Historically, the practice of medicine has been a physically intimate endeavor. Physicians have used their hands to palpate and reveal the secrets hidden within the body. Smelling the breath for the ketosis of diabetes or tasting the skin for the saltiness of cystic fibrosis were among the physician's essential practices. Today, perhaps the most defining characteristic of a brilliant clinician is the ability to synthesize many images—from electrocardiograms, ultrasounds, CT scans, and so forth—into a coherent picture that can guide our (...) diagnosis and treatment. Yet this is rapidly becoming a Sisyphean task. Just as we are about to drown in a deluge of data, AI is throwing us a life preserver, to save not only our patients but ourselves. But where will AI take us? (shrink)

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. (shrink)

Advances in applications of artificial intelligence and the use of data analytics technology in biomedicine are creating optimism, as many believe these technologies will fill the need-availability gap by increasing resources for mental health care. One resource considered especially promising is smartphone psychotherapy chatbots, i.e., artificially intelligent bots that offer cognitive behavior therapy to their users with the aim of helping them improve their mental health. While a number of studies have highlighted the positive outcomes of using smartphone psychotherapy chatbots (...) to handle various anxiety related problems no conclusive data illustrate their effectiveness or warrant their use in mental illness diagnosis and treatment settings. Yet smartphone psychotherapy is highly endorsed by experts in the field of mental health research. In this paper, I focus on the specific features of smartphone psychotherapy chatbots intended for the diagnosis and treatment of mental illness and criticize three popular promises; i.e., they enable early diagnosis and intervention through digital phenotyping; they defy the stigma of mental illness diagnosis and treatment; they offer increased access to mental health treatment globally. Going against the popular enthusiasm, I argue smartphone psychotherapy chatbots have epistemic and ethical limitations in the diagnosis and treatment of illnesses. In light of these, I encourage researchers, clinicians, policy makers, patients, and caregivers to pause before jumping on the artificial intelligence bandwagon to seek solutions for mental illness on the grounds of these three promises. (shrink)

The clinical relation is the singular encounter between a patient who complains and a doctor who listens, in order to relieve and cure. But it is going through a period of crisis. One even announces his impending death! Strangely, technological advances are now coming to its rescue, prompting it to bounce back. Two hundred years after the stethoscope, the mediated vision by portable ultrasound becomes reality and enters the stage to probe the sick body “at his bedside”. This virtual (...) visible from the clinical examination becomes thus visible to the clinician, doctors and patients in general, because the images can be shared. That means for the clinician to take possession of space that was impermeable until there: the vision penetrates beyond old barriers, but it will only assert its full power if it is permeated by a clinical relation restored to its true beauty. (shrink)

Stethoscopes, x-rays and other medical technologies are two-edged swords. They make medical treatment and diagnosis more accurate and effective, but do at the same time reveal our perceptual inadequacy. By transcending our senses, these technologies reveal that we can be seriously diseased without experiencing any symptoms at all. This situation has changed our attitude towards our relations and ourselves. The situation can be analysed using Jürgen Habermas’ conception of systems colonisation of the lifeworld. Medical technologies colonise our life world. They (...) change the way we think and act. They make us all accept that we can become patients almost any minute, even if we feel perfectly healthy. Sense transcending technologies turn us all into proto-patient. (shrink)

Tim Bayne and Susanna Siegel have recently offered interesting arguments in favor of the view that we can experience high-level properties like being a pine tree or being a stethoscope (Bayne 2009, Siegel 2006, 2011). We argue first that Bayne’s simpler argument fails. However, our main aim in this paper is to show that Siegel’s more sophisticated argument for her version of the high-level view can also be resisted if one adopts a view that distinguishes between perceptual experiences and (...) seemings. (shrink)

Advances in medicine have brought us the stethoscope, artificial kidneys, and computerized health records. They have also changed the doctor-patient relationship. This book explores how the technologies of medicine are created and how we respond to the problems and successes of their use. Stanley Joel Reiser, MD, walks us through the ways medical innovations exert their influence by discussing a number of selected technologies, including the X-ray, ultrasound, and respirator. Reiser creates a new understanding of thinking about how health (...) care is practiced in the United States and thereby suggests new methods to effectively meet the challenges of living with technological medicine. As healthcare reform continues to be an intensely debated topic in America, Technological Medicine shows us the pros and cons of applying technological solutions health and illness. (shrink)

To provide basic health care services in rural areas is one of the major challenges for developing countries like Bangladesh because of lack of infrastructures and unavailability of qualified medical doctors in the villages. Telemedicine viewed as a new way of offering health care services that has the potential to overcome this problem. Author is a member of extended group at Dhaka University (DU) which has been developing telemedicine equipment and data acquisition software to promote telemedicine practice in Bangladesh. PC (...) based ECG equipment, Digital stethoscope, Digital microscope, Digital X-ray view box and some other essential medical equipment was developed for telemedicine services. The data acquisition software establishes an easy and appropriate patients to doctor interaction through a trained operator in a remote center that involve management and arrangement of consultation of a chosen and agreeing doctor by a patient. Upon establishing audio-visual connection between patient and doctor relevant physiological data from different diagnostic instruments will be uploaded securely in a dedicated web server which can be viewed real time using unique patient/doctor ID and password. Recently the Telemedicine group of DU and a local NGO named SAMAMA with support from Service innovation fund (SIF) of Prime Minister Office (PMO) of Bangladesh took the initiative to establish eight rural telemedicine centers and one expert center for the field trial of telemedicine in Bangladesh. The aim of this paper is to examine the ethical challenges of such health care system and our effort to overcome those problem before starting the field trial. (shrink)

As the patient drew her last breaths, with her daughter at her bedside, and the curtain closed across the room, my resident, whom I will call Emma, talked me through what was happening. She explained that the patient's only hope for survival had been surgery, yet surgery would surely have killed her. Emma talked about the different ways different families approach withdrawing the level of care provided in the intensive care unit, allowing a loved one's death. She talked about how (...) hard it is to leave behind everything that happens in this job when she goes home. An intern arrived to make the declaration of death, and Emma encouraged me to go back into the patient's room for this. I placed my stethoscope on the patient's still chest, confirming what we already knew to be true. Death was palpable in that room, and my response was visceral. I did my best to leave the ICU calmly and then ran down five flights of stairs to the hospital chapel and sobbed. When I returned, Emma could see that I was shaken. “It's human,” she told me. In the afternoon, I felt the deep tiredness that I always feel after really crying. In that haze of emotion, I wasn't sure quite how to respond when Emma's next activity for us was to find a patient who needed an arterial blood gas. (shrink)

I felt good about myself, driving to the free medical clinic that evening. A full professor at a medical school, leaving my warm home on a cold night after a day at the hospital, seeing patients in clinic in the morning and teaching second‐year students medical ethics in the afternoon (autonomy was the theme; we'd covered beneficence and maleficence earlier in the week). Once a month, patients with cardiac problems come to the clinic, and this was the night. Two students (...) presented the patient, a middle‐aged woman with chest pain. Their presentation was disjointed, in part because of their inexperience, in part because she spoke no English and her story was obtained with the help of a translator. Her eyes rarely met mine; she kept glancing at the translator. I auscultated her heart and lungs, letting the students listen through my stethoscope. What to do now? Had she been a patient that morning back in my clinic, I would have thought to myself, “I can't get a good history; why not do a stress test?” I thought, for what seemed like an eternity: If I send her for a stress test, that will deplete the funds needed for other patients. How important is this test? Is it really necessary? If I send her for a stress test, will someone with a suspicious mass on their chest x‐ray not be able to get a CT scan because no money is left? (shrink)

The definition of what constitutes minimal monitoring rests not so much on a scientific analysis of physiologic variables and their specificity, sensitivity, and predictiveness, but more on a usage pattern in a given community or country. In the United States, the minimal monitoring standards accepted in the majority of institutions and used for routine anesthesia care of patients not classified as high risk include (1) the alert anesthesiologist or nurse anesthetist observer, (2) an electrocardiogram, (3) a blood pressure measuring device, (...) and (4) an oxygen analyzer in the breathing circuit. To this basic cluster of monitors can be added a finger plethysmograph, a neuromuscular junction monitor, a temperature probe, and an esophageal/precordial stethoscope which are used in many communities. In the near future we expect to see a capnograph and a pulse oximeter added to this list, and later on the automated anesthesia record. (shrink)

It has been a little over three months since I returned. My day begins with an altercation with a new security guard who stops me as I drive up to the gate of the brand-new university hospital. He tells me that I am to use the other entrance, as only the chairman’s car is allowed through this gate. I inform him that I am the chairman. He peers at me suspiciously. The chairman sahib is a man not a woman, he (...) says. I put on a stern face and tell him that I am the chairman and he will get into trouble for not letting me through. He looks uncertain but eventually lets me drive in through the gate. I pick up my white coat and stethoscope from my... (shrink)

Small, mundane technologies, such as stethoscopes, medicinal bottles, labels, cleaning and dispensing equipment, are integral to the practice of western herbal medicine in the UK. A focus on such technologies reveals the dynamic character and porousness of medical systems and allows us to identify cultural interactions. In this photo essay, based on long-term anthropological research, I explore an assemblage of everyday technologies used by WHM practitioners and the ways in which these technologies contribute to shaping diagnostic stories, to performing medical (...) legitimacy and invoking herbal traditions. The biomedical, herbal and domestic technologies-in-use come into view as vibrant and dynamic objects with highly contingent meanings and identities. Their absorption into this non-biomedical therapy supports the performance of medical legitimacy, authority, tradition and professionalism, while the use of everyday domestic objects may signal female-coded practices of care. This demonstrates the adaptability of a medical practice situated at the margin of mainstream healthcare and subject to ongoing technological and ideological influence. The strategic integration of this assemblage of everyday technologies into WHM contributes, I suggest, to evoking a competent, trustworthy and time-honoured medical practice, which is simultaneously inscribed with multiple tensions, ambiguities and contestations. (shrink)

La pensée fait du bruit, non seulement lorsqu'elle parle, mais aussi dans ses textes. La voix, le ton, l'accent, l'intensité, le volume font partie des idées. Une pensée doit s'écouter, déclarait Nietzsche qui se vantait d'avoir les oreilles les plus petites mais les meilleures de la philosophie. L'attention récente portée aux voix de philosophes, grâce aux enregistrements audio-visuels de penseurs tels que Arendt, Sartre, Beauvoir, Deleuze, Lacan, Foucault, Barthes, Kristeva... a influencé la façon de les lire et de les comprendre. (...) A l'oral, mais aussi à l'écrit, des souffles, des vitesses, des rythmes particuliers inspirent le développement de leur pensée. Parfois ce sont des accents régionaux qu'un philosophe exprime, comme le bourguignon Bachelard, ou qu'il veut réprimer, comme Derrida, honteux de son accent juif algérien, ou encore le béarnais Bourdieu... Ausculter les textes, c'est écouter aussi les silences, les sons inarticulés - hurlements ou murmures - qui se logent dans la pensée : Deleuze entendait des cris dans les concepts de Spinoza. Et si nous écoutions les oeuvres philosophiques comme des paysages sonores? Les sound studies se sont développées en Amérique du Nord depuis une dizaine d'années et enrichissent peu à peu l'histoire, la littérature, la sociologie, l'écologie. Cet essai propose d'en montrer la puissance pour une toute nouvelle approche de la philosophie : il observe les dispositifs acoustiques de la parole et de l'écriture philosophiques, dès l'Antiquité, lorsque Pythagore se cachait derrière un rideau pour enseigner à ses disciples, jusqu'aux théoriciens de l'écologie sonore qui montrent les enjeux politiques du son. Apprendre à lire avec les oreilles, tel est le programme d'une nouvelle écoute qui découvre les significations inouïes de la philosophie. Et si nous enlevions les bouchons de nos oreilles pour entendre enfin le son des idées? La pensée fait du bruit, nous l'avons oublié : de grands vacarmes ou de légers bruissements. La voix des philosophes, leurs accents, font partie de leur pensée. Même dans leurs écrits nous entendons des cris et murmures. Depuis les dispositifs acoustiques de l'Antiquité jusqu'à l'utilisation du microphone aujourd'hui, François Noudelmann pose son stéthoscope sur la philosophie. Il étudie les milieux sonores les plus favorables à la réflexion et propose une écologie sonore de la pensée. (shrink)

This chapter examines the hazards and pseudohazards of thought experiment. It attacks most skepticism about thought experiment as arbitrary. It argues that once the standards that are customary for compasses, stethoscopes, and other testing devices are applied, thought experiments measure up. They should be used as part of a diversified portfolio of techniques. Although all these devices are individually susceptible to abuse, fallacy, and error, they provide a network of cross-checks that make for impressive collective reliability.

In lieu of an abstract, here is a brief excerpt of the content:To Nurse BetterJaime HenselWhen things were quiet again I asked him what training he’d had to become the director of hospital security. “I worked for 20 years in corrections,” he answered proudly, and I was saddened but not surprised.In September 2010 I started an accelerated graduate entry nurse practitioner program to become a family nurse practitioner. Accelerated programs leave little time for preamble, since the idea is to take (...) a total novice and turn her first into a nurse and then into a nurse practitioner in just three years. While the classroom information was vital, it was our clinical experiences that really initiated us into the profession. In just the second week of school, we were divided into small groups and assigned to clinical preceptors—hands–on teachers who introduced us to our first patients, curbed our mistakes, quelled our fears, and pushed and pulled and cajoled us into being nascent healthcare providers. In showing us how to give bed baths, suction secretions, insert Foley catheters, and hang IV bags, our preceptors really began showing us how to use our hands as healers.In that first semester my patients also proved to be invaluable instructors. Talking to them, administering their medication, washing their bodies made me keenly aware of the delicate balance of vulnerability and power and trust and respect and intimacy that underlies all healthcare relationships. I hope, wherever those patients are now, they know how deeply I appreciate their patience and good humor and their collusion in my education.In December, the first semester and the first clinical rotations ended. Four months into nursing school I had a basic understanding of what it means to be a nurse. Frankly, most days I still felt like an impostor in blue pajamas sporting a stethoscope I didn’t really know how to use and new Dansko clogs that squeaked with every step. But in an accelerated program, fast and furious is the name of the game. We went away for winter break—a much needed breather—and came back to something completely different: psychiatric nursing.In preparation for these new clinicals, we were taught in class that we should not wear dangly jewelry or stethoscopes. That we should never let the patient get between us and the door. That psychiatric (psych) patients could escalate quickly; psych patients could have surprising triggers; psych patients could be very unpredictable. And psych patients could be violent. We were taught about physical and chemical restraints, and about show of force. We were cautioned, as students, to stay out of the way if things got tense on the floor. In stark contrast to medical patients, psych patients were made to sound less like people who had diseases and more like adversaries. I drove to my first day on the floor with trepidation.My new preceptor had spent her entire career in psych. She loved her job, loved the care of psychiatric patients. She set up a rotation because she wanted our entire clinical group to get full exposure to the breadth of psychiatric services offered by this medium–sized community hospital. We would each get to spend shifts on the locked psych floor, observing outpatient group therapy sessions, and in the psych emergency department (ED).I rotated to the psych ED for the first time on a Friday night. The first couple hours of the shift were very slow. I started talking to the mustachioed guard on duty, who looked as bored as I felt. He told me about his kids, I told him about nursing school. He seemed nice.When our conversation flagged, I explored the psych ED. It didn’t take long—just a short hallway with a bathroom, the social workers’ office, and two patient rooms without doors. The majority of the designated psych beds were actually around the corner in the main room of the medical ED—stretchers lined against the wall, without curtains or any [End Page 98] other attempt at privacy. I noticed that from where the guard stood at the corner of the psych hall he had a pretty good view of all the beds. Then again, so did most of the other patients... (shrink)