Article

'The hallmark of a doctor': the stethoscope and the making of medical identity

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Abstract

The stethoscope, and its use in the medical examination, has become iconic of ‘doctors’ and their work. Drawing on fieldwork in a London hospital, this article explores why this is so. It argues that the application of this instrument in a clinical situation allows for a particularly neat enactment of key ‘dispositions’ of what might be described as a doctor ‘habitus’ (Bourdieu, The Logic of Practice, 1980). Examining the politics of stethoscope ownership and display, the article also reveals some of the capacities or types of ‘agency’ doctors assign to the instrument that they exploit in the day-to-day production and performance of their medical identity (Gell, Art and Agency in Anthropological Theory, 1998). At a time when new diagnostic technologies threaten to render the stethoscope obsolete, doctors are shown to want to retain the instrument as a symbol of the skill and knowledge they possess, but which they believe to be increasingly devalued and undermined in modern medicine.

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... How do these views of doctors, in public opinion as well as inter-professionally, affect the work of medical professionals? Medical TV drama has, for instance, received attention from medical research (Gordon, Williamson, & Lawler, 1998;O'Connor, 1998), not least for its depictions of "doctorly dispositions" (Rice, 2010) that a person attains in the process of becoming a professional. ...
... That white jacket remains a striking symbol of distance, cleanliness and goodness. The other symbol is the stethoscope, which recently has been investigated as being "the hallmark of a doctor" (Rice, 2010). Rice's idea is that the stethoscope is part of a "doctor habitus", which is formed during medical training and affects the way in which doctors act and think about their practice. ...
... In several instances, respondents in my study also refer to these competences with a fixed personality. The description of the highly employable is therefore also a description of the most powerful and influential individuals in professional practice; the ones with a doctor's habitus (Rice, 2010;Sinclair, 1997) and with high volumes of capital. Smeyers and Burbules (2006) argue that we should view education as an initiation into practice. ...
Thesis
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Based on four articles, this compilation thesis analyses the demonstrated com-petence defining a medical doctor, to the extent to which he or she acquires a high status and high level of employability in professional practice. Overall, the thesis aimed to describe and analyse professional socialization during doctors' transition from education to work. Questions addressed included how higher education should be understood as preparation for professional practice, how ideals of the future professional were conceived and how these ideals differenti-ated 'good' from 'bad' doctors in professional development and recruitment. The research employed a version of practice theory as its theoretical framework, developed with the aid of work by Pierre Bourdieu, Judith Butler, John Dewey and Theodore Schatzki. Throughout the individual studies, ideals were con-structed and understood as moral imperatives, stating how doctors are expected to perform in professional practice. Article I explored the ideals of academia and higher education practices in a general sense. In this study, the ideals involve the perceived function of higher education in relation to work. Three different and conflicting perspectives were constructed with the aid of a literature study. Arti-cle II was a survey investigation of how two cohorts (n=169) of recent graduates from a Swedish medical programme viewed their competence and the prepara-tion they received for work through the medical programme. The results show that graduates might be overly prepared from a knowledge perspective, while lacking in practical skills and preparation for difficult situations in the work-place. Article III investigated the ideals of the medical programme using an interview study with eight medical students and eight medical teachers. The ideals constructed show how conflicting ideals, such as strength and humility, shape conceptions of the future professional. Finally, Article IV reports an inter-view study with recruiters of medical interns in Sweden's 21 most popular hospi-tals. Results showed that the most attractive candidates balanced two traits: orientation towards performance and orientation towards human relations. They also successfully demonstrated possession of these qualities in their appli-cation and subsequent interview. Overall, the results from the studies indicated that there are great differences between views of proper preparation for work and views of the highly-employable doctor. While medical knowledge and skills were seen as important in preparation for work, they were absent in the views of the highly-competent and employable doctor. Instead, generic attributes, such as drive, curiosity, cooperativeness, warmth, maturity and reflectiveness, char-acterised descriptions of the most accomplished medical professionals. These attributes also were seen primarily as developed before or 'beside' the formal medical education programme.
... How do these views of doctors, in public opinion as well as inter-professionally, affect the work of medical professionals? Medical TV drama has, for instance, received attention from medical research (Gordon, Williamson, & Lawler, 1998;O'Connor, 1998), not least for its depictions of "doctorly dispositions" (Rice, 2010) that a person attains in the process of becoming a professional. ...
... That white jacket remains a striking symbol of distance, cleanliness and goodness. The other symbol is the stethoscope, which recently has been investigated as being "the hallmark of a doctor" (Rice, 2010). Rice's idea is that the stethoscope is part of a "doctor habitus", which is formed during medical training and affects the way in which doctors act and think about their practice. ...
... In several instances, respondents in my study also refer to these competences with a fixed personality. The description of the highly employable is therefore also a description of the most powerful and influential individuals in professional practice; the ones with a doctor's habitus (Rice, 2010;Sinclair, 1997) and with high volumes of capital. Smeyers and Burbules (2006) argue that we should view education as an initiation into practice. ...
... uniforms, thermometers, syringes, stethoscopes, white coats, wigs, gowns, gavels, red tape, couches, straitjackets. Many of these could be described as 'tools of the trade', pieces of equipment essential for the practice of the profession (Connor, 2013:2), while others are anachronistic, serving no obvious practical purpose, but representing a profession to its practitioners and to the outside world (Rice, 2010). Objects and artefacts linked to social work are not so obvious. ...
... Nonetheless, it is probably true that many readers of this paper, if they think about the significance of objects at all, will be most likely to do so in respect of their symbolic power as markers of status, wealth or group membership, including membership of a professional group such as social work; and as expressions of personal or professional identity ( (Dittmar, 2008 :36). This might include items such as clothing associated with a particular characteristic or role (Entwistle, 2000;Scholar, 2013;Wilson, 2003), or objects or equipment, such as the stethoscope (Rice, 2010). Objects can also take on 'magical' properties, becoming invested with powers and associations beyond their ordinary uses, such as buttons, keys and pins for example, whose affordances are richer and more open, so that these objects 'do more and mean more than they might be supposed to' (Connor, 2012:3). ...
... Given the limited number of results, the search was extended to scope material referring to artefacts and practice and/or identity in other health and social care professions. This yielded a further eight relevant articles relating to occupational therapy (Hocking, 2008a(Hocking, , 2008b(Hocking, , 2008c, medicine and health care (Johan, Berlin and Carlstrom, 2010;Pink, Morgan and Dainty, 2014;Rice, 2010;Topo, and Iltanen-Täähkävuori, 2010;Twigg, 2010) and physiotherapy (Nicholls, 2015). ...
Article
Artefacts, objects and paraphernalia and their relationship to social work practice and identity have attracted little attention in social work despite their ubiquity in all aspects of our lives. This article introduces some theoretical perspectives on the qualities of artefacts and the nature of relationships between the material and social worlds; and considers the ways in which artefacts have been understood in social work research to date. It concludes by suggesting that noticing when and how social workers engage with artefacts may contribute to the development of our understanding of social work’s relationship with the non-human world and offer new insights into aspects of social work identity and practice.
... Symbolic representation, or symbolism, is a popular area of study in the humanities. Medical instruments such as a stethoscope and white coat often convey symbolic implications [4,5], affecting people's identity, emotions, and behavior [5,6]. These symbolic implications influence how people perceive others who are associated with these objects, which influences how they react to the objects. ...
... Symbolic representation, or symbolism, is a popular area of study in the humanities. Medical instruments such as a stethoscope and white coat often convey symbolic implications [4,5], affecting people's identity, emotions, and behavior [5,6]. These symbolic implications influence how people perceive others who are associated with these objects, which influences how they react to the objects. ...
Article
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Background The clinical importance and efficacy of facemasks in infection prevention have been documented in the international literature. Past studies have shown that the perceived susceptibility, the perceived severity of being afflicted with life-threatening diseases, and the perceived benefits of using a facemask are predictors of a person’s use of a facemask. However, I argue that people wear a facemask not merely for infection prevention, and various sociocultural reasons have been motivating people to wear (and not wear) a facemask. Facemasks thus have sociocultural implications for people. Research on the sociocultural meanings of facemasks is scant, and even less is known on how the shifting sociocultural meanings of facemasks are related to the changing social environment, which, I argue, serve as remarkable underlying factors for people using (and not using) facemasks. As new infectious diseases such as avian influenza and Middle East Respiratory Syndrome have been emerging, threatening people’s health worldwide, and because facemasks have been documented to have substantial efficacy in the prevention of infection transmission, understanding the sociocultural meanings of facemasks has significant implications for public health policymakers and health care providers in designing a socially and culturally responsive public health and infection control policy for the community. Methods A qualitative research design involving the use of 40 individual, in-depth semistructured interviews and a phenomenological analysis approach were adopted. Results The sociocultural meanings of the facemask have been undergoing constant change, from positive to negative, which resulted in the participants displaying hesitation in using a facemask in the post-SARS era. Because it represents a violation of societal ideologies and traditional Chinese cultural beliefs, the meanings of the facemask that had developed during the SARS outbreak failed to be sustained in the post-SARS era. Conclusion The changes in meaning not only influenced the participants’ perceptions of the facemask but also influenced their perceptions of people who use facemasks, which ultimately influenced their health behavior, preventing them from using facemasks in the post-SARS era. These findings have critical implications for designing a culturally responsive infection prevention and facemask usage policy in the future.
... Are there professional 'belongings', then, that help secure a profession's identity over time? The role of 'stuff' has been explored in the development of professional medical legitimacy (Fiol and O'Connor, 2006), referencing the stethoscope in particular (Rice, 2010). In nursing, the transmission of 'tactile knowing' through gels and gloves has been analysed by Pink et al. (2014). ...
... 6. Practical objects are those used in direct work. In some professions, practical objects abound, like the stethoscope in medicine (Rice, 2010). Social work's heavy reliance on communication skills-listening, observing, talking-perhaps explains the relative lack of such objects in the collection. ...
Article
This article examines the possibility of demonstrating social work through a collection of objects. It presents the experience of a web-based project, Social Work in 40 Objects, which aimed to provide an alternative approach to understanding social work—through display rather than definition and description. The project was experimental, with no presumption that it would be possible to express the abstraction of social work through the materiality of objects. An open, online ‘donation’ process successfully elicited 127 objects from people across twenty-five countries and five continents. The process by which the objects were collected is discussed, with the author cast in the role of curator of a Virtual Exhibition of social work. Theories from material culture and museum ethnography are introduced to understand the broader significance of stuff, its relevance to social work and the power of metonymy and metaphor. Examples of donated objects are used to consider their ability to convey the complexities of social work. An object typology is suggested, derived from the modes of meaning ascribed to the objects in the collection. The project uncovered the importance of the stories underpinning the objects via explanatory plaques, and the significance of the relationship between object, person and profession in creating charged objects.
... Essentially, this question touches on a key conceptual issue in understanding the performance of medical professionals in sport settings, as with any other context: the importance of power in shaping the everyday practices that constitute their work (Dingwall and Lewis, 1983;Freidson, 1970;Malcolm, 2017;Turner, 1995). In general, the medical profession typically affords its (senior) practitioners considerable power over others, due in large part to the formal institutional authority and professional charisma associated with medicine (Horobin, 1983;Turner, 1995;Rice, 2010). Although the power invested in institutions such as the medical profession is always open to contestation, and may shift in form and degree with broader social developments (Malcolm, 2017), so central is the importance of power to medical work that Pilnick and Dingwall argue asymmetrical power relations (favouring doctors over their patients) lie "at the heart of the medical enterprise" (2011:1374). ...
... In addition to physical staging, another common strategy for establishing authority was to 'dress the part' (see Rice, 2010). For Prus (1999), such 'leveraging tactics' are an important means of establishing consensus, by asserting symbols with shared social meanings which have specific implications favouring the tacticians using them. ...
Article
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The lack of power experienced by medical professionals working in various sport settings has been consistently evidenced by sociologists researching the provision of medical care to athletes. In this paper, which focuses on the work of medical professionals within ‘unregulated’ combat sports in England, we extend this discussion by focusing on the means by which such professionals attempt to (re)construct power within contexts where it cannot be taken for granted. To explore this issue we conducted 200 hours of observational fieldwork at competitive combat sports events, along with interviews with 25 medical professionals with experience in this field, 7 combat sports referees, and 9 event promoters and their staff. Employing the concept of power as ‘intersubjective accomplishment’, we argue that the influence necessary for medical professionals to undertake their work must be actively won within specific situations, principally relying on their ability to tactically interact with various other people. In so doing, we evidence both successes and failures of medical staff in this respect, arguing that such informal means of securing power make caring for the health of combat athletes a particularly challenging proposition.
... Doctors' symbols, such as the white coat and the stethoscope, which have been extensively theorised as professional symbols (Becker et al. 1977;Rice 2010), are worn by the students at their own discretion. However, they also have a clear nametag positioning them as medical students. ...
Article
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This paper reports on a study of how liminality relates to the facilitation of reflective practice in professional education. Liminality refers to sites and positions that exhibit 'in-betweenness', or bordering positions, that might draw together different institutional conditions. The present project aims to examine the role of liminality in professional educational practice with a specific focus upon how liminality may support student reflection. Using a qualitative and comparative research approach, we analysed interview and observational data from police education and a medical programme. Observations and interviews explore practices of collective interactional (and hence observable) reflection at sites that are characterised by ‘betweenness’ of work and education. Findings indicate that situations that afford reflection are characterised by a sense of undeterminedness in terms of either the subject, space or activity. Thus, we conclude that there is some evidence that liminality affords reflection, but also that liminality and underminedness are fragile states that are not easily organised in a professional education curriculum.
... Initially, however, its introduction into the realm of medical diagnostics was met with harsh criticism and refute [15]. With time, however, the stethoscope has become among the most iconic symbols and tools of medicine, transforming the way medicine has been practiced [16]. It is apparent that the stethoscope is no longer enough in many emergent cases [17]. ...
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Within the past several decades, dramatic changes have been made in the field of diagnostic imaging. Many of these changes have been with ultrasound, which has been transformative in the efficiency and accuracy of diagnostics. Emergency physicians, intensivists, and other acute care clinicians are using and relying on critical care ultrasound imaging to better triage and diagnose patients at the point of care. As this new frontier of medicine continues to forge forward using this new and improving technology, we strongly believe in integrating ultrasound training earlier into the medical education curriculum. This paper reviews and discusses the transformation of medical diagnostics within the last few decades and describes changes that should be expected as point-of-care cardiac ultrasound evolves within medical education. Published by Elsevier B.V.
... Indeed, relationships between consumer and commodity offer insights into the meanings embedded in things. For example, as Rice (2010) discusses, the Pre-proof, to be published in Environment and Planning A, not to be quoted without permission stethoscope is a tool a doctor uses to examine patients, however it is also a commodity that demonstrates status, power and knowledge (see Akrich, 1992;Dant, 2006;Streeck, 1996). ...
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In this paper I look at a farm that diversified its business and within this process bought a secondhand sausage vacuum filler. I do this in order to question how this machine came to be understood and valued by the farmers who bought it. The themes discussed include the role of the machine in changing the working practices of the farm, as well as factors unknown when buying secondhand—purchasers can only ever truly know the reliability and levels of performance of the machine retrospectively. While much work has considered the secondhand cultures of goods such as clothes, brick-a-brac, or cars, the departure I make here is to consider goods bought and used in commercial contexts. I consider the calculations made when a secondhand commodity is invested with the risks and tensions of expanding a business. There are critical and additional pressures resting on the machine: for example, if the machine fails to work, it may be detrimental to the business. The paper focuses on the appreciations of two farmers and how the machine they bought was used and appreciated.
... De Leon and Cohen (2005) state that instead of examining the artefact, object probing aims at studying the informant. Stethoscopes have been utilised in interviews that focused on the construction of medical identity (Rice, 2010), while objects have been used to study strategies adopted in home caring for family members with dementia (De la Cuesta and Sandelowski, 2005). Stephens et al. (2012) studied the role of transitional objects in the lives of people with dementia in residential care. ...
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Although photo elicitation has been thoroughly discussed in the literature, object elicitation has rarely been dealt with explicitly. This article describes the processes involved in object-elicitation interviews in three studies on clothing design, ageing and dementia, and elaborates on the practical, analytical and ethical issues. Object elicitation facilitates discussing concrete objects, such as garments, as well as sensitive issues like embodiment and power relations. Thus, object elicitation interviews may be ethically challenging in terms of anonymity and creating negative affect. Use of the method with ageing people and people with dementia needs to be further developed, with focus on challenges relating to cognition, communication and physical abilities.
... In regard to the former, scholars have made noteworthy contributions to the study of medicine by exploring its instruments. Rice (2010), for instance, argued that the stethoscope helped both to demarcate the physician as professional and to shape medical identity. Emphasizing the centrality and transformative role of instruments in history, Prown (1993) argued that these objects "reflect, consciously or unconsciously, directly or indirectly, the beliefs of the individuals who commissioned, fabricated, purchased, or even used them, and by extension, the beliefs of the larger society to which these individuals belonged" (p. 1). ...
Article
In 1946, Walter Freeman introduced the transorbital ice pick lobotomy. Touted as a procedure that could be learned and subsequently performed by psychiatrists outside of the operating room, the technique was quickly criticized by neurosurgeons. In this article, we take a material culture approach to consider 2 grounds upon which neurosurgeons based their objections-surgical instruments and operative spaces. On both counts, Freeman was in contravention of established normative neurosurgical practices and, ultimately, his technique was exposed as an anomaly by neurosurgeons. Despite its rejection, the transorbital lobotomy became entrenched in contemporary memory and remains the emblematic procedure of the psychosurgery era. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
... These histories have tended, however, to focus on external objects appropriated for use within institutions. 5 In selecting a purposefully designed and in-house constructed device, I have therefore also drawn guidance from the histories of apparatus and instrumentation in the connected disciplines of psychology and medicine (e.g., Benschop, 1998;Evans, 2000;Galison, 2004;Green, 2005;Pope, 1990;Rice, 2010;Schmidgen, 2005;Schraven, 2004;Sturm & Ash, 2005). In particular, I have taken up David Pantalony's (2011) challenge for historians to engage in close studies of artifacts (see also Pantalony, 2009). ...
Article
During the latter half of the 19th century, a device known popularly as the "Utica crib" became widely used in asylums and state hospitals across North America. The design varied to an extent between institutions but generally consisted of an enclosed, rectangular box made from combinations of wood slats or metal screening, with a hinged lid that could be latched closed on one side. The box was large enough to allow a person to lie straight inside with the lid closed. It has generally been described as no more than a restraint device used to confine patients in a recumbent position. In this article, I resituate the Utica crib in its broader historical context, focusing on the key role it played in the boundary debates faced by North American alienists. Particular attention is paid to the challenge from British alienists with regard to the nonrestraint movement and the attack from neurologists concerning the purported expertise of alienists. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
... The white coat worn by physicians conveys nonverbal cues about his or her function. In addition, a stethoscope around a doctor's neck is a visible sign of status, and determines how others will respond to him or her (Rice, 2010). ...
Article
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Interpreters express in one language what is said in another. Verbal language is, of course, the basic system by which humans often interact, and a large percentage of our communication is based on the exchange of words. Bilingual language skills are fundamental and are, as might be expected, emphasized in any interpreter-training program. Issues dealing with verbal language such as knowledge of medical terminology in two languages, cognates, false cognates, syntactical structures, and idioms are essential. They should be a very important part of the training provided for interpreters working in many public service settings (legal, health, education, housing, environmental health, and social services). Although the organized system of vocal sounds, known as verbal language, is fundamental to communicate meaning between individuals, there are also nonverbal features that are utilized in everyday conversation (including interpreted-mediated events). Following Fernando Poyatos (2002a, 2002b, 2002c), this article briefly examines the triple structure of discourse, language-paralanguage-kinesics, and its relevance for interpreters. One of the main differences between public service interpreting and other types of interpreting (such as conference interpreting) is the opportunity for interpreters to intervene, particularly in healthcare settings. These interventions occur in order to stop the flow of the conversation and clarify terms, expressions or ideas; point to a misunderstanding; signal a cultural reference; and/or relay the meaning of specific nonverbal behavior. The idea of the interpreter as mere conduit has now been put into question, and with reason. S/he is now regarded as a visible co-participant in a verbal and nonverbal interaction that allows two people from different languages and cultures to communicate with each other. Because nonverbal communication is an important part of the triadic interpreted-mediated events that take place in healthcare settings, it is becoming much more visible as part of interpreter education. The present article first considers communication through nonverbal signs, and often just through nonverbal signs. Next, it stresses the need for interpreters to account for nonverbal cues in the routine triadic events taking place in healthcare settings. The article adopts an expanded definition of interpreting, a particular notion of language, and a constructivist approach to learning.
... 46 Some aspects of this procedure are already part of clinical practice, for example, the routine display of medical certificates in doctors' offices; others are inherent in the tools of the doctor, such as the symbolic properties of the stethoscope. 47 However, there is likely to be scope for testing their effects and augmenting their use if appropriate. ...
Article
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Objectives@ placebo effects can be clinically meaningful but are seldom fully exploited in clinical practice. This review aimed to facilitate translational research by producing a taxonomy of techniques that could augment placebo analgesia in clinical practice. Design: literature review and survey. Methods: we systematically analysed methods which could plausibly be used to elicit placebo effects in 169 clinical and laboratory-based studies involving non-malignant pain, drawn from 7 systematic reviews. In a validation exercise we surveyed 33 leading placebo researchers (M=12 years’ research experience, SD=9.8), who were asked to comment on and add to the draft taxonomy derived from the literature. Results: the final taxonomy defines 30 procedures that may contribute to placebo effects in clinical and experimental research, proposes 60 possible clinical applications, and classifies procedures into 5 domains: the Patient’s Characteristics and Belief (5 procedures and 11 clinical applications); the Practitioner’s Characteristics and Beliefs (2 procedures and 4 clinical applications); the Healthcare Setting (8 procedures and 13 clinical applications); Treatment Characteristics (8 procedures and 14 clinical applications); and the Patient-Practitioner Interaction (7 procedures and 18 clinical applications). Conclusions: the taxonomy provides a preliminary and novel tool with potential to guide translational research aiming to harness placebo effects for patient benefit in practice.<br/
... Rengiant būsimus socialinio darbo specialistus, kurie dirbs praktikoje, vis labiau integruojančioje šiuolaikines technologijas, turi transformuotis ir socialinio darbo studijų programos, turi keistis, plėstis dėstytojų kompetencijos. Kai kurios profesijos turi priemonių, reprezentuojančių profesiją išoriniam pasauliui, pavyzdžiui, stetoskopas (dabar ir echoskopas) medicinoje ar nuotolinio stebėjimo prietaisai astronomijoje (Fenwick & Edwards, 2016, p. 123;Rice, 2010;Scholar, 2017, p. 633), socialinis darbas tokių priemonių neturi, nepaisant to, kad materialūs daiktai padeda suprasti kliento situaciją ir yra prasmingi praktikoje (Scholar, 2017). Visgi daiktai daro įtaką socialinio darbo "praktikos atlikimo būdui ir padaro vienus dalykus įmanomus, o kitus -sudėtingus ar neįmanomus" (Scholar, 2017, p. 643). ...
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This article explores the attitudes of Japanese and Lithuanian social work program teachers towards the challenges posed by modern technologies that may transform social work profession and studies. Study data revealed that scientists from both countries admit that “taming” technologies and optimally “cooperating” with them is the main challenge of social work practice and studies. On the one hand, belief that technological development will provide more opportunities to fulfil the mission of social work was prevalent among the study participants, on the other hand, they had expressed concern that eventually the use of technology will change the essence of social work as a profession of human relations or will create modified forms of social exclusion. Additionally, a niche for the new role of the social worker was identified: to help the world “occupied” by technology remain “social”. Attitudes of research participants from both Lithuania and Japan can be linked to traditional concept of sociality and vision of social work as profession that belongs exclusively to area of human relations. B. Latour’s asocial sociality concept can be applied for broader look into this situation. This concept states that efforts to trace the contribution of actors of an inhuman nature to what belongs in the human world may be more successful when one ceases to view the world exclusively through human eyes and tries to reveal the inner perspectives of phenomena of a mixed nature.
... The act of auscultation is also an important ritual in the doctor-patient relationship. 2 The stethoscope is routinely used to examine multiple organ systems and has other physical examination uses as well, including as a makeshift reflex hammer, 3 a hearing aid for communication with deaf patients 4 and a malingering detector. 5 However, it has arguably the greatest immediate impact in general internal medicine when used for pulmonary auscultation. ...
Article
Background Electronic stethoscopes are becoming more common in clinical practice. They may improve the accuracy and efficiency of pulmonary auscultation, but the data to support their benefit are limited. Objective To determine how auscultation with an electronic stethoscope may affect clinical decision making. Methods An online module consisting of six fictional ambulatory cases was developed. Each case included a brief history and lung sounds recorded with an analogue and electronic stethoscope. Internal medicine resident participants were randomly selected to hear either the analogue or electronic lung sounds. Numbers of correct answers, time spent on each case and numbers of times the recordings were played were compared between the groups who heard each mode of auscultation, with a p value of less than 0.05 indicating statistical significance. Results 61 internal medicine residents completed at least one case, and 41 residents completed all six cases. There were no significant differences in overall scores between participants who heard analogue and electronic lung sounds (3.14±0.10 out of 6 correct for analogue, 3.20±0.10 out of 6 for electronic, p=0.74). There were no significant differences in performance for any of the six cases (p=0.78), time spent on the cases (p=0.67) or numbers of times the recordings were played (p=0.85). Conclusion When lung sounds were amplified with an electronic stethoscope, we did not detect an effect on performance, time spent on the cases or numbers of times participants listened to the recordings.
... It stands to reason that loupe magnification has evolved from a simple tool of the trade to become the recognizable icon of the dental industry, similar to how the stethoscope evolved to become the symbol for the application of medicine and research worldwide. 2 The operational field for dental practitioners is confined and cramped, with many other drawbacks. Direct sight lines are often limited, which creates awkward adjustments to contort the clinician's body, making it deviate severely from an ideal posture. ...
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The majority of American dental school’s pre-clinical and clinical programs are being revised to require dental students to use magnifying loupes at the start of their dental education. This requirement will become a habit and will be carried forward after graduation and has a number of advantages. It promotes quality of care and prolongs the professional career by improving the ergonomics in dental practice. Choice of magnification is an individual’s decision and is determined by the comfort at which dentistry is delivered. Dentistry shares the need for magnification with numerous other medical specialties that have all recognized that better care can be delivered when one can see more and better. Thus, new dental identity based on optical principles and designs, dental magnifying loupes can be rightly labeled today as the new icon and hallmark of dental profession.
... For example, a preceptor's lack of auscultation routines, and on the other hand, a physician's explicit request to perform an auscultation in uenced whether the student's felt comfortable performing the assessment. The stethoscope has traditionally been a tool used by physicians, rather than nurses (38), and this may explain the reason for students need to perceive expectations and thus acceptance from health professionals to use it in their practice (39). ...
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Background The overall aim of this study was to explore third-year bachelor nursing students’ stimulated recall reflections on their physical assessment competence development. The choice of learning strategies in nursing education seems to have great impact on nursing students’ use of physical assessment skills while in clinical rotation. There is a need to explore nursing students’ learning processes related to the use of physical assessments. Methods Explorative qualitative design using a triangulation of data collection methods. Nine final-year nursing students’ physical assessment performances during patient encounters were audio-taped and observed. Shortly after, an individual stimulated recall interview based on the audio-recorded patient encounter and observation notes was conducted. A two-fold analysis was conducted: 1) analysis of students’ performed assessments, and 2) a meaning condensation analysis of the stimulated recall interviews. Results 1) Students’ assessments shifted from a checklist approach to a symptom-based approach, and they emphasized conversation as part of their assessments. 2) Through the stimulated recall interviews, students described reasons for using physical assessments in patient encounters, how the learning environment facilitated or hindered their use of physical assessments, and their own learning strategies. Conclusions Findings contribute a novel, in-depth description of what influenced nursing students’ learning processes of using physical assessment during clinical rotation. This study reveals the importance of designing and implementing learning activities in practical and theoretical courses to support and strengthen students’ learning processes. Further, findings suggest that stimulated recall as a reflective practice should be used systematically to enhance clinical reasoning skills and thus provide deep learning. A more targeted course design for physical assessment— building on and emphasizing nursing students’ prior knowledge and competence—may lead to more confident registered nurses and promote patient safety in different health care contexts.
... The control group showed no improvement. [9]. this goes to show that timely intervention and repetitive auditory learning accompanied by the regular theoretical orientation given to students makes a drastic impact on their ability to identify heart sounds in the future. ...
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OBJECTIVES: To assess basic stethoscope knowledge and maintenance practices among medical and nursing students, and factors affecting proper stethoscope usage. INTRODUCTION: We have ventured upon an aspect that is the appropriate application of a core technique in the biomedical arena. A doctor is identified by his tool - the stethoscope; it is but natural to know all the aspects of this implement. There is very little literature regarding this pertinent topic hence we conducted a study to assess the knowledge, attitude, and practices of medical and nursing students with respect to the stethoscope in Mangalore, India. DESIGN: A descriptive, cross-sectional design was conducted using a self-administered questionnaire. The questionnaire included sections pertaining to demographic details, practices, attitude, and knowledge of the stethoscope. SETTING: Medical college and research center. PARTICIPANTS: a total of 110 participants ranging from 1st to 4th year MBBS and 30 nursing students completed the questionnaire. RESULTS: Incorrect basic knowledge and poor confidence in their skills were noted among the participants. Most students attributed their inadequate skills to poor teaching and lack of interest. Nursing students had significantly lower mean scores in all the items as compared to medical students. Majority of the students followed appropriate stethoscope hygiene but did not believe in its importance. CONCLUSION: Our medical and nursing students have very poor knowledge on appropriate use of the stethoscope. Their lack of confidence while using the stethoscope reflects their inadequate knowledge and skill in effective use of stethoscope. Students believed the cause was poor teaching and lack of interest on their part. Majority of students depended on online sources for learning the appropriate usage of stethoscope. KEYWORDS: stethoscope; abnormal heart sounds; knowledge of medical students; nursing students; diaphragm of stethoscope; auscultatory sounds; nosocomial infections; appropriate use of the stethoscope.
... 5 These studies take medical training situations, in which auscultative knowledges and skills are explicated, demonstrated, and exercised, as empirical examples. They argue that apprentices are trained to see the contemporary version of the stethoscope as the "hallmark of a doctor" (Rice 2010), whose ways and purposes of listening are directed toward generating knowledge. Listening analytically to "specific characteristics of sound" (Supper and Bijsterveld 2015, 133) serves the purpose of monitoring or diagnosing well-defined clinical signs (Supper and Bijsterveld 2015, 135;Bijsterveld 2018, 73). ...
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Context. —Medical educators have had a growing sense that proficiency in physical diagnostic skills is waning, but few data have examined the question critically.Objective, Design, and Setting. —To compare the cardiac auscultatory proficiency of medical students and physicians in training. A multicenter cross-sectional assessment of students and house staff. A total of 8 internal medicine and 23 family practice programs of the mid-Atlantic area.Participants. —A total of 453 physicians in training and 88 medical students.Interventions. —All participants listened to 12 cardiac events directly recorded from patients, which they identified by completing a multiple-choice questionnaire.Main Outcome Measures. —Scores were expressed as the percentage of participants, for year and type of training, who correctly identified each event. Cumulative scores were expressed as the total number of events correctly recognized. An adjusted score was calculated whenever participants selected not only the correct finding but also findings that are acoustically similar and yet absent.Results. —Trainees' cumulative scores ranged between 0 and 7 for both internal medicine and family practice residents (median, 2.5 and 2.0, respectively). Internal medicine residents had the highest cumulative adjusted scores for the 6 extra sounds and for all 12 cardiac events tested (P=.01 and.02, respectively). On average, internal medicine and family practice residents recognized 20% of all cardiac events; the number of correct identifications improved little with year of training and was not significantly higher than the number identified by medical students.Conclusions. —Both Both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events. This study suggests a need to improve the teaching and assessment of cardiac auscultation during generalists' training, particularly with the advent of managed care and its search for more cost-effective uses of technology.
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Over the past two to three decades there has been vigorous debate in the sociological literature as well as in popular forums concerning the changing social position and status of the medical profession and the extent to which consumerism has entered the doctor-patient relationship. Few qualitative sociological inquiries, however, have directly sought the views of medical practitioners themselves on these issues. To address this hiatus, this article discusses the findings from an empirical study using semi-structured indepth interviews with 20 doctors living and working in Sydney about their views on the contemporary status of the medical profession and their experiences of medical practice. Three major aspects are discussed: the extent to which the social position of doctors has changed, the impact of consumerism on medical practice and the qualities of a ‘good’ doctor. The implications of these data for theorising the nature of contemporary medical practice, power and professional status is explored, with particular reference to the insights offered by Foucauldian theory.
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As part of their training, medical students in the United Kingdom are obliged to develop a degree of familiarity with the technique of stethoscopic listening, also known as auscultation. They must learn to handle and apply the stethoscope, and over time become adept at identifying and interpreting a range of sounds emitted by the body. The channelling and focusing of auditory attention demanded by auscultation is unfamiliar to students, and teaching doctors must bring awareness to sensory processes that otherwise operate at an unconscious level, or that resist verbal articulation. In this paper I provide a detailed account of the making of sensory knowledge in an attempt to move closer to what Cohen terms the ‘micromechanisms’ of ‘embodied knowledge’ (this volume). I do so by drawing attention to the sensory specificities of stethoscopic listening, the challenges posed by this form of auditory engagement, and the strategies employed by teaching doctors to overcome them. With the example of one student who is self-described as ‘hearing-impaired’, I also demonstrate how the assumption of a bodily homogeneity, implicit in many studies of embodied knowledge, obscures the complexity and specificity of individual circumstances that affect perceptual skill acquisition. In conclusion, I introduce the idea that stethoscopic listening is a ‘dying art’ and suggest that the inherent difficulties experienced in teaching and learning the technique might be a factor contributing to its demise. While the human capacity to teach and learn is impressive, pedagogic systems may struggle to meet the challenges that certain kinds of skill acquisition present. A failure to overcome the complexities of knowledge transmission decisively may have consequences for the perseverance of particular communities of practice.
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The practice of mediate auscultation—listening to the body through a stethoscope—was at the center of new articulations of medical thought and practice in the 19th century. During that period, the stethoscope became the hallmark of medical modernity. This article offers a detailed examination of the work of RTH Laennec and other important writings on the stethoscope in order to argue for the centrality of a distinctive orientation toward listening in modern medicine. The development of mediate auscultation applied medical and scientific reason to listening, just as a particular practice of hearing the body became integral to everyday functioning of medicine. Mediate auscultation was thus an artifact of a new approach to reason and the senses, one based in a scientific mindset and a logic of mediation.
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If professions are characterized by their monopolization of esoteric knowledge, autonomy in work performance, and authority over clients, then "deprofessionalization" is measured by the degree to which these characteristics are diminished or lacking for the members of a profession. Physicians' monopoly of knowledge has been recently challenged by computer technology and the public's rising educational level; their authority has eroded as patients adopt a more questioning attitude toward medicine; and their autonomy has lessened with the growth of group practices, peer review and cost-containment measures. Current evidence is insufficient either to retain or reject the physician deprofessionalization hypothesis; more time is needed before the erosion of medicine's authority can be assessed.
Article
Medical educators have had a growing sense that proficiency in physical diagnostic skills is waning, but few data have examined the question critically. OBJECTIVE, DESIGN, AND SETTING: To compare the cardiac auscultatory proficiency of medical students and physicians in training. A multicenter cross-sectional assessment of students and house staff. A total of 8 internal medicine and 23 family practice programs of the mid-Atlantic area. A total of 453 physicians in training and 88 medical students. All participants listened to 12 cardiac events directly recorded from patients, which they identified by completing a multiple-choice questionnaire. scores were expressed as the percentage of participants, for year and type of training, who correctly identified each event. Cumulative scores were expressed as the total number of events correctly recognized. An adjusted score was calculated whenever participants selected not only the correct finding but also findings that are acoustically similar and yet absent. Trainees' cumulative scores ranged between 0 and 7 for both internal medicine and family practice residents (median, 2.5 and 2.0, respectively). Internal medicine residents had the highest cumulative adjusted scores for the 6 extra sounds and for all 12 cardiac events tested (P=.01 and .02, respectively). On average, internal medicine and family practice residents recognized 20% of all cardiac events; the number of correct identifications improved little with year of training and was not significantly higher than the number identified by medical students. Both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events. This study suggests a need to improve the teaching and assessment of cardiac auscultation during generalists' training, particularly with the advent of managed care and its search for more cost-effective uses of technology.
A Fortunate Man: The Story of a Country Doctor
  • John Berger
Berger, John (1967) A Fortunate Man: The Story of a Country Doctor. New York: Vintage Books. Bourdieu, Pierre (1980) The Logic of Practice. Cambridge: Polity Press.
Ode to a Stethoscope, the Umbilical Cord of Health Care
  • Michael Gerchufsky
Gerchufsky, Michael (1995) 'Ode to a Stethoscope, the Umbilical Cord of Health Care', Advance 3: 47-50.
The Death of the Stethoscope: Murmurs of Discontent
  • Michael Kirsch
Kirsch, Michael (1998) 'The Death of the Stethoscope: Murmurs of Discontent'. URL (consulted July 2010): http://www.acponline.org/journals/news/dec98/stetho.htm
New Doctors Have Dangerously Poor Stethoscope Skills
  • Salvatore Mangione
  • Linda Z Nieman
Mangione, Salvatore and Nieman, Linda Z. (1997) 'New Doctors Have Dangerously Poor Stethoscope Skills', Journal of the American Medical Association 278: 717-22.
The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present
  • Roy Porter
Porter, Roy (1997) The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. London: Fontana Press.
The Science of Diagnosis: Diagnostic Technology
  • Stanley J Reiser
Reiser, Stanley J. (1993) 'The Science of Diagnosis: Diagnostic Technology', in William F. Bynum and Roy Porter (eds) Companion Encyclopedia of the History of Medicine, pp. 826-51. London: Routledge.
Listening as Touching and the Dangers of Intimacy
  • Tom Rice
Rice, Tom. (2007) 'Listening as Touching and the Dangers of Intimacy', Earshot: Journal of the UK and Ireland Soundscape Community 5: 15-21.