Expensive stethoscopes
Started by officedepot
If physical exam findings were lab tests . . . we'd never order them.
Look, it's all part of the pieces of the puzzle that you put together. And if you think you can hear things just fine/same on all steth's you're ******ed. Now this doesn't mean you have to buy the newest litman cardio electronic steth, but get something decent. If you decide to play stupid games, you will win stupid prizes.
Good luck.
I have a littman classic and have heard subtle murmurs before. I'd trust a cardiologist with a cheap plastic scope more than a med student with any scope haha
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From what faculty and older students tell me, you'll be using your steth, and much of your other equipment, through residency and likely for your first gig as an attending. Paying an extra couple hundred now for all top tier equipment made the most sense to me. I understand your argument, and the skill of the operator >>> the craftsmanship of the equipment, but if I'm paying top dollar for healthcare, I expect my doc to have top tier equipment. And I suspect most patients feel the same (whether or not they can tell a $17 stethoscope from a $170 one is a different argument). Spend now, so you don't have to buy again later.
My $50 littman classic will do just fine for my prelim surgery year, and I don't plan to carry a steth ever again in my medical career. Not all medical specialties carry stethescopes, you know. Can you tell the difference between a Littman classic and a cardiology 3? I doubt a patient can either.
Do you never plan on doing a basic exam or physical on friends or family? Even if one plans on going into something super specialized, I doubt one would never use a stethoscope ever again. If that is you, feel free to stick with whatever steth allows you to pass, but if I were a betting man, I'd bet against you never using a steth again.
And it shouldn't matter one iota whether I or the patient can distinguish between a Littman classic and a cardiology 3. This isn't a game of trick the patient. Get equipment that won't limit what you can do.
I'm in Littman classic camp. It does the job. Another reason why I don't shell out half my loan for a steth is because sometimes in an exam my med school provides you with a steth, and trust me, it's not a Littman cardio by any stretch of imagination. Similarly ID ward where I was rotating had a separate steth for each patient for infection control purposes, and again, that stuff looked like it was made of plastic.
I think it was worth learning to hear things using simpler tech, because if one is only used to high quality amplified no interference sound, if the situation would arise that all you have is a plastic steth you wouldn't hear a thing through it. Now, this situation may never arise, but I still want to know my heart wouldn't sink if this is to happen.
I think it was worth learning to hear things using simpler tech, because if one is only used to high quality amplified no interference sound, if the situation would arise that all you have is a plastic steth you wouldn't hear a thing through it. Now, this situation may never arise, but I still want to know my heart wouldn't sink if this is to happen.
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I also have a Littmann Classic. I rotated with a 4th year who had some kind of electronic stethoscope and I swear every patient we came across he said he heard some diastolic murmur that nobody else could hear. Either he wanted to hear it or the stethoscope that he probably paid 3-4x as much as the rest of us did was just that much better.
Either way, I know my auscultation skills vastly improved once I actually started closing my eyes and really listening. Before I was just sort of going through the motions. The physical exam can tell you a ton about a patient that more expensive tests could also tell you, but the art of being a physician is pattern recognition based on findings you can see with your eyes, hear with your ears, feel with your hands, etc, not your ability to write for the most tests or labs or imaging or whatever.
Either way, I know my auscultation skills vastly improved once I actually started closing my eyes and really listening. Before I was just sort of going through the motions. The physical exam can tell you a ton about a patient that more expensive tests could also tell you, but the art of being a physician is pattern recognition based on findings you can see with your eyes, hear with your ears, feel with your hands, etc, not your ability to write for the most tests or labs or imaging or whatever.
I got a Harvey DLX and can definitely tell the difference in sound clarity between it and even a Cardio III. Whether or not I can use that difference is another matter entirely. 😛
The Harvey DLX is what I use and like the best. I could give a **** about murmurs. I hear the lungs much better.
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Be weary of super expensive steths. They are prime targets of being stolen in the hospital. I know, the best method is to keep it around your neck or pocket, but **** happens, you leave it by a computer then get paged for something, lose sight of the steth for a few mins.... gonzo.
Depends on what you go into. If you go into EM, Anesthesia or primary care specialties, you probably need a better one than if you end up going into other specialties. If the derm or optho consult is the guy who catches the subtle murmur the internal medicine resident misses, there are often some very upset attendings. Path and diagnostic radiology residents and attendings rarely even carry stethoscopes, so it's pretty much garbage for them (although rads and the other ROAD specialties are going to have intern years). And if you are in a big city hospital, such a large percentage of patients are going to be on contact precautions, so you are going to be using those $5 disposable scopes 90% of the time anyway. It's almost worth it to get good with those.
Reading comprehension is a useful skill, I never said I'd never use a steth again, simply that I wouldn't carry one, I can always borrow a steth from a resident/med student in any case. Pretty sure I've never seen an radiology resident/attending carry a steth.
You're making the assumption a classic will limit you in auscultation, my argument is that it won't in anything besides perhaps cards.
Definitely not. If I'm in a field where I'm not using a stethoscope regularly why would I want to keep one around to do physicals on my family members or friends? I will obviously have very little skill if I'm not doing it regularly so fancy stethoscope or not I wouldn't trust my findings.
Lung sounds are much higher yield than cardiac auscultation. I've actually made clinical decisions based on lung sounds and I don't consider my physical exam skills to be all that great.
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agreed
I fundamentally believe that every specialty (save maybe derm) should and will involve a stethoscope. It is our responsibility as physicians to help our patients. Sure, the ENT doc may not be the one diagnosing a COPD exacerbation in the ER, but they certainly are physicians and they can certainly perform a physical exam. One particular example I like to site is that we (as the ENT outpatient docs) detected a renal bruit that had gone unmentioned in a series of progress notes from other physicians.
Alot of people say "its the farmer, not the tools." That its whats between the scope that matters (i.e. you and your training). That is totally correct. But here's where I'd like to change the perspective. As novice physicians, learning the physical is hard. And, there are many excuses as to why you fail, many excuses as to why you just "shouldn't bother." Its a road taken by many students.
So what I say is that it is worth it to get an expensive stethoscope, even if you are "just learning" or "won't use it that often." If you can reduce the scapegoats, if you can feel, deep in your soul, that the inability to hear sounds is a product of your training and your training only, you are likely to train harder. If you have confidence in your stethoscope you will have confidence in your ability to eventually learn.
I used a Littman master Classic for a while. Upgraded to a Cardio III and was able to hear my girlfriends 1/6 murmur, where I just didn't believe she had one with the Master Classic. Now, I'm not going around listening for grade 1 murmurs, but the point is that things I might not have been able to hear I now will hear, and hoepfully will make a better effort to listen.
It is the farmer not the tools (usually), but a nice tractor is better than a pair of ox.
The sad thing about cardiac auscultation is that, while its pretty impressive to nail the diagnosis on the head just by auscultation, the end result is always the same. Echo. And usually, you don't get to the Echo any faster by what you hear. Still, if you want to impress people around you in academia (because very few people in training have yet to realize that echo is the next step anyway, apparently) cardiac auscultation is the way to do it.
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Well, I would argue that if you know what cardiac murmur you're hearing, you might be able to avoid getting an unnecessary echo.
