How many stethoscopes have you lost?

[deleted875186]

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Just lost my stethoscope in the hospital. Anyone ever have theirs find their way back to them.

Do people even still carry stethoscopes in practice, or just use the disposable ones on the rare occasion it’s needed?

 

[ProtonPump]

Have had the same stethoscope since medical school, lost it several times, have a name tag on it and it's always come back to me.

 

[chocomorsel]

Never lost one. Had mine for over 9 years and yes, I still carry it and actually use it. A lot of people don't though in PP. Or at least they don't carry them openly. Probably tucked in their bags somewhere and not always used. In many of my hospitals there were always stethoscopes hanging on the medicine/anesthesia cart. I just found that gross to share ears though plus I listen to most of my patients in preop too.

 

[Psai]

I keep it nicely tucked away with my ophthalmoscope and queens hammer

 

[chocomorsel]

I keep it nicely tucked away with my ophthalmoscope and queens hammer

What’s a queens hammer?

 

[deleted162650]

I still carry it and actually use it.

Flea collars. 🙄

 

[Guillemot]

I carry one. Recently replaced a cardiology III that I had since MS1 that wore out (both bell and tubing) with a lower end littman that is still vastly superior to the toy ones. Too loud in pre-op to detect anything subtle with a fancy ones anyways.

 

[coffeebythelake]

use the disposable ones.

 

[NICMAN]

I bought the best non-electric one about 14 years ago and still use it everyday. I even listen for carotid bruies.

 

[NICMAN]

Didn’t buy the $1,000 otoscope/ophthalmoscope/neuron exam at the start of Med school since they had those in literally every single exam bay/room in School. Also you can check reflexes with fingers—or just consult neurology.

 

[narcusprince]

Here is the real question. How often do you use your stethoscope?

 

[deleted171991]

Here is the real question. How often do you use your stethoscope?

On every patient.

 

[coffeebythelake]

Here is the real question. How often do you use your stethoscope?

i use stethoscope on patients that need it.
known cardiopulmonary history, recent URI, low baseline sats, etc
after intubation especially if performed by someone other than myself

 

[Psai]

Here is the real question. How often do you use your stethoscope?

I think having it is better than not

 

[pgg]

I lose mine several times per month but my name is on it and it always finds its way back to me.

 

[chocomorsel]

Here is the real question. How often do you use your stethoscope?

Errrday!!!!

 

[coffeebythelake]

over the years, i've have a NET GAIN of stethoscopes.
cardiology III's...
not intentional...
but what that means is somebody else lost theirs....

 

[deleted87051]

3 stethoscopes. Countless phone charging cables. And I put my name on everything.

 

[psychbender]

I had my very first stethoscope (that I bought for myself when I was an EMT) walk off one day in residency. After that, I bought a Cardiology III, along with a nice holster, and have had it with me since. Use it with every patient

Sent from my SM-G930V using SDN mobile

 

[OB1🤙]

My stethoscope is an ultrasound machine.

 

[San Marzano]

Here is the real question. How often do you use your stethoscope?

How else could I chart "RRR CTAB" on every patient?

 

[cowbydoc]

I once lost one on my last day as a med student at a small rural hospital. They found it, called my med school and mailed it to me a thousand miles away. Unbelievable that they did all that. 13 years later I still have it.

 

[ProtonPump]

I once lost one on my last day as a med student at a small rural hospital. They found it, called my med school and mailed it to me a thousand miles away. Unbelievable that they did all that.

I think it's because people hate that feeling of having lost a stethoscope so if they find one and can identify who owns it they really will try and go out of their way to reunite it with it's owner.

 

[axeon123]

I bought an expensive one during medical school because it was like the only cheap base model in the student store (Cardiology series). Lost it during residency between cases. It was tagged with my name and pager number on it. Out of disgust, I used the disposable ones for the remainder of residency.

After that I purchased one of these: Amazon product ASIN B002TMPO0I
Works decent enough and I can lose 8 for the cost of one Littmann Cardiology.

 

[deleted875186]

I’m convinced there is no actual need for a high end stethoscope. Perhaps the only important things to note would be wheezing, crackles, or the occasional AS murmur, all can be done with a cheap stethoscope. Beyond that, we get echos or chest x rays.

 

[narcotics999]

Lost one during internship, Welch Allyn Harveys, 250+ bucks. Name engraved on it. Whoever kept it needs to give a good explanation about the name. Actually I was somewhat relieved. The dual bells were so heavy and my neck hurt (or hip hurt if on pants)

Got master cardiology. So far so good (pls keep this way). Use it everyday. Vascular MD know I have a good one and ask for it after AVF.

 

[Psai]

Lost one during internship, Welch Allyn Harveys, 250+ bucks. Name engraved on it. Whoever kept it needs to give a good explanation about the name. Actually I was somewhat relieved. The dual bells were so heavy and my neck hurt (or hip hurt if on pants)

Got master cardiology. So far so good (pls keep this way). Use it everyday. Vascular MD know I have a good one and ask for it after AVF.

So that's why my scope says narcotics999 on it...

 

[deleted697535]

Never lost one, never bought one. Cheapo disposable ones just as good/useless as anything else.

They're like an id tag for the flappers in a hospital

 

[deleted643396]

The clipboard warriors at one of my hospitals decided that stethoscopes cause Ebola, so we are not allowed to bring our own into the OR. Instead we have Fisher Price stethoscopes that we reuse and hang on the back of our machines...because that’s probably cleaner.

 

[DocVapor]

Was given a nice stethoscope way way back in undergrad when I started volunteering in EMS. Somewhere around 15 years ago. Still carry it in a holster and use it every day. Might have misplaced it once or twice, but never lost it.

My dignity, on the other hand...

 

[mimelim]

I have a Littman Cardiology II in my whitecoat and a cheap disposable one on my jacket. I lost my Cardiology III in medical school.

 

[coffeebythelake]

The clipboard warriors at one of my hospitals decided that stethoscopes cause Ebola, so we are not allowed to bring our own into the OR. Instead we have Fisher Price stethoscopes that we reuse and hang on the back of our machines...because that’s probably cleaner.

clipboard *****s!!!!!!

 

[Twiggidy]

What are these “stethoscopes” you guys speak of?

 

[dannyboy1]

Still have mine from medical school. And still haven’t learned how to use it 😉

 

[Consigliere]

Zero. Can't lose what you don't have. If I MUST use a steph-o-whatever (for appearance sake only) I'll borrow one of the nurses.

 

[Ezekiel2517]

RIP breath sounds

 

[pgg]

I take it you guys don't believe in "performing a focused examination of the patient" as mandated by the ASA standard*?

The relevant ASA practice advisory states, "At a minimum**, a focused preanesthetic physical examination should include an assessment of the airway, lungs, and heart, with documentation of vital signs."

So, are you really never doing these things, and not documenting an exam in the record?

Or are you really never doing these things, and documenting (falsifying) an exam in the record?


* standard, not guideline
** emphasis theirs, not mine

 

[Twiggidy]

Zero. Can't lose what you don't have. If I MUST use a steph-o-whatever (for appearance sake only) I'll borrow one of the nurses.

 

[Twiggidy]

I take it you guys don't believe in "performing a focused examination of the patient" as mandated by the ASA standard*?

The relevant ASA practice advisory states, "At a minimum**, a focused preanesthetic physical examination should include an assessment of the airway, lungs, and heart, with documentation of vital signs."

So, are you really never doing these things, and not documenting an exam in the record?

Or are you really never doing these things, and documenting (falsifying) an exam in the record?


* standard, not guideline
** emphasis theirs, not mine

This reminds me, I need to start documenting a murmur preop for our valves

 

[chocomorsel]

I take it you guys don't believe in "performing a focused examination of the patient" as mandated by the ASA standard*?

The relevant ASA practice advisory states, "At a minimum**, a focused preanesthetic physical examination should include an assessment of the airway, lungs, and heart, with documentation of vital signs."

So, are you really never doing these things, and not documenting an exam in the record?

Or are you really never doing these things, and documenting (falsifying) an exam in the record?


* standard, not guideline
** emphasis theirs, not mine

I worked in a few places where there isn't even a place on the preop sheet to document the PE.

 

[vector2]

I take it you guys don't believe in "performing a focused examination of the patient" as mandated by the ASA standard*?

Well, the full text of that part of the ASA standard says:

"

1. Interviewing and performing a focused examination of the patient to:
   2.1 Discuss the medical history, including previous anesthetic experiences and medical therapy.
   2.2 Assess those aspects of the patient’s physical condition that might affect decisions regarding perioperative risk and management."

"

When I'm staffing the ICU, every patient gets a daily focused PE (either by me or resident/fellow) because these people have proven illnesses. But in the pre-op setting I don't auscultate unless I have something from my history or interview that gives me a pre-test probability which justifies doing so. On an ASA 1 for a toe surgery who has no complaints other than the foot, no chest pain/SOB, and good exercise tolerance, there are no "aspects of the patient's physical condition" that affect my perioperative risk stratification or management.

The relevant ASA practice advisory states, "At a minimum**, a focused preanesthetic physical examination should include an assessment of the airway, lungs, and heart, with documentation of vital signs."

So, are you really never doing these things, and not documenting an exam in the record?

Or are you really never doing these things, and documenting (falsifying) an exam in the record?


* standard, not guideline
** emphasis theirs, not mine

First of all, this is just an advisory and I take it with a grain of salt. Secondly, let's look at the text from that document:

"A preanesthesia history and physical examination precedes the ordering, requiring, or performance of specific preanesthesia tests and consists of (1) evaluation of pertinent medical records, (2) patient interview(s), and (3) physical examination. No controlled trials of the clinical impact of performing a preanesthesia medical records review or physical examination were found (Category D evidence)."

Do I think the pre-op physical exam is totally worthless? No, I don't, and of course there are people with obvious symptoms or a dense medical hx who do need to be examined. But I definitely believe that a blanket statement like "100% of patients need pre-op heart/lung auscultation" is nonsense.


Same goes for listening to breath sounds after intubation. Total waste of time when the tube is at a standard shallowish depth and compliance on the bag/vent is normal. I've looked at hundreds of CXR of patients coming to the unit after anesthesia and 99.99% of them are 5 cm above the carina.

 

[pgg]

Well, the full text of that part of the ASA standard says:

"

1. Interviewing and performing a focused examination of the patient to:
   2.1 Discuss the medical history, including previous anesthetic experiences and medical therapy.
   2.2 Assess those aspects of the patient’s physical condition that might affect decisions regarding perioperative risk and management."

"

When I'm staffing the ICU, every patient gets a daily focused PE (either by me or resident/fellow) because these people have proven illnesses. But in the pre-op setting I don't auscultate unless I have something from my history or interview that gives me a pre-test probability which justifies doing so. On an ASA 1 for a toe surgery who has no complaints other than the foot, no chest pain/SOB, and good exercise tolerance, there are no "aspects of the patient's physical condition" that affect my perioperative risk stratification or management.



First of all, this is just an advisory and I take it with a grain of salt. Secondly, let's look at the text from that document:

"A preanesthesia history and physical examination precedes the ordering, requiring, or performance of specific preanesthesia tests and consists of (1) evaluation of pertinent medical records, (2) patient interview(s), and (3) physical examination. No controlled trials of the clinical impact of performing a preanesthesia medical records review or physical examination were found (Category D evidence)."

Do I think the pre-op physical exam is totally worthless? No, I don't, and of course there are people with obvious symptoms or a dense medical hx who do need to be examined. But I definitely believe that a blanket statement like "100% of patients need pre-op heart/lung auscultation" is nonsense.


Same goes for listening to breath sounds after intubation. Total waste of time when the tube is at a standard shallowish depth and compliance on the bag/vent is normal. I've looked at hundreds of CXR of patients coming to the unit after anesthesia and 99.99% of them are 5 cm above the carina.

All fair points.

However, 3 things -

1)

But I definitely believe that a blanket statement like "100% of patients need pre-op heart/lung auscultation" is nonsense.

I don't disagree. Yet that's not what's being said in this thread ... we have people who don't own stethoscopes, and/or never use them. Surely some number less than 100% but more than 0% deserve a listen.

2) "No controlled trials of the clinical impact of performing a ... physical exam ..." has the ring of "No controlled trials of the utility of parachutes ..."

3) And the last point I was getting at is that there is a disconnect between what our society's guidelines and standards say, and what many people are doing. We have a standard and guideline that really very strongly endorse doing an exam on everyone (and documenting it of course), with obvious implications for what a plaintiff's attorney would say if there's no such documented exam. So is everyone documenting an exam, even the people not doing one? It's a rhetorical question. 😉

 

[pgg]

I worked in a few places where there isn't even a place on the preop sheet to document the PE.

Interesting. I never have.

Actually, where I'm at right now, our departmental peer review will mark charts without an exam as deficient.

 

[pgg]

This reminds me, I need to start documenting a murmur preop for our valves

LOL 🙂

 

[chocomorsel]

I am with @pgg on this one.

 

[Twiggidy]

Interesting. I never have.

Actually, where I'm at right now, our departmental peer review will mark charts without an exam as deficient.

Ours too. The problem is it has created a culture where people just check boxes so they don't "get called to the principal's office".

 

[jthedestroyr]

How else could I chart "RRR CTAB" on every patient?

like the surgeons friend, "unlabored breathing."

 

[pjl]

Over 100 times. Fortunately, I have great techs that find them and reinforce my lack of respect for my stethoscope. I have had 2 “nice” stethoscopes, but usually use the medium grade ones we buy 50 at a time whenever the pile gets low.
In response to the rest of the thread, I listen to every patient in holding, and after intubation. Seems like the right thing to do.

 

[jwk]

The clipboard warriors at one of my hospitals decided that stethoscopes cause Ebola, so we are not allowed to bring our own into the OR. Instead we have Fisher Price stethoscopes that we reuse and hang on the back of our machines...because that’s probably cleaner.

🙂 that would be a non-starter with us. Ask them to show you the literature.

 

[chocomorsel]

🙂 that would be a non-starter with us. Ask them to show you the literature.

This is literally a "patient care safety issue" as the nurses like to call things.