Chest auscultation - tradition and expectations Concerns and promises in the era of smart stethoscopes.

AI-assisted digital stethoscopes can classify heart and lung sounds with accuracy comparable to or exceeding that of the average clinician and help the physician in the diagnostic process. With this essay we want to discuss benefits and downsides of this new technology. Will proficiency in auscultation, which brings joy and pride to many stethoscope users, be suffering when interpretation of chest sounds is taken over by AI? And how will recommendations from AI in the diagnostic process influence decision making and the patient-doctor relationship? A tendency toward deskilling of auscultation proficiency can be counteracted when AI-assisted interpretation is used as a reflective tool, comparing machine output against clinical perception to sharpen diagnostic acuity. This concept of a collaboration of humans and AI will be important with regard to keeping AI-algorithms trustworthy. We still need more research on heart and lung sounds, to gain a detailed understanding of the clinical significance of various sound characteristics. The smart stethoscope will be useful for this research. Better knowledge will benefit not only algorithm development but also clinicians using traditional stethoscopes. The traditional stethoscope will probably prevail as the main instruments for chest auscultation in foreseeable future. Smart stethoscopes may become useful tools in the education of their users.