Statistics, more than
1.2 m illion new paid jobs o f this
kind will be n eeded by 2028. But
filling them will be hard, given
low p ay, difficult work conditions,
limited o pportunities f or
professional advancement a nd
high turnover.
This notion of a domestic Peace
Corps f or caregiving, i f you will,
has b een circulating since 2013,
when it surfaced in a Twitter chat
on e lder care. In 2 017 and 2 018,
bills i ntroduced in Congress
proposed a demonstration
project, unsuccessfully.
Now, f our organizations will
spearhead the C are Corps project:
the o asis Institute, which runs
the n ation’s largest v olunteer
intergenerational tutoring
program; the C aregiver A ction
Network; t he National
Association of A rea Agencies o nAging; and the Altarum Institute,
which works to improve care for
vulnerable o lder adults.
The initial grant to the g roup is
$3.8 million; total funding for t he
five-year p roject is e xpected t o be
$19 m illion, said Greg L ink,
director o f the ACL’s office of
supportive a nd caregiver services.
This fall, project leaders will
invite organizations across t he
country to submit proposals t o
serve “nonmedical” needs o f older
adults and younger adults with
disabilities. Next spring, up to 30
organizations will get 18-month
grants of $30,000 to $250,000,
said Juliet Simone, director of
national health a t the oasis
Institute.
The goal is to discover
innovative, effective p rogramsthat offer services to diverse
communities ( geographic, r acial
and e thnic) and t hat can b e
replicated i n multiple locations.
“We want the o rganizations
that apply t o be v ery flexible and
creative,” s aid Anne montgomery,
deputy director o f Altarum’s
Program to Improve Eldercare.
“A nd we’re aiming t o create a
volunteer infrastructure that c an
last and be s ustainable.”
All v olunteers will undergo
background checks a nd training,
and t here will be a n emphasis on
evaluating program results.
“We want to be able to say,
‘Here a re the services that people
really need, and these are the
types o f things t hat work well f or
specific populations,’ ” s aid John
Schall, chief executive of t he
Caregiver Action Network.
Services could include preparing
meals, taking seniors to church or
home-based tech support for
computer u sers, among many
other possibilities.
Care Corps faces several
challenges. A big one: The grant is
tiny compared w ith the t rillions
of dollars spent o n health care. It
could take a long time t o build i t
into a national effort that attracts
more investment.
Project l eaders a re o ptimistic.
To n onprofit organizations
working i n the a ging f ield, “it’s a
lot of money — they can do q uite alot with t hese grants,” s aid Sandy
markwood, CEo o f the National
Association of A rea Agencies o n
Aging. Programs may find w ays to
license successful models, and
local a nd national foundations
may step in with additional
support, Simone said.
recruiting volunteers could be
another challenge. At the C enter
for Volunteer C aregiving in Cary,
N.C., which h as been providing
“friendly visiting,” t ransportation
and c aregiver respite services f or
27 years, “it’s the biggest i ssue w e
face,” E xecutive D irector Elaine
Whitford said.
Because her organization
focuses on building relationships
with seniors, it asks v olunteers t o
commit to at l east a year. “ We g et
a lot of interest,” Whitford said,
“then people realize that t his just
isn’t g oing t o fit into t heir
schedule.”
Helen Anderson, 86, has s ickle
cell disease, l upus and c hronic
pain. She l ives a lone in a Cary
apartment. Without help from
the c enter’s v olunteers, t hree
women and a man who’ve taken
her s hopping, cleaned her
apartment and done her l aundry
since 2008, s he said, “I could not
live independently.”
Scores of volunteer p rograms
serving seniors and people w ith
disabilities a lready e xist, but m ost
are s mall a nd many o lder adults
and t heir families don’t know
about them. How they’ll interact
with the Care Corps i s not yet
clear.
one o f the l argest is Seniors
Corps, run by a federal agency
called the C orporation for
National and Community Service.
Through its Senior Companion
program, volunteers age 55 and
older v isit n eedy o lder adults and
help them with tasks such a s
shopping or paying b ills. About
10,500 volunteers s pend 1 5 to 2 0
hours a week, on average, serving
33,000 s eniors through this
program.
recent research from Senior
Corps d emonstrates t hat
volunteers r eceive benefits while
giving to others — a finding
confirmed by a large b ody o f
research. After two y ears of
service, 88 percent of S enior
Corps v olunteers r eported feeling
less isolated, while 7 8 percent
said they felt less depressed.
To l earn w hether Service
Corps’ companion program is
near you, u se a new tool on its
website: nationalservice.gov/
programs/senior-corps/get-
involved/senior-corps-
pathfinder. The group also o ffers
less intensive services to 300,000older a dults a nd people with
disabilities t hrough i ts retired
Senior Volunteer Program.
To l earn a bout o ther volunteer
programs in your c ommunity,
contact a local s enior center, a
nearby Area Agency on Aging o r
your county’s d epartment o f
aging, experts suggest. ACL’s
Eldercare Locator can help you
identify these organizations.
Another source i s the National
Volunteer C aregiving Network,
which l ists about 700 p rograms,
most of t hem c hurch-based, on its
website.
“Volunteer caregiving c an
make the d ifference b etween
someone h aving quality of life
and n ot having any at a ll,” s aid
Inez russell, board chair of t he
organization. She’s a lso the
founder of friends for Life, a
Te xas program that offers
volunteer aid to seniors t rying to
live independently and that
reaches out to seniors who don’t
have family m embers on
birthdays and holidays, a mong
other services. Altogether, the two
programs reach a bout 4,000
people a year.
In montpelier, Vt., Joan Black,
who i s 88 a nd lives alone in a one-
bedroom a partment, has b een a
member o f onion river Exchange
— a time bank — for 10 years.
onion river m embers c ontribute
goods and services (a ride t o the
airport, a homemade c asserole, a
newly knit b aby sweater) t o the
time bank a nd receive goods and
services in exchange. for years,
Black gave out i nformation about
the e xchange at f armers markets
and o ther community events —
her w ay o f banking c redits.
It’s a form of volunteerism t hat
“creates a sense of c ommunity f or
many people,” s aid Edisa muller,
chairwoman of the onion river
board.
for Black, who lives on a small
fixed i ncome and c an’t v acuum,
scrub her tub, dust her w ooden
furniture or shovel the driveway
that leads to h er apartment,
participating i n the t ime b ank has
become a w ay t o meet n ew p eople
and r emain i ntegrated with the
community.
“I like a tidy h ouse. When
things a re out of order, I ’m o ut or
order,” s he s aid. “I don’t b elieve
I’d be able to do e verything I do or
live the way I do without their
help.”this column is produced by kaiser
Health news, a nonprofit news service
and an editorially independent
program of the kaiser family
foundation that is not affiliated with
kaiser Permanente.Working toward a volunteer care corps for elderly
Navigating
Aging
Judith
GrahamThis notion of a
domestic Peace Corps
for caregiving, if you
will, has been
circulating since 2013.