Internist Augments Physical Examinations & Improves Patient Education

Summary: Internist Luis Fernandez, MD, finds many patient benefits in CORE™ digital stethoscope technology from Eko Health.
Physician meets with smiling patient
Digital stethoscope becomes a novel patient education tool

As an internist, Luis Fernandez, MD, knows it’s important to engage patients and educate them about their health. Eko’s CORE™ digital stethoscope technology offers him a novel way to do that.

“The patients really like it. They look forward to being able to see and hear what their own heartbeat looks and sounds like,” Dr. Fernandez said. “I’ve made it part of their physical exam.”

Dr. Fernandez also uses Eko’s CORE™ digital stethoscope technology to help patients learn how to use their breathing to alter their heart rate in a sort of virtual biofeedback. 

He has patients inhale for five counts, hold their breath for five counts, then exhale for five, and then repeat the same process but this time for a count three (breathe in, hold and release each count of three). He records what he’s hearing via the Eko App and then plays back their heart sounds so patients can hear their heart’s real-time response to the relaxation breathing. “It’s fun for them. They get to learn without realizing they are learning,” Dr. Fernandez observes. 

Ability to see the rhythms as well as hear them assists with differential diagnoses 

After he had cared for patients for about two decades, Dr. Fernandez felt it was time to update one of his primary tools. “I had been using the same stethoscope that I had while in training,” he said. 

Seeing an ad for the Eko CORE™ Digital Attachment, he bought one to use with his analog stethoscope for sound amplification. “In hospital medicine, cardiovascular and pulmonary exams are big ones. Improved acoustics with amplification was a big help,” he said.

Dr. Fernandez’s interest in medicine was first sparked when he read a National Geographic article about the immune system as a high school sophomore. He completed his undergraduate medical school prerequisites and went on to graduate with his doctorate from the University of Miami in 1997. 

Later, after his wife matched for her pediatric oncologist residency training in Nashville in 2002, the couple relocated there. Dr. Fernandez then spent the next 20 years caring for patients as a hospitalist physician. Then about four years ago, he joined a large, 10-site, multi-specialty medical practice as an internist.

When he switched to primary care, Dr. Fernandez bought the 3M™ Littman® CORE Digital Stethoscope. The digital stethoscope helps him distinguish among differential diagnoses, such as heart failure and pneumonia. He explained how it also makes it easier to identify conditions that have nuanced breath sounds, like mild bronchitis. “Using it every day, you’d be surprised how much easier it is to hear,” he said. 

Recently, Dr. Fernandez was asked to trial the Eko CORE 500™ Digital Stethoscope with TrueSound™ technology and plans to purchase that. “Being able to see the rhythm strip while listening has changed my exam. It’s the biggest plus for me in primary care,” he said. “Seeing and hearing makes a big difference rather than just hearing without context.”

Internist makes surprising discoveries during physical examinations

Dr. Fernandez said that by using Eko CORE™ digital stethoscope technology, he has made surprising discoveries in asymptomatic patients. 

“I had a female patient in her early 40s who came in for a quick, routine exam,” he recalled. “She came in wearing yoga clothes and appeared very healthy.” 

When he had her do the breathing exercise, Dr. Fernandez heard an unexpected change in her heart rhythm, like she was dropping every third heartbeat. A 12-lead EKG confirmed that the patient had a Mobitz Type 1 second-degree AV block, also known as a Wenckebach block. 

“I couldn’t believe it,” he recalled. It’s not every day that you see a healthy-looking 40-year-old walk in and find a heart block.” 

Dr. Fernandez made another surprising discovery in a patient who is a former electrophysiology cardiologist ― an arrhythmia specialist. The patient had recently retired from practice and scheduled his routine physical examination.

Dr. Fernandez used the CORE 500™, connected to the Eko App, to listen to the patient’s heart sounds and visualize their heart rhythm. Eko’s AI-assisted AFib detection results showed the patient was in an undetermined rhythm. Later, a 12-lead EKG confirmed the patient was in atrial fibrillation, or AFib, which was a new diagnosis for him.   

“The patient had done this for a living but didn’t realize that he was in AFib,” Dr. Fernandez said. “There is no way I would have picked that up with my analog stethoscope,” he added. 

The grateful patient told him that the CORE 500™ had uncovered something new that he had no idea was going on. “It augments your exam. It’s like night and day,” Dr. Fernandez said. “I call it a game-changer.”

Learn how Eko’s CORE™ digital stethoscope technology is a powerful tool for internists who perform physical examinations and focus on patient engagement and education.

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