Clinical gear?

[amakhosidlo]

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We got sent the list of gear last month that we'll be using to learn the physical exam next quarter, and I'm really at a loss as to which brands to go with and what kind of quality we should be looking for. We just had a Welch-Allyn rep in, who was trying to hock some obscenely expensive kits, and I just felt like there has to be some middle ground between the $500 Otoscope kit he was selling, and something you'd expect to find a Fisher-Price label on.

By spring quarter we're supposed to have:

A BP cuff
A stethoscope (already got one)
Otoscope
Reflex hammer
2 tuning forks

So far the only advice I've heard is to make sure you have an XL BP cuff in your tool kit (They were half-joking that sizes should run peds, adult, and 'American adult' 🙄)

Anyone have any recommendations?

 

[DrBowtie]

I'd just buy a reflex hammer and if you can find them really cheap the tuning forks.
Borrow an otoscope kit if you really need one.

Confirm the "requiredness" of purchasing these things from upperclassmen, but the above seemed to be true amongst myself and friends at other schools.

 

[CardiacIntensivist]

Don't listen to those Welsh-Allyn Reps!

Agree with above, learn what is required first and what you can get away with sharing with another student.

Then buy it online!!!

None of my classmates really use our own equipment except stethoscope, penlight and sometimes reflex hammer. To be honest though, someone taught me how to use my stethoscope as a reflex hammer and I haven't gone back since.

 

[Melicopter]

Stethoscope and penlight. That's it.

If you want to practice BP, you can buy a cheap one online. I could see how that could come in handy. There's no way I'd buy an otoscope. Those things are crazy expensive.

Get a good stethoscope, though! It's hard enough to distinguish the sounds. I'd hate to learn to do that while using a stethoscope I can hardly hear with. I have the cardio III, and I love it.

 

[Forthegood]

Like everyone else here, I also didn't buy my own oto/optho set. When I need it (~1 or 2x /week--bc I actually do full physicals) I just use my buddies. We keep the set in his locker and I have his combo. I think I bought him lunch once as a "thank you".

But if you DO buy this stuff, do NOT buy cheap equipment. One of the guys I round with bought a cheap set, and you can't see jack with his otoscope, and the optho is worse. He eventually sold it on ebay "opened, barely used" and now shares with my buddy as well.

Cheap equipment is cheap. Eye exams are hard and you need good equipment and lots of practice. Ear exams you need a bright light.

Also, most of the speculum covers fit Welch Alllyn products only. I am sure there are other good kits out there, but I would recommend trying a couple out first if you are going to buy one, then get it online.

 

[OveractiveBrain]

This has been discussed a couple of times on SDN, so for more detailed info, go check out the search function.

Tuning Fork. It doesn't matter what you get. Bigger ones have more wavelengths, blibbity blah. For a med student, you are going to ask "can you hear this" and "is it louder in your left or right ear." Get a cheap tuning fork. You are going to lose it, and are unlikely to use it again, except on your one-month neuro rotation.

Reflex Hammer. It doesn't matter what you get. With reflex hammers it is definitely the user and not the product (i usually use the head of my stethoscope since I am often without one). Get a cheap tuning fork. You are going to lose it (Ive "lost" three; I give the people near my white coat the benefit of the doubt). This one, however, you SHOULD be using often, but its likely to fall out of your pocket.

BP Cuff. Hopefully you are going to be use this to practice on each other, not to actually care around a kit to practice medicine. I practice in what might as well be a third world country, and we have a BP cough for everbody. I would not even buy one of these unless you intend to actually practice it with your friends outside of your clinical diagnosis session. In any case, buy a cheap one, like one from walmart.

Otoscope. I had the misfortune of actually getting one from my parents first year. I never used it. It was an expensive pen light. The ERs and Clinic Room ALL have wall-mounted opthos and otos, and the ONE time I was on a ward and had to use one it was totally nonessential. DONT get an otoscope. Obviously, as was said, confer with upper students as to the absolute "necessity" of your own Oto.

Never buy from Reps or Bookstores. They are always overpriced. I am originally from Connecticut and like Moore Medical's service (where their distribution center and HQ is). Any website will do, but If i do business, I do it with Moore Medical.

 

[justdoit31]

we were required to have both an otoscope and opthalmoscope- they had one workshop that required it but that is the only time I see myself using it. I ordered a cheaper one from starvingmedstudent.com which wasn't "cheap" but beat the heck out of the expensive ones they were selling at school and anytime I need one in clinic it is available so the only time I would use my lower quality one would be on missions trips.

 

[Laryngophed]

It was suggested by the powers that be that we purchase the oto/ophthalmoscope, however they aren't required.

I bought my stethoscope from Steeles, and they were great to me. I have a $20 reflex hammer that was a gift, as was a 256 Hz tuning fork (it was about $5) but I've never really used them outside of learning the PE.

 

[nitemagi]

I have a $20 reflex hammer that was a gift, as was a 256 Hz tuning fork (it was about $5) but I've never really used them outside of learning the PE.

You'll use them on neuro.

 

[Laryngophed]

You'll use them on neuro.

I've heard as much, but I should focus on learning neuro as an MS1, first. 😉

 

[DoctwoB]

There are other threads about this, do a search. General idea is:

1. Talk to upperclassmen to see if you actually need these things or if they are actually required. A lot of schools say you need them then they get stashed away and never touched. At my school, we do actually use them at least 1x week in doing h&p's in the hospital, where there is supposed to be an oto/ophtho scope for the unit, but good luck finding it (for outpatient clinics and VA there in every room).

2. Decide if its worth the money for a nice set. They're expensive, but there is a definite difference in quality. I opted for the "bought a nice set used on the cheap from a fourth year" approach, which I highly recommend.

3. Definitely pick up a decent stethoscope, either a litmann cardio III or harvey elite, and then label it everywhere so it doesn't walk away. You don't want to be the one guy who can't hear the murmur on your medicine rotation.

 

[MossPoh]

Stethoscope.

Maybe a nice penlight with replaceable batteries that clips with your pens.

Not really much else. I have a reflex hammer....I usually use my stethoscope head because it is convienent and one less thing to carry around. Obviously when I was doing neuro exams all day for research I had a real one, but never really use it much otherwise.

BP cuff? I guess if you want to practice.

All the scopes? I'm yet to encounter a doctor's office that doesn't have one or one I could snag from a nurses station. We also don't rotate at academic centers, so I don't know how stuff goes down there.

 

[nitemagi]

If you're gonna carry a reflex hammer, especially as a medical student (when you're still figuring out where to hit for reflexes), I'd recommend getting one with some heft. Not a regular tomahawk. More like a Troemner, dejerine, or queen's square. Careful with telescoping - cheap ones break easily.

http://www.usneurologicals.com/hammers.html

 

[MossPoh]

If you're gonna carry a reflex hammer, especially as a medical student (when you're still figuring out where to hit for reflexes), I'd recommend getting one with some heft. Not a regular tomahawk. More like a Troemner, dejerine, or queen's square. Careful with telescoping - cheap ones break easily.

http://www.usneurologicals.com/hammers.html

Those telescoping ones are awful. I think for a med student, a Troemner or dejerine is probably a safe bet. Those non-telescoping queen's squares can be a little awkward to throw in a whitecoat.

It is amazing the difference those hammers make from the crappy ones....especially at first.

 

[amakhosidlo]

There are other threads about this, do a search. General idea is:

1. Talk to upperclassmen to see if you actually need these things or if they are actually required. A lot of schools say you need them then they get stashed away and never touched. At my school, we do actually use them at least 1x week in doing h&p's in the hospital, where there is supposed to be an oto/ophtho scope for the unit, but good luck finding it (for outpatient clinics and VA there in every room).

...which is why I did both. The answers on past threads varied widely, as have the opinions of upperclassmen at my school.

So far the only consensus I've gotten has been that:

#1. What's between the earpieces of a stethoscope is more important then the 'scope itself.

#2 A BP cuff is a BP cuff. No, we won't use it often. No, hospital rooms won't have one. Def. required

My main question I guess centers around what exactly qualifies as 'nice', and at what level of quality is generally practical re: the oto/optho

 

[silas2642]

We got sent the list of gear last month that we'll be using to learn the physical exam next quarter, and I'm really at a loss as to which brands to go with and what kind of quality we should be looking for. We just had a Welch-Allyn rep in, who was trying to hock some obscenely expensive kits, and I just felt like there has to be some middle ground between the $500 Otoscope kit he was selling, and something you'd expect to find a Fisher-Price label on.

By spring quarter we're supposed to have:

A BP cuff
A stethoscope (already got one)
Otoscope
Reflex hammer
2 tuning forks

So far the only advice I've heard is to make sure you have an XL BP cuff in your tool kit (They were half-joking that sizes should run peds, adult, and 'American adult' 🙄)

Anyone have any recommendations?

Buying medical equipment was such a waste of money for me. Definitely check with upper classmen to figure out if you're actually required to have this stuff or whether or not you can get away with borrowing a buddy's opthalmascope/otoscope.

The only time i've ever used a BP cuff was to check my own blood pressure. I have never used it on an actual patient. I never carry a real reflex hammer, but if you're considering neurology, a good hammer is a great investment. I bought a cheap penlight, since they have a tendency of growing legs. I have used my otoscope/ophthalmascope like twice to look in my nephew's ears and then I sold it to a first year in brand-new condition.

Look, the only thing that you'll really need is a decent stethoscope. In this department, I do believe that quality matters You'll be carrying enough crap in your pockets as it is when you hit the wards. There is no way in hell you're going to run around with a BP cuff, or a diagnostic set in your pocket (unless you become a neurologist-- in that case you'll have your own little purse of toys).

 

[gro2001]

Those telescoping ones are awful. I think for a med student, a Troemner or dejerine is probably a safe bet. Those non-telescoping queen's squares can be a little awkward to throw in a whitecoat.

It is amazing the difference those hammers make from the crappy ones....especially at first.

I disagree. I use a telescoping Queen's Square hammer, and couldn't be happier. I guess, as in everything else, quality plays a great deal. I can see how a crappy telescoping hammer would be a pain, but mine has never given me trouble.

 

[d1ony5u5]

At the beginning of the year, I refused to buy anything but the cheapest equipment, except for the stethoscope.

The stethoscope you will use all throughout your training, so it makes sense to buy something of good quality. I got the Littman III on allheart. I suppose you can get away with a toy one for the preclinical years, but I can't imagine that being a good strategy later on, when distinguishing what you hear starts mattering a lot more...

BP cuff does seem to be an exaggeration... Never heard of doctors carying these around, but if your school absolutely requires it, I guess you'll indeed need one. Find out from upper classmen! And you really can learn to take a BP measurement quite fast, it is not that complicated a technique. So --personally-- I don't think a BP cuff is worth it at all, if you can find one to learn on.

Tuning forks and pen lights you can get for really cheap, as well as the reflex hammer (like $20 for all, max. Probably a lot cheaper if you get online). So, why not?

Now the really tricky issue of oto-ophthalmoscopes. I was absolutely against getting this expensive piece of equipment given all the arguments exposed here and elsewhere. I even got through my Physical Exam class without one, just borrowing from people in my class. When I asked upper classmen, I got the whole spectrum of answers. From "don't, it's a waste of money" to "you really need it several times throughout, so you'd better get one." Finally, I've decided that if I want to really learn eye and ear exam techniques, it is really good to have my own set. Borrowing from friends makes this difficult because every model is a bit different, and so on top of the innate difficulty of these techniques (specially fundoscopy), having to get used to a new instrument everytime you have a session complicates things further.

Having said that, I'm still reluctant to throw the ~$400+ at Welch-Allyn on principle. At the moment, it is also impossible for me to come up with that money and not end up homeless during the summer... So I've been looking into the wisdom of getting a cheaper set. From experience with a number of sets (from my borrowing days), I know that the difference in quality is noticeable, but won't stop you from seeing what you need in most but the absolute cheapest of sets. That, and the fact that most doctors never carry these, have made me decide for a low to mid-range set. If I had the money, I'd probably invest in a Welch-Allyn-like set because they are really easy to use and the view is actually pretty nice. Then I'd sell it to get some of that money back. Since that is a luxury I can't afford, I spotted this little set that seems like a good fit:

http://www.amazon.com/Riester-Pen-Scope-Otoscope-Ophthalmoscope-Vacuum/dp/B0013EMTC4

From the limited reviews I've found, and from actually trying it out in the bookstore, it looks like it will do the trick. The optical quality is definitely inferior than that of the W-A stuff, but it's not as low as others my classmates have bought (ADCs and nameless brands). Also, by virtue of being cheap, I won't be as aprehensive about taking it with me on the wards in the future...

Bottom line, I think it is wise to get one. At least just to learn the basics. Hope that helps!

PS. Does anyone have any experience with the oto-ophthalmoscope set (Riester Pen-Scope) posted above? There are very few reviews online, and would like to know a bit more about it.

EDIT: So, just corresponded with a fellow here on SDN who has the above scopes. He doesn't recommend them for learning. Back to the drawing board...

 

[BigRedder]

Enough people have made the mistake of buying oto/ophthalmoscopes they don't need that you can Welch Allyn ones on eBay most all the time, usually priced at 50-75% off what they cost if you order through the school...

 

[avatarftw]

A BP cuff-10 bucks on amazon.
A stethoscope (already got one)
Otoscope--150 or so from what I've seen online (used) for the welch allyn ones.
Reflex hammer--2 bucks on amazon
2 tuning forks--3 bucks on amazon.

Its not that expensive if you look. Why would you spend 500 bucks on a kit when you will have little use for it in the future?

We got sent the list of gear last month that we'll be using to learn the physical exam next quarter, and I'm really at a loss as to which brands to go with and what kind of quality we should be looking for. We just had a Welch-Allyn rep in, who was trying to hock some obscenely expensive kits, and I just felt like there has to be some middle ground between the $500 Otoscope kit he was selling, and something you'd expect to find a Fisher-Price label on.

By spring quarter we're supposed to have:

A BP cuff
A stethoscope (already got one)
Otoscope
Reflex hammer
2 tuning forks

So far the only advice I've heard is to make sure you have an XL BP cuff in your tool kit (They were half-joking that sizes should run peds, adult, and 'American adult' 🙄)

Anyone have any recommendations?