Maybe we shouldn't even be using "lub dub" to describe heart sounds - pmc.ncbi.nlm.nih.gov/articles/PMC...

You can hear the difference between "neun und neunzig" and "ninety-nine" while listening to the song, the band start out singing in English and switch to the original German for the penultimate chorus.

By questioning why we do what we do, we transform from robots following protocols into thoughtful clinicians making informed decisions. In an era of evidence-based medicine, understanding the "why" is just as important as knowing the "how."

More effective alternatives in English would be phrases like "one-one-one" or sustained vowel sounds like "eee," both of which create better chest resonance than our translated "ninety-nine."

This illustrates the problem of following procedures without understanding their purpose. When we know that the underlying principle is to pick a phrase which will cause significant reverberations within consolidated lung then we can pick an appropriate phrase.

The German "neun und neunzig" produces a prolonged resonant sound ideal for auscultation. The English "ninety-nine" is shorter and doesn't create the same acoustic effect. It's the resonance which which indicates if vocal fremitus is present - and vocal fremitus is indicative of consolidation.

When English-speaking doctors adopted the technique, they simply translated the words without considering their function. "Ninety-nine" in English creates entirely different vocal vibrations compared to the German phrase.

This technique originated with German physicians who would ask patients to say "neun und neunzig" (99 in German). When spoken in German, this phrase creates a specific vocal resonance that effectively transmits through the chest wall.

It's common for doctors to ask patients to say "ninety-nine" while listening to their lungs? There's a historical reason behind this specific phrase that reveals something important about medical practice.

@rajacexplains.bsky.social

I *still* don’t know what FFICM is for! Felt like being interviewed for a job I was already doing.

Single moment high stakes exams need to be thrown away.

I’ve volunteered to trial the OSCE/SOE replacement and I have high hopes for something more similar to actual clinical practice.

Reconciling my exam performance with my workplace performance was challenging. It completely messed with my perception of myself.

I was lucky to have understanding colleagues, supervisors and a professional support and wellbeing service with access to coaching.

I have developed an intense hatred for post-grad exams and I have struggled to separate my emotions related to the exam from my emotions related to the job.

3 goes at MRCP Part 1, fluked Part 2 pass, 3 goes at PACES.

3 goes at the FFICM MCQ, 2 at the SOE and 3 at the OSCE.

Watch this youtu.be/l9XskAF-1Lc?... to see live demos of hacking an insulin pump and compromising the device used to update the settings of a pacemaker.

It’s a deep dive into the technical side of how it’s done but the final demo showing the “do you want to die?” screen speaks for itself.

However, each wireless connection represents a potential entry point for those with malicious intent.

Enter the ethical hackers of the cybersecurity community who identified the vulnerabilities which could be used to cause harm such as a disabling stroke or cardiac arrest.

This might sound like a spy film but the cybersecurity concerns around implantable medical devices are real and increasingly relevant as these life-saving technologies become more connected.

Pacemakers and insulin pumps offer remote monitoring and automatic adjustments that improves outcomes.