Avoiding bad auscultation techniques

I was taught that good contact between the chest and stethoscope is essential for accurate auscultation—even to the point of wetting the chest in some particularly hirsute men. These days, I see clinicians listening through garments, i.e., undershirts, even shirts or dresses. Is this practice to be condoned or condemned? — Rudi Kirschner, MD, Phoenix

Performing auscultation through garments violates the basic acoustic properties of the stethoscope at the very least and should be condemned. By failing to undress patients, we also run the risk of missing equally important visual diagnostic clues. This question draws attention to only one of many physical exam techniques that have deteriorated in direct contrast to the purported "progress" of modern, technology-driven medicine. — Christopher Ruser, MD (158-6)