René Laënnec was a French physician and flutist who, in 1816, invented the tool carried around by almost all medical professionals, the stethoscope. Prior to the invention of the stethoscope, a physician would have to place their ear on the patient’s chest and shake them vigorously. This was known as the Hippocratic succussion, and was the most prevalent technique to listen for fluid. Laënnec carried out the development the stethoscope at Hôpital Necker. Here are some lessons from his discovery.
1. Respect your patient
“I was consulted by a young woman presenting general symptoms of disease of the heart. Owning to her stoutness, little information could be gathered by application of the hand to percussion. The patient’s age and sex did not permit me to resort to [direct application of the ear to the chest]“
Laënnec’s vignette explains that he was presented a patient with a difficult body type to percuss. This is not far from common in today’s clinics. He also describes that his patient, a young woman, probably did not feel comfortable with Laënnec’s ear to her chest.
Patience is an important tool for a physician. For Laënnec, who did not yet invent the stethoscope, patience was among his only tools. Everyone is entitled to dignity and respect, no matter how challenging the encounter. Laënnec might have been a little frustrated with this patient at first, but he was respectful toward the young woman.
2. Maintain a personal hobby
“I recalled a well-known acoustic phenomenon, namely, if you place your ear against one end of a wooden beam the scratch of a pin at the other extremity is most distinctly audible. It occurred to me that this physical property might serve a useful purpose in the case with which I was then dealing.”
This “acoustic phenomenon” that Laënnec remembered was most likely gathered from his experience as a flutist. Perhaps one could argue he had some knowledge of physics, but as a musician, Laënnec would have been a good listener (both to his professors and patients).
In medical school, the temptation to abandon one’s interests and hobbies is very present. Trading hobbies for more time to study is lucrative. However, credit to inventing the stethoscope is owed just as much to Laënnec’s musical talents as his medical knowledge. If Laënnec had curtailed his flute, the medical profession would have been too.
3. Believe in yourself
“I at once saw that this means might become a useful method for studying not only the beating of the heart but likewise all movements capble of producing sound in the thoracic cavity….With this conviction, I at once began and have continued to the present time, a series of observations…”
There is always an excuse not to do something. At times we may get sidelined with personal events, but there is never good cause to give up on a great idea. Laënnec believed his idea would work beyond just the heart, and it did. He continued to pursue his invention, refining its design. We may not know what was going on in Laënnec’s personal life at this time, but we do know that if any personal events stifled his work, medicine today would be much different.
4. Ameliorate your idea
“The first instrument employed by me consisted of a cylinder or roll of paper…substances of medium density, such as paper, wood, and cane, are those which have always appeared to me preferable to all others…I consequently employ at the present time a wooden cylinder…it is divisible into two parts by means of a screw and is thus more portable.”
Laënnec continues on to describe the advantages of a bell, funnel-shaped end,
and the effects of length and diameter. The essential aim is that Laënnec was not content with just a paper cylinder held together with “gummed paper.” He set out on designing the perfect tool because in medicine there is no tolerance for flaws.
There is a constant need to reevaluate design in medicine. We should not settle for adequate tools, but strive to produce the best. Healthcare is certainly expensive, so developing more efficient, agile systems is important.
5. Do no harm
“Glass and metals, apart from their weight and the sensation of cold they impart in winter, are not such good carriers…I shall be careful, when discussing each variety of exploration, to mention the positions which experience has taught me to be most favorable for observation and least tiring for both the physician and patient.”
This lesson should go without mention since it is the cornerstone of our profession. However, what is significant here is that Laënnec did not forget this sacred truth. He made sure that his invention did not cause the patient discomfort: educating on proper use of the device and not using strong conductors.
Medicine today is full of procedures aimed at helping to cure patients of their ailments. Causing some pain may be unavoidable. However, we should pursue every avenue before subjecting our patients to painful procedures or irradiating imaging techniques.
René Laënnec died from tuberculosis at the age of 45. Thanks to his work, physicians are able to listen to the human body with much more clarity. Heart murmurs, bruits, and friction rubs can be identified thanks to the stethoscope. Despite being a ubiquitous tool (which was slowly adopted), the stethoscope is certainly a special object among physicians. I certainly look at my stethoscope differently.