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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  1. Specialization tasks  
 2. Pathway  
 3. Common job scopes  
 4. Common terms  
 5. Career opportunities  

 Cardiology 

 Cardiology is a branch of medicine dealing with disorders of the heart as well as parts of the circulatory system the field includes medical diagnosis and treatment of  congenital heart defects ,  coronary artery disease ,  heart failure ,  valvular heart disease  and  electrophysiology . Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons. The supporting role of the surgeons and physicians are  cardiology nurses . 

 Although the cardiovascular system is inextricably linked to blood, cardiology is relatively unconcerned with hematology and its diseases. Some obvious exceptions that affect the function of the heart would be blood tests, decreased oxygen carrying capacity, and  coagulopathies . 

   

  source: Resus.me  

 Specialization Tasks 

 All cardiologists study the disorders of the heart and all cardiology nurses are trained to take care of either adult or children conditions. This is due to differing aspects of training for adult and paediatric physiology. Surgical aspects are not included in cardiology and are in the domain of cardiothoracic surgery. 

 For example, coronary artery bypass surgery and cardiopulmonary bypass are both surgical procedures performed by surgeons, and not cardiologists. As a nurse, your task will be that of assisting the cardiologists in this matter. A properly-trained cardiology nurse would have the necessary critical thinking in order to draw conclusions to make meaningful impact of treatment. 

 Common tasks in the wards that you might have to do include the insertion of stents, pacemakers, and valves. 

 Pathway 

   

  source: verywell  

 Cardiology is a specialty of internal medicine. To be a cardiology nurse, a three-year work experience followed by a post-basic or relevant course is required. It is possible to sub-specialize in Malaysia. Recognized sub-specialties in cardiology for Malaysia are cardiac  electrophysiology ,  echocardiography,  interventional cardiology, and  nuclear cardiology . 

 Currently there is insufficient data for Malaysia, for salary, but it is guaranteed to be higher or on par with other similar nursing specialists. 

 Common job scopes 

 Cardiology is a vast field. Not only does it involve the heart and its systems, it also involves supporting systems such as haematology and its diseases. It is important to know and train for this when pursuing this specialization. 

 Cardiac electrophysiology 

   

  An example of echocardiography  

 This is the science of elucidating, diagnosing, and treating the electrical activities of the heart. The term is usually used to desccribe studies of such phenomena by  invasive catheter recording  of spontaneous activity as well as of cardiac responses to programmed electrical stimulations. These studies are performed to assess complex arrythmias, relieve symptoms, evauate abnormal ECGs, assess risk of developing arrhythmias in the future, and to design treatment. 

 Cardiac examination 

 The cardiology nurse is able to carry out cardiac examinations of patients. It is performed as part of a physical examination, or when a patient presents with chest pain suggestive of a cardiovascular pathology. It would typically be modified depending on the indication and integrated with other examinations especially the respiratory examination. Like all medical examinations, the cardiac examination follows the standard structure of inspection, palpation, and auscultation. 

 Paediatric cardiology 

   

  source  

 Paediatric cardiology is a specialty of paediatrics. To be a paediatric cardiology nurse, one must complete at least three years of registered working experience and pass all the required courses. Adult cardiology certifications are not valid due to differences in physiology in children. 

 Common complications that you will see as a nurse practicing paediatric cardiology are  paediatric hypertension ,  paediatric hyperlipidemia , heart palpitations and arryhthmias. 

 Diagnostic tests 

 Diagnostic tests in cardiology are the methods of identifying heart conditions associated with healthy vs. unhealthy pathology heart function. It is commonly started by obtaining a medical history, followed by auscultation. Blood tests soon precede after, and imaging can be done on a need-to-do basis. 

 Common terms 

 1. Tetralogy of Fallot 

 It is the most common congenital ehart disease arising in 1-3 cases per 1000 births. The cause of this defect is a ventricular septal defect and an overriding aorta. These two defects combined causes deoxygenated blood to bypass the lungs and going right back into the circulatory system. The modified  Blalock-Taussig  is used as a treatment for this condition. 

 2. Pulmonary atresia 

 This happens in 7-8 births per 100,000 and is characterized by the aorta brancing out of the right ventricle. It causes deoxygenated blood to bypass the lungs and enter the circulatory system. Fixing it can by done by a team of cardiologists and nurses by redirecting the aorta and fixing the right ventricle-pulmonary artery connection in surgeries. 

 3. Double Outlet Right Ventricle 

 Double outlet right ventricle is when both great arteries, the pulmonary artery and the aorta, are connected to the right ventricle. There is usually a ventricle in different particular places depending on the variations of DORV, typically 50% are subaortic. A VSD closure is the most common form of treatment for this condition. 

 Career opportunities 

 Search for  high-paying cardiology nursing jobs  on  MIMS Career . Browse, save, and apply for nursing jobs, all in one-click. Take the opportunity for higher pay and better work locations. Our pages are all mobile-responsive, allowing you to take that leap for a better job whenever, wherever you are. All our job postings are heavily screened to  prevent scams and mistrustful behavior . 
   

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 Our team got to know about this privately-run nursing in a cozy neighborhood of Petaling Jaya. Impresif Home Care is run by a total of 3 nurses, 7 workers and their supervisor. We had the chance to speak to the supervisor, Raja. Raja is a wonderful guy, and based on just a few conversations with him you can really tell that he cares a lot about what goes on in the nursing home and its occupants. 

 Impresif Care Home is looking to hire staff nurses with minimal experience to help with their workload.  Visit their job listing page to apply.  

 
  What is the vision behind your nursing home? How did it come about?  

 The home was a house bought by our founders, En. Mohd Faizal and his wife Pn Zainab. Pn. Zainab was a matron for a big hospital. There she realized that a lot of patients still require care, but since they can’t stay admitted for too long they are discharged. 

 It was disheartening to see that, so she and her husband founded this home. We have been privately funded ever since, and do not rely on donations. 

 We have about 30 occupants, with the age range being from 55 to 90 years old. Some of them have children who are not able to take care of them; it is cheaper to send the parents here for nursing care compared to hiring a nurse who comes to the house, which can be very expensive. Some of the occupants here just do not have anywhere to go… but we are grateful we can still support them here. 

  How is the home culture like? 
 
   

 A lot of people come here to visit, thinking it to be depressed and lonely for the elderly to be here. But it’s actually a lot of fun! Everyone tries their best to be happy. I myself have never been happier in my life, now that I’m working here looking after other people. 

 It’s a relatively slow working lifestyle. We wake the occupants up at 630am, then prepare breakfast, wash, clean them, and take them out for exercise. Those who need parenteral feeding will be fed by our nurses. We have lunch around noon, and then it’s some TV time followed by an afternoon nap. Dinner is at 7, then it’s free and easy. 

 Weekends are a bit busier. Relatives and children come over to visit, and will ask the staff questions like “What medication is he/she on?”, or “How has my father been this week?”, things like that. 

 This is a suitable place for nurses out of nursing school to gain some experience before going on to do their Degrees or Post-Basics. The occupants here are all low-dependency type of patients. 

  What do you do to make your staff happy and enjoy working here?  

 It helps that the elderly are all funny and exciting in their own way. I always get “invited” to any one of the uncles or aunties houses. I’ve worked here for 8 years and I still don’t know where their “houses” are.  laughs  

 The location of the home is very nice and quiet. It has easy access to the Federal Highway and the New Pantai Expressway, so staff can easily get here from all over. It can be tiring at times but not as busy as hospital work, and they get paid well too. 

  What cool pieces of tech do you have in your clinic?  

 Everyone has their own wheelchair! So they can decorate or personalize it to fit their own characters. Some carry small tokens on their wheelchairs to remind them of people or places they used to meet. 

 We have fully adjustable beds like the ones in hospitals for our more needy occupants. 

 Our dispensary is always kept fully-stocked. 

  What kind of people are you looking to hire as your staff?  

 We’re looking for nurses who are patient, hardworking, and with a soft heart for the elderly. Applicant must also be willing to work six days a week, especially on weekends. That’s when we’re the most busy. 

  How does your staff get hired?  

 Our nurses gets hired by Pn. Zainab. She talks to the nurses that is going to work here. It’s not much of a screening; it’s just to get to know who you are as a person and how you’ll do your work. 

 We take our staff from maid agencies, so they’re mostly Indonesian. 

  What does the future of this nursing home look like?  

 We want to keep doing what we do for a long time. We’re looking to increase the number of nurses that we employ to help the current workforce cope better with the workload. At the moment we are looking to hire any qualified nurses, even ones with minimal work experience. We’ll help to guide you in the right direction. 

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  source: Larm Rmah  

  1. Paediatrics  
 2. History  
 3. Key differences  
 4. Ethics  
 5. Training  
 6. Job scope  
 7. Required skills  
 8. Common Cases  
 9. Career Opportunities  

 Paediatrics 

 Paediatrics is the branch of medicine that deals with the medical of infants, children, and adolescents. The American Academy of Paediatrics recommends people be under paediatric care up to the age of 21. A medical practitioner who specializes in this area is known as a paediatrician. 

 The word paediatrics can be spelled as either  paediatrics , as per British English, or  pediatrics , as per the American counterpart. Both spellings are acceptable. 

 The word paediatrics comes from two Greek words: “ pais “, meaning children, and “ iaitros “, meaning “doctor” or “healer”. Paediatric nurses usually work in hospitals, assisting physicians in specialized subfields like  neonatology . 

 History 

 Paediatrics is considered to be a new subset of medicine today. Ancient Greek physicians like Hippocrates, Aristotle, Celsus, Soranus, and Galen understood the differences in growing organisms like children; as compared to fully-mature adults. Soranus, a Greek physician and gynaecologist from Ephesus (located in modern-day Turkey) has published  records dealing with neonatal paediatrics . 

   

  source: EIT Mental Health  

 Paediatrics as a specialized field of medicine continued to develop in the mid-19th century. The first generally accepted paediatric hospital is the L’Hopital des Enfants Malades, which literally translates from French as “The Hospital for Ill Children.” It opened in Paris in the month of June, 1802. It accepted patients up to the age of 15 years, and still continues to operate today. 

 Key Differences Between Adult and Paediatric Medicine 

 Maturation of the human body is paralleled by differences in body size. In other words, the smaller the infant, the more different the physiology of the said patient. The smaller body of an infant or a neonate (a baby) provides a greater concern to physicians or nurses in the paediatric ward. Congenital defects, genetic variance, and developmental issues adversely affect children more than adults. 

 Children, therefore, must not be treated as “a smaller version of adults.” 

 Nurses and physicians in the paediatric specialty must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses. 

 Ethics 

 Another major difference between adult and paediatric medicine, is that  children cannot make decisions for themselves . This is important enough to warrant its own subsection in this article. 

 The issues of guardianship, privacy, legal responsibility and informed consent must  always  be considered in every procedure. 

 
 … children cannot make decisions for themselves. 
 

 Rather than just treating the child, those working in paediatrics often have to treat the parents and the family. Adolescents are in their own legal class, depending on the country, and they have rights to their own health care decisions in certain circumstances. 

 Not only will a paediatric nurse or doctor take into account the desires of a child when considering treatment options, he or she will conform to the wishes of many people. This becomes especially  important when dealing with conditions of poor prognosis, and complicated or painful procedures.  

 Training 

 Courses are available to registered nurses who have completed a minimum number of service years. The number of years differ according to country. The qualifications range from advanced diplomas, to PhD research focusing on paediatric care. Many academicians forgo clinical practice in order to pursue research that will improve the quality of healthcare or bring about favourable policies to the care of children and adolescents. 

   

  source: paediatricemergencies.podbean.com  

 It is very common for paediatric nursing training to be comprised of  didactic  and clinical components covering the management and treatment of acute and complex child patients. 

 In Malaysia, paediatric training also comprises of management of sophisticated technology, providing nurses with the capability to offer quality care in a variety of situations. Training for disease prevention and recuperative treatment are also common modules in a paediatric nursing course. 

 Core modules of training would include  interpersonal skills and counselling ,  values and ethics ,  paediatric principles and practice ,  nursing of children with special needs ,  paediatric oncology , and some clinical practice. 

 Job scope and responsibilities 

 Typical activites may vary according to the role and work setting of the paediatric nurse. Children with special needs often require a different level of care compared to others. With that said, responsibilities include: 

 
	 assessment and critical reporting of patients 
	 preparing patients for pre- or post-op 
	 setting up drips, transfusions 
	 administering drugs and injections 
	 explaining procedures, treatments, to patients or guardians to acquire their consent to treatment 
	 support, comfort, and advise the child and family 
 

 Required skills 

 Children are sensitive, therefore tread lightly when giving care. Paediatric nurses need to display: 

 
	 respect towards the patients and their family’s decisions 
	 excellent communication skills 
	 be able to communicate on a level that the child would understand (if required) 
	 ability to deal with a range of patients at one time 
	 emotional resilience, and mentally strong to handle patients under difficult conditions 
	 compassion to others’ suffering 
 

 Common cases 

 Flat feet 

   

  source: smartlivingnetwork.com  

 Usually happens when the bar ossifies, about 8-12 years old. The tarsal area coalesces and causes rigid and painful flat feet. Operative treatment is not usually needed, unless severe. Usually managed non-operatively. 

 SUFE (Slipped Upper Femoral Epiphysis - also known as SCFE) 

   

  source: Raymond Liu, MD  

 This is a disease that afflicts adolescents (13-18 years old). The growth plate widens during growth spurt and some factors then predispose to slip. Adolescents who suffer from obesity, femoral neck retroversion, endocrinopathies, and trauma are particularly likely to be diagnosed with this. 

 Bradycardia 

   

  source: cardiachealth.org  

 Bradycardia is defined by a heart rate less than the lower limit of normal for age. For infants below 3 years, it is 100 bpm. For children 3-9 years, it is 60 bpm. For 9-16 years, it is 50 bpm. Bradycardial abnormalities can be diagnosed using the 12-lead ECG or the 24-hour holter monitor. 

 Exercise stress testing is not needed in the diagnosis, but may be helpful to determine chronotropic competence. 

 Non-neonatal jaundice 

   

  source: patient.info  

 Jaundice is a yellowish discolouration of the skin, sclera, and mucous membranes due to high counts of bilirubin. It occurs as a result of abnormal bilirubin metabolism and/or secretion. Typically occuring in neonates, jaundice can occur in all age groups. 

 Treatment is done after classifying the jaundice as conjugated or unconjugated hyperbilirubinemia in the older child. Jaundice in older children may be the first clinical manifestation of unrecognized chronic liver disease. 

 Career opportunities 

 Paediatrics is one of those specialties that becomes deeper with more things to explore the more experience you have. Subspecialties in hospitals and community areas include: 

 
	  neonatal intensive care  
	 paediatric oncology 
	 child protection 
	 ambulatory care 
	 asthma 
	 diabetes 
	 counselling 
	 special needs 
 

 A more senior paediatric nurse is likely to have less and less clinical duties as a ward manager or ward sister. A future as a clinical unit manager is entirely within reach. 

 Outside clinical settings, opportunities to work in private healthcare, social services, NGOs, charities, or volunteer organizations are aplenty. 

 Search for high-paying nursing jobs on  MIMS Career . Browse, save, and apply for nursing jobs, all in one-click. Take the opportunity for higher pay and better work locations. Our pages are all mobile-responsive, allowing you to take that leap for a better job whenever, wherever you are. All our job postings are heavily screened to  prevent scams and mistrustful behavior.  
   

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Career Highlight: Paediatric Nursing

source: Larm Rmah 1. Paediatrics 2. History 3. Key differences 4. Ethics 5. Training 6. Job scope 7. Required skills 8. Common Cases 9. Career Opportunities Paediatrics Paediatrics is the...

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