The Story of the Stethoscope
Seeing people in parts in order to understand their problems is closely related to another chapter in the manual of medical training, the need to develop professional distance. At the same time that we dig deep into the body to understand its workings and make diagnoses, we are taught to step back personally so that we can dispassionately determine what our patient needs. At one level, we protect ourselves against emotional burn-out by staying detached from our patient’s lives that can, at times, be quite tragic. But more logically, we are told that this “experience-far” view, exalting “disengaged reason as the royal road to knowledge”, enables us to remain unbiased and objective in our perspective. The knowledge we obtain by this means is “studied quite independent of us, where we don’t need to understand it at all through our involvement with it, or the meanings it has in our lives.”
Applied to medicine, we step back from too much awareness of, or involvement in, people’s individual lives so that we will not impede the formation of an objective clinical gaze. So we start by listening to what the patient tells us, but not too much or for too long, because their report of what is going on, their symptoms, is subjective and fraught with bias; what we seek is objective signs. At first we gained these unbiased signs through a careful reading of the body by a thorough physical examination, a hands-on approach of direct palpation and probing. But before too long we introduced our first technology for better information. It is the story of the first stethoscope, which has been the iconic image of medicine ever since.
It was September 13, 1816 and Rene Laënnec, perhaps the greatest physician of the early nineteenth century, was examining a woman with symptoms of a diseased heart at the Necker Hospital in Paris. His efforts to examine the patient by the usual methods of “percussion and application of the hand were of little avail on account of the great degree of fatness.” The other method of examination, the application of the ear to the front of the chest, was “rendered inadmissible by the age and sex of the patient”. In the wink of an eye, the world of clinical medicine was completely transformed when Laënnec, remembering some principles of acoustics, rolled up a sheaf of paper into a cylinder, placed one end on his patient’s chest and put his ear to the other. For the first time he heard the augmented sounds of a heartbeat transmitted along the length of the tube, and the stethoscope was born.
This basic but helpful technique for better examination initially created but a foot of space between doctor and patient. But ever since this first separation, we have been moving farther and farther away in the search for more objective information. Ever evolving techniques produce sharper images and more precise test results but at increasing distance from the patient. Once we surrounded the bed of the patient to discuss their case; now we conference around computer screens, looking at images, evaluating numbers and managing the function of each and every organ without ever having to see the patient. We don’t even have to see the patient to listen to their heartbeat anymore; a digital stethoscope can capture those audio waveforms and transmit them to our phone, tablet or computer. With each step away we gain a deeper sense that our experience-far view is steeped in objectivity for the benefit of the patient. But the farther away we get, the more likely we see the body as separate from the person, ultimately a profound partition that sees the body as “it”, an infinitely malleable and ever-changing product of our own perspective and pursuits.
Content taken from Pursuing Health in an Anxious Age by Bob Cutillo, ©2016. Used by permission of Crossway, a publishing ministry of Good News Publishers, Wheaton, Il 60187, www.crossway.org.
