Is lung auscultation necessary?

Question

I am asking on behalf of a friend who is a CF patient.

My question: is lung auscultation part of the necessary physical examinations in the context of a quarterly clinic visit, if rale was noticed in the past?

In the pediatric clinic, a physical exam (also of the abdomen as well as the mouth and throat) was common during every clinic appointment. In the adult clinic, my lung was checked (percussion and auscultation) only twice during the past two years (that is, over the course of eight visits), even though I indicated infections, whistling noise during breathing, increased sputum, and shortness of breath, respectively. After I asked for an auscultation once, my request was accommodated, but since then the relationship to the clinic has been strained. It was made quite clear to me that that was considered an inappropriate demand.

In CF-Fokus, issue 3/2008, page 3, it says: “The results of lung auscultation are important for the prognosis, too.” How am I supposed to act in the future?

Thank you for your answer.

Answer

Hello,

lung auscultation is part of it!!! There surely aren’t any studies that show it to have a decisive influence on the progression or the therapy the doctor will determine. There are other parameters, after all, such as blood tests, X-ray or pulmonary function. However, I think – and I assume so do all doctors who appreciate the simple means of physical exams – that auscultation absolutely is a part of every visit (and not just every three months, but even if the patient appears with an infection in between). If nothing else, I find it important because it gives the patient the feeling that I look after and examine her/him personally and do not just put down written orders about several exams to be made to which I then send her/him (even a computer can do that). And last but not least, the auscultation results are part of quality assurance because it is registered there if and when there have been any noticeable findings with the patient.

Kind regards

Prof. Dr. J. Bargon

01.12.2008