The Stories of Mitral Stenosis - 2

Times have changed. We had to rely on our clinical acumen using conventional instruments like a stethoscope to make a diagnosis of a heart disease. I recall listening to recorded cassettes of heart sounds to learn this skill. With advances in instrumentation, people started relying on tests like 2D Echocardiography to make this diagnosis. Then the students started feeling great if they just detected a murmur in the heart, not if they diagnosed the type of the murmur and the nature of the heart disease. When they became resident doctors in our department, they continued the same trend. I felt this practice was quite dangerous, as one would not have access to such technology at all times in any institute, and at all in many parts of the world. Without a diagnosis, even a tentative one, one could not treat a patient. So I decided to test the acumen of the resident doctors once in a while, just to see which ones were good and also to motivate the rest to study better. One day a pregnant woman came to the antenatal clinic. She was asymptomatic, but had a tight mitral stenosis. For hose of my readers who don't know about it, mitral stenosis produces quite characteristic heart sounds and murmur, nd can be diagnosed quite easily and accurately by cardiac auscultation. I called the resident doctors and lecturers one at a time and asked them to diagnose her heart condition by auscultation. The results of their test are shown in the following table.

Doctor	Diagnosis
First year resident doctor 1	Normal heart
First year resident doctor 2	Normal heart
First year resident doctor 3	Some murmur
Second year resident doctor 1	Normal heart
Second year resident doctor 2	Mitral stenosis
Second year resident doctor 3	Ejection systolic murmur
Third year resident doctor 1	Normal heart
Third year resident doctor 2	Chest is clear
Third year resident doctor 3	Some murmur
Lecturer 1	Normal heart
Lecturer 2	Ejection systolic murmur
Lecturer 3	Some murmur

I did not know whether to be aghast that three junior consultants and eight out of nine resident doctors were wrong, or to be ecstatic that at least one of them got the diagnosis correct. The one who had said the chest was clear went on to become a lecturer in due course (which illustrates the point I made in the beginning. I did the test the next year, and the results were similar.