Diagnostic Equipment

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OzzyIV

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I'm a 1st year and need to buy my diagnostic equipment for next semester but with so many out there I really don't know what's worth the money and what isn't. I need

stethoscope
diagnostic set – ophthalmoscope and otoscope
sphygmomanometer

tuning fork
reflex hammer


Any suggestions?

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In short:
Stethoscope - Littmans Master Classic, Littman Classic SE II ($100)
Oto/Optho - Don't get one, they are available everywhere you practice
Tuning Fork/Reflex Hammer - cheapest you can find, technique > tool
Pen Lights - they walk, alot. Get a box of el cheapos.

Stethoscope.
Beginner Recommended: Littman Master Classic (one sided, tunable diaphragm), Or Littman Classic SE II (Switchable Bell and Diaphragm) $100

Advanced Preference: Littman Cardiology III, Littman Master Cardiology, Welch-Allyn Elite (in no particular order)

I rolled in to medical school as a paramedic, and was already using the Littman Master Classic (tunable diaphragm). It runs about 100 bucks, is highly durable, and will be competitive for the use of any medical student. I do not recommend investing 200+ for a Cardiology iii, Master Cardiology, or Welch-Allyn Elite. While these are considered the top of the line popular scopes, what becomes more important is the person using the scope, not the scope itself. But at the same time you want to be able to hear the sounds you are supposed to. So getting the 30 dollar scope will allow you to look like you are going through the motions, but you may not be able to hear the sounds. What is subtle for you is probably obvious to the attending, so having a slightly better scope will help you identify what you are supposed to hear, not the superfluous sounds of artifact.

There is a significant amount of debate between scopes. There is no real good resource for distinguishing which is best online. You will likely be influenced by some one you respect's opinion, and be pushed into one over the other. Some advocate for bell-diaphragm being separate to force you to learn the different pathologies and when to use one or the other. Others will say the tunable diaphragm makes things easier and is just as good. Honestly, as a novice, it really won't matter, and any mid-range, decent scope is well worth the money.

Oto/Optho.
Do Not but anything

DO NOT buy an opthalmoscope/otoscope unless directed by your institution. Literally every clinic or ER bed I've been to (and I've worked in about as third world as you can get without leaving the country) has their own set on the wall. Fun to play with, maybe useful to practice with friends, you will not carry around your own. if you do, you will likely be made fun of or even chastised for being over prepared. Over-prepared says "lack of confidence" not "looking forward." My parents didn't know any better and bought me one my first year. I was all excited "yay im going to doctor some people!" I didn't use it once except to practice with my girlfriend. Then if broke in a move. 150 bucks wasted. Now, I always have access to the ones on the wall. PLus you dont want to be that douche gunner that carries around all their own equipment when you barely know how to use it in the first place.

Fork and Hammer.
Anything you Can find cheap

Any tuning fork and reflex hammer will do. There are differences in frequencies, size, and yadda yadda, but again, for your purposes (practice mostly) getting any cheapo version is going to be great. Don't spend more than 10 dollars on a tuning fork or 10 dollars for a reflex hammer. Your school bookstore likely has grossly inflated prices which may make the 10 dollar mark seem small. Again, it is more about developing your skill in eliciting the responses than the equipment. I've lost two reflex hammers and resort to using my stethoscope unless I suspect neurologic involvement, where I go find somebody with a hammer.

Pen Light.
Buy a Box of el Cheapos

I literally never have one when i need to. I've actually adjusted my physcial exam to not require it since I'm always without it. If i have the otoscope on the wall, I use that. That being said, you should ALWAYS have a pen light. It helps you see in the dark, it helps you see in the throat, it helps you test pupillary reactivity. But these things break, get lost, and fall out of your coat. Buy a box of 20 or so super cheap ones. That should last you through medical school.

BP Cuff.
Anything Cheap

You aren't starting a clinic. Get something cheap enough for you to practice on your freinds, if you intend to practice at all. Thats all your BP cuff is good for. Unless you are worried about your own BP, and want to practice by checking it, buy whatever cheap one is at the Bookstore.

Final Note
I like Moore Medical for purchasing stuff. They are usually cheaper than the Bookstore, not the cheapest, but man are they reliable. I've bought a bunch of stuff through them for my paramedic job and as a medical student. I have had one problem which was promptly corrected at no cost to me. The trade off of superior customer service for a little more than the cheapest chinese knock off is totally worth it, in my opinion.
 
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Thank you for the detailed information... it's very helpful! Unfortunately I AM required to purchase a oto/otho. What is your suggestions on a set that is worth the money?
 
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I got one that was 300 dollars. Im not sure of the make or model now, since it broke, and I tossed it. What a waste.

The other day I saw a combo set (two wands, one for each the oto and optho) in the book store from ADC for like 130 bucks. Honestly, unless you are in the carribean AND they don't have decent technology for you to use, ANY model is going to be good enough to practice with.

If you need something to actually diagnose the ill with, I'm going to have to defer to some one more knowledgeable. I've never actually looked at the make or model of the ones on the walls of the clinics and ER beds.
 
Oto/Optho.
Do Not but anything

DO NOT buy an opthalmoscope/otoscope unless directed by your institution. Literally every clinic or ER bed I've been to (and I've worked in about as third world as you can get without leaving the country) has their own set on the wall. Fun to play with, maybe useful to practice with friends, you will not carry around your own. if you do, you will likely be made fun of or even chastised for being over prepared. Over-prepared says "lack of confidence" not "looking forward." My parents didn't know any better and bought me one my first year. I was all excited "yay im going to doctor some people!" I didn't use it once except to practice with my girlfriend. Then if broke in a move. 150 bucks wasted. Now, I always have access to the ones on the wall. PLus you dont want to be that douche gunner that carries around all their own equipment when you barely know how to use it in the first place.

This has been discussed here before, and the point you're missing is that in-patient rooms generally don't have scopes on the wall. OP, your best bet is to buy a used one from a graduating student.
 
Another option is to use Ebay. If you go with that route make sure that you read the listing thoroughly to make sure you're not bidding on something that is ancient & won't work.
 
Required or "Required". Ask upper levels.

BINGO!

We have lots of "required" things at my school. Most of us never buy them. Because you don't actually need them for anything.
 
If you need an oto/opthoscope for classes in the first two years, borrow it from an upper level student for the day.

If you need it for third year, get a cheap and reliable one. Inpatient rooms at less wealthy hospitals often don't have them so yes you will need it in those instances. Do not for the love of god buy the Pan-optic ones, those are really good but completely useless unless you intend to become an ophthalmologist.
 
Do not for the love of god buy the Pan-optic ones, those are really good but completely useless unless you intend to become an ophthalmologist.

Unless you buy it used for about $100, because they are totally awesome. :thumbup: Also, I recently saw an ophthalmologist who doesn't own one, which made me feel especially silly for having it.
 
If you need an oto/opthoscope for classes in the first two years, borrow it from an upper level student for the day.

If you need it for third year, get a cheap and reliable one. Inpatient rooms at less wealthy hospitals often don't have them so yes you will need it in those instances. Do not for the love of god buy the Pan-optic ones, those are really good but completely useless unless you intend to become an ophthalmologist.
Disagree with this. A panoptic makes it WAY easier to do a fundoscopic exam. I realize that most people don't even do a fundal exam anymore, but I (and some of my attendings/residents/etc) happen to think it is useful and an integral part of the physical exam.

None of the inpatient rooms at any of the hospitals in which we rotate have oto/ophthalmoscopes in them, so you need your "own" (or need to hope that someone else on your team has one.)

Panoptic = easier = not jacking around with one of the pocket scopes that most people buy = quicker

Whether you think they are worth the money (I got the top-of-the-line set for ~$400 barely used on eBay) is your call, but to say that they are completely useless is just not true...
 
I went with the Welch Allyn Panoptic set with the Lithium handle, otoscope, etc. I did plop down ~750 bucks for it new through the WA website with the student discount. I've used it for the piddly assignments/physical diagnosis during second year when you don't really know what you are doing, during third year rotations where you really learn physdx, and fourth year rotations/AI, etc. I carry it with me almost all the time since none of our ward rooms at the county hospital or VA have them (which is where I spent 85% of my time during 3rd/4th year) and no one else ever has one either. I found that spending the relatively large amount of money upfront encouraged me to use it much more than if I had to go find one to do a fundoscopic exam, etc. I basically did eye/ear exams on every patient I saw during third year in order to practice that part of the exam. I think this is the only way to figure out what a "normal" and "diseased" retina looks like. It is a good feeling when a patient really needs a fundoscopic exam to solidify your differential and you use equipment that you are familiar with and narrow down your differential right there, then present that finding on rounds. I can think of quite a few times this happened on IM (CMV retinitis in HIV), trauma (detached retina), and especially my neuro block (at least 3 pseudotumor cerebri pt's in a month).

Sure, anything you can do with your own ophtho/otoscope can be accomplished with a borrowed one, but the ease of pulling a familiar piece of equipment, which you have used a bunch, out of your pocket and doing it as a seamless part of your exam vs. hunting down one which you may or may not be familiar with; I find this worth the upfront cost.
 
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