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.

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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.



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 Finding a new job can be very tiring, and time-consuming. It can be difficult to schedule some time to your job-seeking activities. However, the end of the year is a period of time you don’t want to miss if you want to maximize your chances of landing that precious new job. Here are four reasons why: 

  1. Employers are getting ready for the New Year  

   

 Traditionally people wouldn’t advise you to hunt for a job at the end of the year, when employers have maxed their yearly budgets and are just closing the financial year with some wrap-up activities. 

 But growing evidence seems to suggest otherwise: as employers return from the holidays with a renewed vigor, new goals, and new KPIs, they are more inclined to act upon your application immediately. 

  2. Employers have plans for 2018  

   

 Whether its a big hospital, a small clinic, or a humble retirement home, everybody uses the last few weeks of the year to reflect back on their performance in order to stay afloat. It is normally during these periods of time that they make the decision to allocate budgets to hire new staff… 

 So get to applying! 

  3. You’re ready to apply for one  

   

 The best time to apply for a job is also whenever you feel you’re ready. 

 When you want new experiences, new training, different exposure, or an increase in salary… you know it’s time to go. 

 So update your resume, acquire new skills, and hunt for that job. 

  4. You’re starting to feel miserable at your job  
 
  
Find yourself feeling unnaturally tired? Even if you’ve been getting enough sleep? 

 If you’ve been exhibiting signs of stress due to your current job like fatigue, headaches, migraines and depression, it’s probably a sign that you should cut your losses and look for opportunities elsewhere. 

 Don’t think it’s your fault for not being able to fit in… sometimes the shoe just doesn’t fit.

4 Reasons You Should Apply For A New Job NOW

Finding a new job can be very tiring, and time-consuming. It can be difficult to schedule some time to your job-seeking activities. However, the end of the year is a period of time you don’t want to miss if you want to maximize your...

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  Photo by Rami Al-Zayat  

  1. Note-taking  
 2. Scheduling  
 3. Reading  

 Smartphone as a work assistant 

 Our phones have gone from blocky, awkward devices to sleek, thin machines. It is now 2017, and processing power in smartphones (even in budget ones) have overcome the performance of some computers just ten years ago. 

 With the modern smartphone now more of a pocket computer than a communication device, several apps have been made to make work easier. These apps, when used with a bit of creativity and time, can help you  stay on top of your goals, never miss an important piece of info, track everything that matters to you and increase mental focus.  

 Read on to find out how you can transform your phone from a typical communications device to an indispensable work and life assistant. 

 1. Note-taking 

 Text 

 Take notes with your phone rather than on a piece of paper. Unlike paper, you won’t lose digital notes if you have them backed up to the cloud. Moreover, you can take hundreds of notes with you on your phone without needing to carry thick notebooks everywhere you go. 

 Most note-taking apps are searchable, like a web browser. Retrieve your information quickly and easily, whenever you need it. On Android, the best note-taking app is  Google Keep . Keep allows your to color-code your notes to your fancy. Add them to your home screen as a widget for quick access. You can still view your notes on any computer with an internet connection. Simply go over to the  Google Keep  site, log in with your Google account, and browse through your notes. 

   

  source  

   

  source  

 On iOS, we recommend the default Notes app. It’s beautifully designed, clean, and robust. Write notes on the fly, and format your text in  bold ,  italics , or underlined. Much like Google Keep, you can attach photos on to your notes. You can also organize them in folders, for easy retrieval. 

   

  source  

  Bonus tip : You can create a note with your voice! Activate Siri by long-pressing the home button, and say “ Make a note “. Siri will ask you what to write about, and it will write whatever you just said. 

 Scan documents 

 What if you had access to all the paper receipts, documents, letters, and notes; any time, anywhere? You can! Your smartphone has a camera. The best scanner is the scanner you always have with you! 

 Simply point your phone towards a paper document and take a photo. Make sure you adjust the focus a bit so text is clear on your phone’s screen. Then, simply create a photo album in your phone’s photos gallery, label it  SCANS  and move the photos of your documents there. 

 Evernote ( iOS ,  Android ) is a multi-platform note-taking app that has a really cool scanning function. When you scan documents with Evernote, the app will brighten the document, making it seem like it was really scanned using a proper scanner. In dark environments, the app will automatically activate your phone’s flash to brighten up the image. Even when taking scans of the document at an angle, Evernote will modify the image to make it seem like you took it straight down! 

   

  source  

 Evernote has OCR (Optical Character Recognition); meaning that words in the document scans are searchable in the app. It even works for handwriting! 

 Other alternatives to Evernote include  Scanbot ,  PDF Scanner + OCR Free , and  Scanner Pro . 

 Draw sketches 

 Sometimes text just doesn’t cut it. What if you need to draw something? It happens a lot, especially in nursing and medical work. 

 Both Google Keep and iOS notes have the ability to create drawings. Unlike pen and paper, you’ll never run out of ink! 

   

  Android Police  

   

  How to make a drawing in Notes iOS  

 2. Scheduling 

 Calendar 

 Schedule events or tasks that you can’t do today. Any calendar app works well; but we recommend Google Calendar ( iOS ,  Android ). It has natural language text-parsing, meaning you simply type your event into the app like how you’d say it. For example, typing: 

 
 Midwifery refresher seminar 8pm Sunday at UMMC 
 

 Will add a calendar entry  Midwifery refresher seminar , dated on Sunday at 8PM, and location at UMMC. The app can take the information of the location of the event from Google Maps. So on that day, it notifies you what time you should leave to arrive on time! 

   

  Macworld  

 3. Reading 

 Books 

 Why bring your whole bookshelf when you can just carry your phone with you? Many textbook publishers also offer ebook versions of their textbooks. With an ebook reader app, you can read books you’ve saved on your phone. Now you can refer your favorite 900-page physiology textbook anywhere without needing to break your back. 

 The Kindle ( iOS , Android ) app allows you to buy ebooks from Amazon and you can read them anytime you like. Check out their selection of  nursing textbooks  that you can get cheaper than the physical copies. Even if you delete the ebooks off your phone, you can still re-download them from Kindle. 

   

  Play Store  

 3. Task Management 

 Todoist (iOS, Android) 

 Putting tasks out of your head and into a system that you trust is one of the best ways to prevent information overload. This enables you to have less mental distractions as you only focus on the task you are currently doing, rather than having other future tasks nagging in your mind. 

 Using task management apps can seem complicated, but it actually is not. The end goal is to spend less time doing the things you want to do, so that you have more time to do the things you want to do. 

 Having a to-do list makes it easy for you to see what you have right now, and what actions are up next.  Todoist  is a great app for this. It’s available on all platforms: iOS, Android, Windows, and Chrome. 

   

  Todoist  

 Start by listing down tasks in your Inbox. As your task list grows, you might start to see some tasks are related to each other. Create projects in Todoist to group these tasks and sort them. 

 Some tasks are more complicated than other tasks. You can break down these tasks into a series of sub-tasks, allowing you to focus on tackling one thing at a time in pursuit of a larger goal. Remember, to eat an elephant, you need to take one bite at a time. 

   

  Todoist  

 Also, just like Google Calendar, Todoist accepts natural language input; set tasks to recur daily, monthly, every two weeks, or even something complicated such as “ Every third Saturday of the month “. Todoist will understand you. See  here  for the complete guide. 

 Todoist is free to use, but with a small subscription fee, premium features such as location-based reminders, file attachments, and tagging are unlocked. 

 
 The modern smartphone is a great tool for self-improvement, organization, and productivity. In such a small device, you can read books, take notes, and stay on top of your work any time, any day. As nurses’ work become more and more complex, we need better tools to help us keep track of daily life. Hopefully you have gained insight into using this great tool, and help you take on challenges that will advance your career as a nurse. 

 Head over to  MIMS Career  and discover our wide range of nurse jobs. All of our pages are mobile-responsive; browse jobs, sign up, and apply are all doable on your smartphone. Make your next career move, with  MIMS Career . 
   

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You Should Be Using These Apps On Your Phone

Photo by Rami Al-Zayat 1. Note-taking 2. Scheduling 3. Reading Smartphone as a work assistant Our phones have gone from blocky, awkward devices to sleek, thin machines. It is now 2017, and processing power in...

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