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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 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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  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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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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  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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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...

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