|
 
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| REVIEW ARTICLE |
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| Year : 2020 | Volume
: 8
| Issue : 4 | Page : 93-95 |
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A journey of medical intern with stethoscope during internship
Keerthi Balachandran1, Manish Taywade2
1 Ex Intern and Medical Student, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Community Medicine and Family Medicine, Bhubaneswar, Odisha, India
| Date of Submission | 01-Oct-2020 |
| Date of Decision | 28-Nov-2020 |
| Date of Acceptance | 09-Dec-2020 |
| Date of Web Publication | 25-Dec-2020 |
Correspondence Address:
Dr. Manish Taywade
Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/mjhs.mjhs_2_20
The Internship in Medical Education is one of the vital and important time during this medical knowledge gets transformation into the practice. The opportunities make you learn and that experience is the worth sharing. Learning opportunities come in front of medical student in many ways, ultimately taught many aspects of practice medicine.
Keywords: Community physician, intern, medicine, stethoscope
How to cite this article:
Balachandran K, Taywade M. A journey of medical intern with stethoscope during internship. MRIMS J Health Sci 2020;8:93-5 |
| Introduction | |  |
The best thing about stethoscope is you can deaf to all the noise and listen to the truth, if only, for a minute. The word stethoscope is derived from the two Greek words, stethos meaning chest and skopein meaning to explore.[1]
An instrument that is used to transmit low-volume sounds such as a heartbeat to the ear of the listener. Apart from listening to the heart and chest sounds, it is also used to hear bowel sounds and blood flow noises in arteries and veins. Stethoscope may consist of two ear pieces connected by means of flexible tubing to a diaphragm that is placed against the skin of the patient. The stethoscope has become one of the symbols of the medical profession. The origins of the stethoscope can be traced back to the French physician Rene-Theophile-Hyacinthe Lennec, who in 1816 invented a crude model that consisted of a wooden box that served to help physicians hear the sounds within the chest cavity. It has undergone many modifications since then.[1]
The first stethoscope was introduced in 1819 by French doctor Lennec and consisted of a wooden tube, similar to an ear trumpet (used by those who were hard of hearing).[1] Before the invention of the first stethoscope, physicians would place their ear directly to the patient (known as immediate auscultation) and percuss the chest (a process of gently tapping the body with fingers-still used today). A series of updates and improvements were made in the mid-1850s including the development of the binaural device we know and continue to use today. Dr. David Littmann, a distinguished cardiologist and Harvard Medical School professor, is accredited with further developing the stethoscope in the mid-1960s and in particular, improving the acoustic performance. The basic components of the stethoscope are the headset, tubing, and the chestpiece. Some stethoscopes feature a single head chest piece that incorporates a diaphragm and bell into one known as multifrequency stethoscopes. These work by varying the pressure applied to the chestpiece to hear different levels of sound as if it was diaphragm/bell type (dual head). The diaphragm is used to listen to high pitch sounds and the bell, mid, and low pitch sounds. The diaphragm of a stethoscope functions much like the human eardrum, in that it vibrates. These vibrations move the air in the stethoscope tubing, which in turn is detected by your eardrum and interpreted as sound by your brain. The stethoscope can be used to listen to a variety of sounds to assist with the assessment and diagnosis of a patient. These include lung, heart, and bowel sounds. The stethoscope is also routinely used in association with a sphygmomanometer to assess blood pressure by listening to blood flow sounds. When using a stethoscope remember that the ear tips should point forward in your ears to follow the natural path of your ear canals to ensure the best acoustics. The best practice when using a stethoscope is to use it at skin level and do not forget to clean it after use to help control the risk of infection. Single-tubed stethoscopes are better than double-tubed ones. The tubes in double-tubed stethoscopes can rub together. This noise can make it hard to hear heart sounds. Thick, short, and relatively stiff tubing is best, unless you plan to wear the stethoscope around your neck. In that case, a longer tube is best. If you want a stethoscope with really high sound quality, you might want to consider an electronic stethoscope. An electronic stethoscope provides amplification so that it is easier to hear heart and lung sounds. Using an electronic stethoscope may make it easier to hear your patient's heart and lungs, but they are expensive. The normal sounds of the human heart, which sound like “lub-dub.” These sounds are also called systolic and diastolic. Systolic is the “lub” sound and diastolic is the “dub” sound. The “lub,” or systolic, sound happens when the mitral and tricuspid valves of the heart close. The “dub,” or diastolic, sound happens when the aortic and pulmonic valves close.
Stethoscopes are now available in a wide array of styles, with designs available for virtually every branch of medicine. Despite all of the improvements and changes, the basic principle behind the stethoscope continues to remain the same; to provide physicians with the means to perform auscultation and identify specific sounds within the body.[2]
The dignity and power doctor gets by wearing a stethoscope have always inspired me from my childhood. Even after I joined my dream MBBS career, I did not had much experience with stethoscope until I entered my internship. Even though there were times in internship when our faculty used to ask us – “where is your stethoscope” as a daily reminder for us to put it on. My internship days had taught me the real value of stethoscope, especially in the departments of critical care, general medicine, and community medicine. My best experience was during my medicine internship posting, it was one of my night duties as I was just checking the vitals of all patients, I noticed a patient whose vitals were unstable. I immediately informed my seniors. As I was examining the patient, on auscultation, I was able to hear bilateral crepts on both sides of lungs which point toward aspiration with the patient showing the sign of dyspnea. Within a fraction of time, we shifted the patient to casualty and was able to save the life of the patient. It was one of the best happy moments, the stethoscope gifted to me. I never thought that the stethoscope which I received as a toy in childhood when I was six would turn out to be the most important part of my career. Stethoscope is the most expensive jewelry, for it costs your youth span of life. Wearing a stethoscope around the neck is one of the most cherished moments in the life of a doctor.
Again very interesting to work in the peripheral posting during the internship. How can I forgot the community medicine posting, which gives me feeling of basic doctor, family physician as first contact in the primary care setting. It was hands-on experience in primary health care. Public health practice per say I learned the promotive and preventive care services at urban and rural centers. To serve the people from rural communities gives very tremendous and intense feeling to I learned the four pillars of primary health care.[3] What was thought in community medicine in the theory lectures, I learned that during my internship. Played various roles over 3 months such as medical officer, counselor, and supervisor to frontline worker, demonstrated the skills of national health programs and develop leadership qualities during the Village Health Nutrition Day sessions and immunization sessions. Although rural centers in our field practice area are in the transforming stage, the training at the peripheral centers is exhaustive, which made to learn me the primary health care. End the end of posting I was able to make a common diagnosis, management of diseases, and decision-making for referral to higher center, communication effectively with the patients and community.[4]
While working in the field at village level, the entire syllabus of community medicine in front of my eyes. Health-care delivery system, Accredited Social Health Activist, Auxiliary Nurse Midwife, Anganwadi center and workers, Gram panchayat, Environmental health, Occupation health. etc. This opportunity increased my learning in various aspects, for example, team building, communication skills, leadership, and managerial skills, also developed toward patients sympathy, empathy, rural bias, etc.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Roguin A. Rene theophile hyacinthe laënnec (1781-1826): The man behind the stethoscope. Clin Med Res 2006;4:230-5.  |
| 2. | Gupta OP. The stethoscope: The iconic medical tool. J Mahatma Gandhi Inst Med Sci 2016;21:6-7. [Full text] |
| 3. | |
| 4. | Lakshminarayanan S, Bhardwaj P, Srivastava JP. Internship training in community medicine-need for reorientation and strengthening. Indian J Community Health 2014;26:338-42. |
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