Diagnostic Kits, Stethoscopes, etc.

My general answer to equipment question is, buy the cheapest possible tool for the task, especially as a medical student. Welch-Allyn reps particularly feed of the neurosis of most students to upsell them the most expensive piece of equipment they can, particularly for "diagnostic sets" and the most useless thing you can buy, a blood pressure cuff. Unless you have hearing loss or some other hearing problem you don't need an electronic stethoscope.

A friend gave me a Classic II S.E. It works just fine as long as you listen against bare skin (which you're supposed to anyway). That being said I was indeed suckered into buying a Master Cardiology on my own. That's the one I carry right now. It works pretty well and I keep the tubing in good shape by reapplying Armor-All to it periodically. If something ever happens to that one I'll go dig the Classic II back out of the closet.

There were a few threads on this subject in the past. The general consensus was that while an electronic stethescope may allow you to ausculate better, you shouldn't buy one because residents and attendings may make fun of you for owning one. You should probably learn how to use a regular stethescope for the wards anyways, so you won't be dependent on needing a battery and so that you can borrow someone else's stethescope and still be proficient with it if necessary. I wouldn't go with the cheapest one, usually, you pay for quality. I've heard other people say that the Littman II was sufficient too, but I went with the Littman III just in case.

I would second the above posters. 1) you don't need an electronic stethoscope. i've never even seen a cardiologist with one of those. Just make sure you don't buy one of the Nurse's stethoscopes (poorer sound quality) and you'll be fine. Littman is a great brand but the reps do try to exploit the med student desire for the fanciest technology possible. I have the Cardiology II (~$125) and am perfectly happy with it. This or a similar model is what most of the residents-attendings seem to have.

2) resist the temptation to buy a diagnostic kit. i am one of the few people in my class who didn't. people thought I was crazy at the time, but there is one available in most settings (ER bays, clinic rooms, etc.). Most adult medicine doesn't require an otoscope. You do funduscopic exams in neurology and in the ER and that's about it. I would hold off on that diagnostic kit until you MATCH in Peds, Ophtho, or Neuro. My guess is that most people can't see the fundus anyway and just fake their way through the exam. Now i have that extra $400 to waste on step 2 review books or something (just as much of a racket).

3) Blood pressure cuff -- forget about it too. I have not taken a blood pressure on anyone but my mom and my Physiology lab partner since I started med school. Most places, NA's or NE's do the blood pressures.

4) Fill your pockets with the cheap stuff no one else has: scissors, penlight, eye chart; and the free stuff no one ever bothers to carry around: alcohol pads, 4x4's, tape, tongue depressors, extra scripts -- and you will look smarter than that jerk who dropped several G's on a bunch of fancy diagnostic equipment and now needs to carry a portable generator, but still can't find the useful stuff that actually helps people through rounds.

get the normal one..i got a cardio..and some of the clinicians do not like it..

my class mates though..are pretty amazed by it..looks really nice and shiny and cool..they use the same ol littmanns..though i would like to have Welsh alynn, the one they use in 'scrubs'

however,once in a hospital, this family practice doctor saw my stet, and she was amazed as well..she has been in practice for quite a awhile,and hasn't seen a cardio stet..

Some clinicians will also make fun of the color of the stet's tubing, get some dark colors..avoid lime green or sexy pink

I actually use the otoscope in the ED on all patients. Not only to check TMs, but nasal turbinates, pupillary constriction, and the oral exam.

Every trauma patient gets an otoscopic exam as well as a nasal septal exam.

Q, DO

I worked with a cardiologist who used THE crappiest stethescope I've ever seen. I once looked at it to make sure it wasn't made by Fischer-Price.

But he was able to show us all kinds of murmurs, even renal bruits, with that thing. So I told him I felt a little stupid using my Littmann Cardio III when I couldn't hear half the stuff he could hear using his daughter's doctor-kit steth (almost).

His response was that medical students don't know what to listen for and so they should actually buy the best thing they can reasonable afford (the "reasonably" stipulation negates the electronic version for most) so they can get the best sound quality.

His explanation for why he used a $2 stethescope was that he had lost his good ones so many times that he just gave up. Plus, clearly it wasn't necessary for him.

mine is the most basic littman cardio that was given to me - it's one-sided though, and it only needs one side. but damn it hears good. there have been 1-2 attendings who used mine when i pick up on murmurs and bruits because they don't hear it on their own from whatever pharmaceutical co gave it to them.

from one experience, i think a stethoscope that hears reasonably well is very important, which is probably all of the 'littman's' intended for md's. in one experience, a patient of mine had developed rales that could be heard on this steth, but not on the whatever steth the resident was using. cxr began showing signs of white-out, and in the next 10 hrs he was in ards and lungs were totally whited out. but it would have been nice if there wasn't disagreement about whether there are rales early on, esp coming from a lowly med student.

i compared this cardio littman to a friend of mine who has the classic littman - both seemed to have their advantages. specifically i found my cardio to be better in the low-pitched tones and i adore mine for this reason [excellent for murmurs and bruits]. but on higher tones, it almost sounded like the classic was slightly better [good for gi and small bowel obstructions]. i don't know if this is what is intended or why one is more expensive than the other. classic littman is probably 75 dollars and well worth it. its all you probably need.


ps; if you want to know what a bad stethoscope sounds like, try using those plastic yellow ones in the stock room, or the flat ones some of the nurses have that are probably only good for bp measurements or frank wheezing.

Get a classic Littman. Don't spend too much money on fancy equipment, technology becomes outdated very quickly. Also, you will get made fun of by me! Some of my friends got the PanOptic opthalmoscope, which they rarely use after Physical diagnosis first year...

Re: otoscopic exams on all trauma pts - like pikachu, I've never seen them done on my ER rotations. Unless the pt had some foreign body up their nose or in their ear, they never looked. CTs were usually done in serious cases. However, the attendings in the ER hounded me to do rectals on nearly every pt. Go figure..you get your head bashed, and we're looking in the wrong end!!

The old axiom that "it?s what?s between the ears that counts most" is very true. That being said I use a Cardiology III. IMHO electronic stethoscopes around student?s necks are risk and can expose the wearer to unnecessary pressure (if you know what I mean), I equate it with painting a target on your back with red letters saying ?Pimp me harder?

I've got the Littmann 4000 and I love it. Haven't been made fun of either. Mostly I get looks of envy from attendings who haven't seen the new technology yet.
Is it necessary? Absolutely not. I started med school with the Cardio III and decided I wanted a new toy midway through my junior year. I have found if very useful though. I have carried a systolic murmur to an attending at clinic to get a 2nd opinion. I have found it most useful in places like the VA that have 4 patients to a room and all but the one you are talking to are watching TV. You can crank up the volume and complete your exam.
I think a diagnostic set is useful too. You will look like crap on wards when an attending wants to use a scope and none of the 4 students have one. They are worthless for clinics, but I used mine on a daily basis on wards.
I agree the BP cuff is worthless. I got a $20 one from a local drug store.
tony

I've been given a lot of ambiguous advice on the type of ophthalmoscope I should acquire for the clinical years. Some students say "Definitely panoptic" others are dismissive. I've yet to hear someone provide a synthesized response like "you should get ___ if you're ___ (going into opthalmology, neurology, etc.; have short forearms; are a gear-goon; etc.)

Any personal experience is greatly appreciated.

Thanks!

if you'd like to learn how to do a good fundal exam, i'd suggest you not buy the panoptic. chances are any clinic you find yourself in in the future will not be equipped with panoptics, and you'd be doing yourself a disservice by not learning how to do a fundal exam on the standard equipment (which provides a smaller view of the fundus).

opthalmologists use much more than panoptics when it comes to examining the eye. thus, i don't think it matters which you buy if you are thinking of ophthalmology. just learn how to do a good fundal exam. and again, be advised that unless you carry your panop everywhere with you, you'll be using the regular model, and so should be comfortable with it.

most neurologists don't carry ophthalmoscopes around with them. if they need one, they'll grab a floor model. and if they are sufficiently concerned with the eye based on their other clinical findings, ophtho is consulted. i've never heard any docotr say, "gosh, anyone have a panoptic? i can't see a thing!"

i have several classmates (we're now 4th years) who are lamenting the fact that they bought new regular models, let alone shelling out the cash for the panoptic. i'd term that a waste of your money. i bought a used, regular model. i learned how to do a good fundal exam from clinicians who then taught me how to use the equipment (and not from the equipment alone).

I bought the hand-cannon (panoptic) and definitely consider a waste of money at this point. For one thing, it's so bulky that I never deemed it to be worth carrying after the first week in the hospital.

I love the panoptic, but don't use it enough to warrant the purchase.

If I were you I wouldn't buy an oto/opthalmoscope period. Its a waste of $$ and a bloody conspiracy by Welch Allyn. I swear they're giving kickbacks to schools to pawn their crap on us.
Same with stethoscopes - get a decent one that isn't too heavy.

The most important thing I carry is my PDA - drug guides, sanford, 5Mcc, etc. I love it

Running bear said:

I've been given a lot of ambiguous advice on the type of ophthalmoscope I should acquire for the clinical years.

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Easy...you don't need to buy an ophthalmoscope during the clinical years. If you need one (which is rarely), there will be one available on the ward or in the clinic rooms.

Jaded Soul said:

If you need one (which is rarely), there will be one available on the ward or in the clinic rooms.

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I guess you don't work in a county hospital

I bought a panoptic and would agree with previous posts about it being too bulky, too little used, and too expensive. It also is a little different than the traditional, so if you get used to it, switching to the traditional (which seems to be used more) is a bit of a challenge.

Wook

Hi All,
I am wondering how many people have tried both and compared them (DRG and Littman looking at the Master Cardiology). The Littman is a gold standard but does it beat neoprene and BOSE?
Hitmanng

I haven't tried DRG, but I own an ADC stethoscope (from allheart.com) and would highly recommend it over any Littman. Mine sports the same features as the Cardiology III but costs much less and is acoustically superior.

I tried a DRG and returned it. The tubing was very stiff and when trying to hold the diaphragm against someone's chest the tubing would rotate to the other diaphragm. I also found the accoustics were very muffled. Maybe the scope I tried was not a good representative of DRG, but I was disappointed. My husband tried it as well and he prefers our old Littman as well.

Not to troll, but Littman is NOT the gold standard (how can a stethoscope without a proper bell be?). I'd recommend a Sprague-Rappaport dual-tube (formerly HP, I think Phillips makes them now) with a Craddock/Pelham bell.

TommyGunn04 said:

I haven't tried DRG, but I own an ADC stethoscope (from allheart.com) and would highly recommend it over any Littman. Mine sports the same features as the Cardiology III but costs much less and is acoustically superior.

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Hey, I've got an ADC too, cardio. I feel that LIttmann has a deeper bass and the earpiece is soft, compared to my ADC, though i would still take ADC over Littmanns. I feel that LIttmanns is overpriced because in most Asian countries, students all use them (I think my ADC is the only one in the whole country/region ) Students here don't like to go beyond the norm, and some attendings screw students if they have brightly colored tubing (lime green, pink) or some super sophisticated electronic because even some cardiologist don't use them

they don't have a bell because that's the trademark of a cardio stet. Bell/Diaphragm on one side (pressure sensitive) makes it easier for the cardiologist

From my experience the bell/diaphragm combo doesn't work as well as a proper bell with sharp edges (Littman has a padded bell, if I remember correctly).

But this is a matter of personal preference. I use what my old-school cardiologist preceptor uses.

Anyone know a good place, either online or physical stores where I can get a decent stethoscope, EMT shears, penlights, and holsters? Preferrably I need to find one located in Canada to avoid shipping fees.

Thanks.

It's not Canada, but I like www.allheart.com for a lot of stuff. Sorry I can't do better for you, but hopefully it'll help.
--Marc

A lot of it is training the ear but a good stethoscope is a big help. We get POS Harvey DLXs from the school and when I switched to my Sprague-Rappaport it was night and day.

ericdamiansean said:

they don't have a bell because that's the trademark of a cardio stet. Bell/Diaphragm on one side (pressure sensitive) makes it easier for the cardiologist

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Actually on the Cardio III you can make the Pediatric side into a bell by pulling off the thing in the middle.

As a soon to be med student, which would be more appropriate, the Littmann Cardio III or the Master Cardio? I am considering cardiology, but I can't be sure of course. Aside from the the Master Cardio having no ped bell (I think that's the term for it) and just an adult diaphram, are there other differences?
Also, how is the Littmann warranty? Has anyone had any experience with their customer service?
Sorry that I'm such a noob, TIA!

subtle1epiphany said:

As a soon to be med student, which would be more appropriate, the Littmann Cardio III or the Master Cardio? I am considering cardiology, but I can't be sure of course. Aside from the the Master Cardio having no ped bell (I think that's the term for it) and just an adult diaphram, are there other differences?
Also, how is the Littmann warranty? Has anyone had any experience with their customer service?
Sorry that I'm such a noob, TIA!

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I like that the Cardio III gives you options. It's all about the options. When you're on your peds rotation and auscultating a tiny newborn whose chest is only like twice the size of the large diaphragm (slight exaggeration), you'll be in business because your Cardio III has a pediatric-sized diaphragm. When you're on adult rotations, you can convert the small diaphragm to a bell to appease the old-school attendings who don't know about the tunable bell/diaphragm-thingy.

In terms of acoustics, I don't think there's any difference between the Cardio III and Master Cardio at our level. Cardiology training is many years away, and you don't know if you're going to do it yet. You can always get a stethoscope with better acoustics later.

I don't know anyone who has broken their stethoscope and had to use the warranty. My Cardio III is still good condition after being stuffed into backpacks, left in the car in 100+ degree heat, sat on, dropped, stepped on, etc. Just about the only thing I haven't done is dropped it in water. I'll probably lose it before breaking it.

Jaded Soul said:

I like that the Cardio III gives you options. It's all about the options. When you're on your peds rotation and auscultating a tiny newborn whose chest is only like twice the size of the large diaphragm (slight exaggeration), you'll be in business because your Cardio III has a pediatric-sized diaphragm. When you're on adult rotations, you can convert the small diaphragm to a bell to appease the old-school attendings who don't know about the tunable bell/diaphragm-thingy.

In terms of acoustics, I don't think there's any difference between the Cardio III and Master Cardio at our level. Cardiology training is many years away, and you don't know if you're going to do it yet. You can always get a stethoscope with better acoustics later.

I don't know anyone who has broken their stethoscope and had to use the warranty. My Cardio III is still good condition after being stuffed into backpacks, left in the car in 100+ degree heat, sat on, dropped, stepped on, etc. Just about the only thing I haven't done is dropped it in water. I'll probably lose it before breaking it.

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wow, i take care of mine like crazy..don't let idiots touch it even

ericdamiansean said:

wow, i take care of mine like crazy..don't let idiots touch it even

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Yeah...that wore off about a month into third year. During the first two years, when I only used it once a week, I really took care of it well. Now, it's just more of a nuisance to have that thing around my neck or stuffed into my coat pocket all day.

Jaded Soul said:

Yeah...that wore off about a month into third year. During the first two years, when I only used it once a week, I really took care of it well. Now, it's just more of a nuisance to have that thing around my neck or stuffed into my coat pocket all day.

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does your hospital have senior consultants or attendings who don't like it when medical students hang their stets aorund their necks?

ericdamiansean said:

does your hospital have senior consultants or attendings who don't like it when medical students hang their stets aorund their necks?

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I've had surgery residents who call it the "dog collar" and poke fun at the med students who wear them around their necks (same if you wear the white coat). That's why mine has been sat on--because I had it in the back pocket of my scrub pants. Every other specialty doesn't seem to care.

Around the neck in medicine, in the pocket (along with your brain ) in surgery. The old-skool way is to have the earpieces around your neck but then I hit myself in the groin every time I stand up and it tends to clamp my carotids shut.

What do you think about electronic stethoscopes that can save the heart sounds as mp3 files to be recorded on a computer? Wouldn't it be wonderful to ask multiple patients in the waiting room to auscultate themselves
electronically and have the sounds stored on the hard drive before the physician comes to see them? And umm.. what about saving the sounds on a 3.5 disc for the patient to take home with them?

Has anyone here used ultrascopes? How effective are they as advertised?

stwei said:

What do you think about electronic stethoscopes that can save the heart sounds as mp3 files to be recorded on a computer? Wouldn't it be wonderful to ask multiple patients in the waiting room to auscultate themselves
electronically and have the sounds stored on the hard drive before the physician comes to see them? And umm.. what about saving the sounds on a 3.5 disc for the patient to take home with them?

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it's not that useful..and I think the attendings etc won't be too happy to see that you have something that is far superior than what they have

and about saving the sounds..that sounds like a person who's gona piss off your other mates

STwei, what school are you in now?

Electronic stethoscopes do not work all that well. There is distortion of sounds and change in loudness of one sound relative to another. Since much of cardiac diagnosis is based on the quality and relative loudness of various sounds, you may be unable to draw the correct conclusions from the exam. I'm also extremely doubtful of the ability of electronic scopes to detect and reproduce low-pitched sounds like S4 and the rumble of mitral stenosis. A typical S4 has lower frequency than what most subwoofers can do. How do you expect a tiny speaker inside the stethoscope to reproduce that? Can your wristwatch or cellphone play realistic heart sounds? How do you expect the stethoscope to?

You don't need to be a cardiologist to be good at cardiac auscultation and ECG interpretation. What if you are a pediatrician or a family doc who misses HOCM and your 16-year-old patient drops dead in a basketball game a week after you signed that it's ok for them to play sports? What if you improperly medicate your patient because you missed their mitral stenosis and they syncope while driving? What if you miss a secundum ASD (most of which are closed with a 40-minute cath procedure now) and your patient comes back in 10 years needing a heart-lung transplant for Eisenmenger's.

And yes, your attendings will rip you a new one. First, because you spent $500 on a crutch for incompetent physicians. Second, because at the very onset of your professional training you will come across as a slacker who is unwilling to work hard on improving your physical exam skills.

I was wondering if anyone could let me know where I could find a price on diagnostic kits that are cheaper then allheart.com and steele.com. Also should i get a battery powered one or one with a plug in rechargeable battery ?? thanks

This one's around $10:

http://www.amazon.com/exec/obidos/ASIN/B000053HN7/002-1902358-9131236

Don't bother with the ophthalmo/otoscope. They have them on the walls all over the hospital and in the clinic rooms.

i have a welch allyn stetchoscope and it comes with two types of diaphragms: a flat one and a corrugated one....

which one is better for listening to hearts?
what's the difference?
what about for the peds head?

thanks for your help...

Harvey stethoscopes are pretty bad and very expensive. If you want decent, get Litman, if you want great get a Phillips Rappaport-Sprague

whichever provides most direct contact with the skin would provide the best sounds. dunno about that corrugated thing, most diaphragms are flat. honestly you could use a funnel to listen to the heart and it would do fine.

are you talking about the bell of the stethoscope?