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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 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 

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

 
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	  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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