The Device That Changed The Practice Of Medicine: The Stethoscope

Imagine for a moment the year 1800. A doctor is meeting with a patient – most likely in the patient’s home. The patient is complaining about shortness of breath. A cough, a fever. The doctor might check the patient’s pulse or feel their belly, but unlike today, what’s happening inside of the patient’s body is basically unknowable. There’s no MRI. No X-rays. The living body is like a black box that can’t be opened.

The only way for a doctor to figure out what was wrong with a patient was to ask them, and as a result patients’ accounts of their symptoms were seen as diseases in themselves. While today a fever is seen as a symptom of some underlying disease like the flu, back then the fever was essentially regarded as the disease itself.

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But in the early 1800s, an invention came along that changed everything. Suddenly the doctor could clearly hear what was happening inside the body. The heart, the lungs, the breath. This revolutionary device was the stethoscope.

The inventor of the stethoscope was a French doctor named René Laennec. In medical school, he had learned to practice percussion – a technique in which doctors tap their fingers against a patient’s chest and listen to the sound to try and hear what’s going on inside.

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One day, he tried percussing a patient but had trouble hearing. So he rolled up his notebook into a little cylinder and put one end on the patient’s chest and one end in his ear. He was so impressed by the quality of the sound that he decided to construct a device for listening to the internal sounds of the body.

The result was the original stethoscope. Laennec had invented a way to hear the inner workings of the human body. Now he needed to connect the sounds he was hearing with what was happening anatomically inside the patient’s body.

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To do this, Laennec listened to people right before they died, and then connected these sounds to discoveries made during the autopsy. Soon, Laennec made some key discoveries using his stethoscope. For example, he found that when a person has fluid beneath their lungs, they make a bleating sound, kind of like a goat. A sound he called egophony. He also discovered sounds that tracked with the different stages of tuberculosis.

Laennec published his results, and soon doctors were making other important discoveries that changed the way people thought about disease. Little by little our entire understanding of disease shifted from one centered around symptoms to one centered around objective observation of the body. Medical language completely changed, as doctors invented new anatomical words for diseases, like Bronchitis, which means the inflammation of the bronchial tubes.

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In parallel, the device evolved as well. In the 1840s, doctors began experimenting with flexible tubing and soon an Irish physician invented the binaural stethoscope design with two earpieces that we still use.

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This evolving device got doctors thinking about disease in new ways, changing their dynamic with patients and giving doctors a lot more power. Before the stethoscope, to be sick, the patient had to feel sick. After the stethoscope, it didn’t matter what patients thought was wrong with them, it mattered more what the doctor found.

René Laennec actually felt that patient’s accounts of their own disease were still important, but the quest for objective information about disease was underway, and the stethoscope was just the beginning. Now we have X-rays, CT scanners and MRI and PET scans. All of these devices are basically trading upon the same paradigm that the stethoscope created: that doctors should be able to detect abnormalities inside the body to reach a diagnosis, regardless of how the patient is feeling.

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These new technologies have led to so many important discoveries about the human body and disease. Today, we can spot tumors before they become life threatening and diagnose problems like high blood pressure before they causes heart disease. But this new way of thinking has also pushed doctors and patients farther apart. The doctor is no longer in your bedroom interviewing you about every detail of your experience.

René Laennec died in 1826 at the age of 45, mostly likely of tuberculosis, a disease he and his stethoscope helped us understand. It’s been 200 years since he first rolled up his note book and pressed it to that patient’s chest. Medicine looks completely different than it did back then, but somehow the stethoscope has endured.

It’s no longer a wooden cylinder, but to this day, when you walk into a doctor’s office for a routine exam, you can expect to feel the familiar stethoscope on your back.

But that could be changing. Powerful imaging technologies like ultrasound have made the stethoscope exam less critical to the diagnostic process. Medical students aren’t as good as using stethoscopes as they used to be, and across the board doctors today rely less on the stethoscope to make diagnoses. The rise of portable ultrasound has some doctors arguing that we don’t need the stethoscope anymore. They say that if you have that technology right at the bedside, why not use it right away? Ultrasound is an incredible tool, but it still isn’t widely available in many developing countries, and even in the United States it’s expensive. Right now the stethoscope functions as a screening tool so that patients don’t need to go get an expensive ultrasound unless they need one.

Dr. Andrew Bomback is a nephrologist and an assistant professor at Columbia. He still uses his stethoscope, but he says that in general doctors aren’t as good at listening to the body as they once were, and they rely on the stethoscope exam less and less to make a diagnosis. “It’s become almost a ritual more than an actual tool in terms of making diagnosis,” Bomback explains.

enter image description here

Regardless of how it’s used, the stethoscope remains omnipresent in our culture. Do a Google image search for doctor, and you will see what a physician is supposed to look like. The plurality of the doctors pictured on the first page of results are white men in white coats. Some of them are peering inside patient’s ears, others are writing something down on a clipboard. But all of them have stethoscopes.

And they are wearing the stethoscope in the exact same way–which is like a shawl around the back of the neck. Andrew Bomback says this way of wearing the stethoscope is a relatively recent fashion trend, probably borrowed from TV shows like ER and Scrubs. Doctors used to wear their stethoscopes dangling down the front of the shirt like a tie, which was practical. If you needed to use it quickly you could just pop it into your ears. Bomback observes that “it’s almost like this new version of wearing it like a scarf or a shawl is almost a concession that it’s more a fashion accessory than actually a tool that we’re using.”

But even if it’s become a fashion accessory, Dr. Bomback isn’t ready to give up his stethoscope. He says it’s an important conduit to connecting with his patients. Physical contact between a doctor and a patient has become increasingly rare. Doctors visits are short and physicians often spend much of time staring at a computer screen. Bomback says the stethoscope provides an important opportunity for intimacy.

“The stethoscope is still a part of the exam” he says, “aligned with the laying on of hands” associated with healers. “When we go to do the physical exam, we move away from our desk, we move away from the computer, and we stand right next to the patient and it’s a much more intimate conversation.”

Bomback says he thinks the stethoscope lives on in part to keep doctors and patients from drifting too far apart. To make sure doctors keep close to their patients, and keep listening.


This article originally appeared on 99pi.org. 99 Percent Invisible is a podcast on the design of things we never stop to think twice about. If you enjoyed this article, head over to their website and listen to their playlists.



Other Articles



 
	  See if the offer is too good to be true  
	  There is a fee to be paid to "process" your employment  
	  You get the job right away  
	  Unprofessional job interviews  
 

 Job scams 

 In 2013, a South African registered nurse was approached by a man outside the hospital she worked in. The 25-year old man was a recruitment agent for the  KwaZulu-Natal (KZN) Department of Health . He offered her a job at another institution, for better pay and work hours. 

 The nurse saw this as a great opportunity. She accepted it, and he produced a contract and offered her the job.  Then he requested USD220 in cash for the job.  

 Thankfully, the nurse grew suspicious, and realized she was being scammed. She immediately alerted hospital staff who arrested the man. 

   

 Grey's Hospital, where the incident happened. 

 That could have ended a lot worse. Luckily in that nurse's case, she was able to spot the scam job offer. It is hoped that this post can help you to spot these harmful acts and avoid costing you your precious time, money, and dignity. Scammers know that finding a job can be tough, and they trick people by advertising where real employers do. 

 Scams are endlessly creative! This list might not encompass all of them, but it will help you in detecting these harmful job scams. 

 
 1. See If The Offer Is Too Good To Be True 

   

 If it seems like you’ve landed yourself the best offer in the world,  DON’T . The hiring managers will say something to you like: 

 
 You can earn as much as you want, there is no upper limit on your salary. You decide what you earn. You can earn USD5,000 in one week by working at home! 
 

 Run away as fast as you can. These scams like to prey on those desperate for a new job. They take advantage of your desperation by having you excited of their offer. Once they’ve gotten you on their hook, those “employers” can start to demand money, information, and time, just to get your application moving. 

  Watch out for:  

 
	 Really high pay with low amount of working hours 
	 Ability to work anywhere, anytime 
	 Really shady phrases, like “ Drive the sports car you’ve ever wanted after only a few months’ work! ” or " Earn USD3000 by only working FOUR HOURS a week! " 
	 The person contacting you is the President or CEO or other executive level staff. Most of the time, the highest-ranking person contacting you for a job offer is some type of manager or human resources employee. 
 

 2. There is a fee to be paid to "process" your employment 

   

 If the hiring manager contacts you again and informs you that you have to pay [insert amount here] to complete your application, forget it. 

 You might see overseas job offers requiring you to pay a few hundred dollars to "process" your application. They'll claim it's to secure your employment. To sweeten the deal, some of them claim that you'll get back the money within days after you get in the company/institution. 

  Here are the most common ways job scams use to cheat your money, like:  

 
	 Buying their software 
	 Paying a fee to complete your application 
	 Sign up for some insurance program that deducts money from your account every month 
 

 Job scammers make all kinds of promises about your chances of employment, and an astounding amount of them require you to pay them for their services to employ you. It's important to note that the promise of a job is  not  the same thing as a job. If you have to pay for that promise, it's most definitely a scam. 

 3. You get the job right away 

   

 You get the job, without much interviewing, or even applying through anything. The "offer" gets sent to your inbox. They often mention that they got your email from Jobstreet, CareerBuilder, or LinkedIn. 

  Most of the time, these job offers are sent with emails that are similar to emails of legitimate employers. Be careful!  

 
 Imagine if a David Chen from  Ramsay Sime Darby  emailed you about a sweet job offer. If he really worked at RSD, his email would be something like david.c@simedarby.com. Watch out for david.c.simedarby@gmail.com, david.c@gmail.com, david.chen.HR.simedarby@yahoo.com, etc. 

 When in doubt, call up the company and ask for that employee! 
 

  A real company would want to talk to a candidate before hiring him or her.  

 4. Unprofessional job interviews 

   

 Look out for interviews online, such as over  Facebook Messenger . Worse still, are interviews using a software that the scammer asks you to install on you computer. You will risk having your computer infected with harmful malware that can  record what you type  ,  activate your webcam without notifying you , and  hold your personal information as ransom . 

 Look out for interviewers with bad grammar or spelling. If it doesn't seem like what a real professional company would say, don't trust it. 

 
 With some common sense, and a bit of suspicion, you can easily spot scam job offers. The rule of thumb is that if it looks too good to be true, sounds too good to be true, and seems to good to be true, then it's definitely not true. Also look out for shady characters and language. 

 As mentioned above, there is no limit to the creativity of these scam artists and their job offers. The tips mentioned above might cover  ALL  the scam job methods out there, but at least you'll be better prepared, and more aware that these things can happen. 

 As a healthcare-focused job portal site,  MIMS Career  takes the legitimacy of any employer and job posting  very seriously . We screen employers thoroughly, contacting them at various levels, to determine authenticity of said employers. Our  privacy policy  also dictates that we  never  share your personal information to unrelated third parties, nor do we sell them. 

 The next time you're in search of a job, apply through  MIMS Career . Sign up, fill in your details, and apply for job vacancies from top healthcare institutions in  Malaysia ,  Singapore ,  Indonesia , and the  Philippines  with one click. 

 Browse through our extensive database of job postings, updated daily. Our pages are mobile-responsive, so you can save jobs you're interested in on your desktop, and continue reading about it and apply later on your phone. 

 Can't find what you're looking for? Set a job alert, and we'll notify you once a job with your preferences is made available. Sign up now with  MIMS Career . It's fast, convenient, and secure. We do the hard work of verifying scam jobs so you won't have to. 
   

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  1. Start high  
 2. Look for an agreeable outcome  
 3. Be aware of supply in the area  
 4. Rates are not permanent  
 5. Negotiate other aspects of your rates  

 Locum Jobs 

 An advantage of taking up locum jobs to boost your income is that you have some flexibility to work. You choose the schedule that you are available to fit into. Also, it can  improve your CV  for future job applications at other institutions by showing that you have a diverse set of employers. 

 For new nurses, doing locum allows you extra time and exposure to choose how you want to plan out your nursing career. Like selecting a specialization. You can read more on the  advantages of doing locum to increase your income here . 

 People seem to be paralyzed into inaction when it comes to setting rates, simply accepting whatever the clinic offers to pay you. While this article focuses on nurses doing locum jobs at private practices, we hope that these points will still be able to help doctors, pharmacists, dentists, and other healthcare practitioners as well. 

 1. Start high 

   

  source: @dan_carl5on  

 Start out by always proposing a rate higher than you would. It doesn’t have to be a lot. 

 Say your desired rate is RM20 an hour. Just mention RM25 as your starting rate. You can slowly reduce it to the price that you sought out initially when discussing with the clinic or institution. 

 You don’t want to be working with people who feel like they have to squeeze the most out of their budget to accommodate you. Such scenarios do not lead to healthy long-term relationships. It’s better to make them feel like they’ve got a good deal. 

 2. Look for an agreeable outcome 

   

  source: pixabay  

 Remember, the owner of the clinic wants to fill some gaps in his workforce, and you want to get paid. Think of it as a bridge. Both of you are on either side. The best outcome is if you both meet in the middle. 

 Don’t rip people off. Good negotiation is about both parties walking away feeling like they both got a good deal. If you think that milking out money from people to the point where they are reluctantly agreeing to your prices, think again. That relationship isn’t going to last very long. 

 The best employer (whether they employ you full-time or otherwise) is one that continuously offers you work. They can’t do that if they don’t like you. 

 3. Be aware of supply in the area 

   

  source: pixabay  

 A lot of nurses doing locum jobs in the area? That might affect your locum fees. Try to look for clinics or institutions that have an under-supply of part-time nurses. The main reason why your locum employer is paying you below average is probably because a replacement for you is so easy to find. 

 Price is a reflection of the demand for the locum jobs and the supply of those capable of doing it in the area. This is commonly known as the law of supply and demand in economics. It applies here as well. 

 4. Rates are not permanent 

   

  source: here  

 Rates are not set in stone. Even if you’ve negotiated quite a while ago, you can still make some changes if you approach the employer tactfully. 

 Explain that you’ve been here for a while, and that you haven’t let him/her down. So you’d like an increase in your rates. 

 The worst thing that can happen is they say no. Don’t worry. It’s not the end of the world. At least you tried. 

 5. Negotiate other aspects of your rates 

   

  source: pixabay  

 While there is a fixed rate for your schedule, try to consider other aspects as well. Things like emergency calls, or last-minute requests to come in for locum. 

 Make it clear to the employer that these are out-of-the-norm occurrences, and that you would like to be compensated accordingly. 

 6. Losing locum jobs is not necessarily a bad thing 

   

  source: blupics  

 When increasing your rates, this isn’t necessarily a bad thing. Doubling your rates but losing half of locum opportunities is great. You get the same amount at the end, but work half as much, which frees up your time. 

 Plus, sometimes someone who charges RM40 per hour looks more professional and qualified than someone who charges RM20 per hour. 

 Conclusion 

 Don’t just look at financial rates; benefits are important as well. Is the job good for your reputation? Are they likely to recommend you to others? 

 Is the work consistent and secure? Do you trust the employer? 

 Remember these 6 steps when negotiating your fees.  If you don’t value your time, no one else will.  

 Browse through  MIMS Career  for an easy way to find locum or part-time jobs in your area.  MIMS Career  is a premier, healthcare-focused job portal site for Malaysia, Singapore, the Philippines and Indonesia. Our simple sign-up process allows you to easily apply for jobs you might be interested in with a single click. Job locations include hospitals, nursing homes, and private practices. It’s free, easy to use, and safe. 

 Can’t find what you’re looking for? Set up a job alert and we’ll notify you by email whenever positions that suit your preferences are available. All of our pages are mobile-responsive, so you can take your applications with you on the go. 
   

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  Think About These 5 Things Before You Decide On A Specialization  

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 A few weeks back Malaysians were shocked to hear of a man  impersonating a medical officer at a hospital  in Alor Setar. What was impressive was that the man kept the act up for about a year before authorities caught him! 

 There have been many cases of people impersonating doctors or surgeons for all kinds of reasons. These are some of the most interesting throughout recent history. 

 1. Kristina Ross 

   

  Fake profession : Plastic Surgeon 

 Kristina Ross frequented bars and pubs, claiming to be a plastic surgeon. She’d approach unsuspecting women, sweet-talk them and get them to know about her “private practice.” Under the guise of a plastic surgeon, she would conduct “breast examinations” on these women, and have them contact her number. 

 Her years of fake activities was brought to a halt when two recipients of her “free breast examinations” contacted the number Ross gave. The number belonged to a real plastic surgery clinic, but had no surgeon that went by the name of Kristina Ross. Their suspicions of the phony surgeon grew, so they called the police. 

 The authorities launched an investigated, and arrested Ross sometime later. But that’s not the last part of the story; upon arrest, it was discovered that she was actually a transgender man who changed his sex. 

 Bottomline: don’t subjugate yourselves to medical exams in non-clinical settings. 

 2. Francisco Rendon 

   

  Fake profession : Dentist 

 Rendon was able to practice his own twisted brand of dentistry for about 16 months before the police finally caught on. 

 His dental clinic was situated between two automobile workshops. His patients grew wary of his dental credentials as they had to sit in a leather office seat instead of a reclining chair. 

 Hygiene was not maintained well; Rendon made his patients spit into a trash can rather than a proper sink. He used unlicensed tools, including a tool which purpose was to polish cars on his patients. 

 When the authorities came to his “office” to arrest him for practicing without a license, he still had many patients in the waiting room. 

 3. Keith Allen Barton 

   

  Fake profession : Doctor 

 This lying physician claimed that he could cure serious diseases like HIV and cancer. He claimed he could “stop the diseases before they spread” and “nip it off from the bud.” He spread lies about the pharmaceutical industry, propagating the myth that corporations were hiding the real cure to those diseases. 

 In reality, what he did was charge his patients exorbitant fees for his homemade cures. Most of his remedies were made of cheap ingredients and did nothing to improve patients’ conditions. Sometimes he even made it worse. 

 He shares the same name as a registered doctor in California, and used this fact to swerve past the authorities. He was finally arrested under charges of identity theft and grand theft. 

 4. William Hamman 

   

  Fake profession : Cardiologist and Medical Speaker 

 Everybody liked him; he flew commercial planes for a living, and was also a cardiologist with 15 years of experience at the side. He frequently published papers in academic journals. He went around delivering lectures at universities and Cardiology seminars. 

 One day he submitted an early draft to a university committee that oversaw publication for their medical journal. One staff member spotted a glaring flaw in the otherwise impeccable paper; he had no M.D. (medical doctor) qualification. 

 What makes Hamman so interesting is that his academic achievements as a fake cardiologist were particularly impressive. His focus was on team-based efforts and how to get cardiology teams to work better together to improve outcomes. It had real academic weight to it. 

 5. William Bailey 

   

  Fake profession : Doctor 

 Bailey was an eccentric man. Being born in the late 1800s, when radioactivity was still a poorly understood science, he was obsessed in marketing the health benefits of consuming radioactive substances for the masses. 

 In 1918, he released Radithor; a tonic that he claimed could cure diseases and restore health by stimulating the endocrine glands. Of course, there was no scientific basis to this. Radithor was made by adding radium crystals into water. It gave off an emission of 1 microcurie per mole of Ra. 

 Despite not being proven to be effective, the public lapped up Bailey’s bogus claims of the healing properties of Radithor. Eben Byers, a young Pennsylvanian competitive golf player, was urged to take the irradiated substance after a consultation with his doctor. He was suffering from pains in his side; so he bought and drank Radithor on a daily basis. 

 Byers died in 1932. He had holes in his skull due to radiation poisoning; his jaw even fell off as it degenerated. He had to be buried in a lead coffin to contain the radioactivity from his body. 

 Bailey died after the Second World War, after having suffered from multiple cancers and poisoning. 

 
 Source: 

 
	  http://www.dailymail.co.uk/news/article-1330725/Kristina-Ross-pretended-plastic-surgeon-conduct-bar-room-breast-exams.html  
	  http://www.nbcchicago.com/news/local/francisco-rendon-fake-dentistry-charges-91216374.html  
	  http://www.nbcsandiego.com/news/local/Phony-Doctor-Keith-Barton-Claimed-He-Could-Cure-HIV-Cancer-DA-186240712.html  
	  http://abcnews.go.com/Health/MindMoodNews/fake-cardiologist-william-hamman-duped-real-doctors/story?id=12395288  
	  https://en.wikipedia.org/wiki/Radithor

Top 5 Fake Medical Practitioners

A few weeks back Malaysians were shocked to hear of a man impersonating a medical officer at a hospital in Alor Setar. What was impressive was that the man kept the act up for about a year before authorities caught him! There have been...

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