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Should I buy a stethoscope from a medical supply online or at medical school. What brand and model is the best?
This topic comes up once in a while. The stethoscope is becoming the vestigal instrument of the physician. Honestly, the vast majority don't know how to use it and don't really want to learn. it takes a long time to really tune your ears as instruments. As a result, when you ask different people what you should get/look for in a scope, you sometimes get strange answers. Here is my two cents.
Your stethoscope should have a diaphragm and a bell. Some companies (ie. littmann) don't sell stethoscopes with real bells anymore. Their master cardiology is supposed to give you low and high frequency sounds by alternating the pressure on the the single head. It works in theory, but a real bell will give you ONLY low pitched sounds, while the littmann gizmo gives either low and high pitched simultaneously or only high pitch sounds. This is a fine point, but certain heart sounds (ie. S4 vs split-S1) are distinguised from eachother by this very mechanism-thus you need a real bell and a real diaphragm.
Tube length is important. It should not be super long. The longer it is the poorer the sound quality and amplitude. Who cares how it looks sitting around your neck. Too short is impractical (and as someone pointed out is not always hygenic). Look for 22-25 inches.
One vs Two tubes. Two tubes is a must. Some companies have two lumens inside of one tube. This is fine. The "rubbing" that occurs when you have two separate tubes is a nice notion, but you should be sitting/standing still when listening, so that really shouldn't matter at all.
I like the following (and this is just my opinion):
Welch Allyn Harvey DLX
Welch Allyn Harvey Elite
Hewlitt Packard
these three all have good bells and diaphragms, two tubes, and the right lenght of tubing.
The Littmann Master Cardiology is ok in my book, but suffers from only having the one sided head. Get the one with the shorter tubing. Littmann makes their's in either 22 or 27 inch tubing. Who cares if it is gold coated or whatever-more likely to get stolen the fancier it looks.
The cardiology III i am not a big fan of. Out of the box it has two diaphragms, one adult and one peds. I have never seen a pediatrician use the peds side. There is NO bell. You can convert the peds diaphragm to a bell, but I have found with mine, that you really get poor low pitch sound response. I just don't like this model.
DRG makes some interesting scopes. I don't know much about them, but I would look for the above items in their products and make up your own mind.
Listening to a scope/test driving it is a good idea. This is hard to do in a store. Ideally you would be able to use one on the floor for a week or so and listen to actual patients at the bedside. The ear pieces should fit comfortably, neither so tight as to pinch your head nor too loose to make a good seal.
All of that said, for most docs, it really doesn't matter. There was an interesting study a few years ago in the Annals of Int. Med I think wich looked at the ability of internal med,family residents, and third year med students to identify basic heart sounds (ie mid systolic murmers). They found that all three groups did equally poorly, identifying less than 40% of what they heard at all, and far less correctly. For the purposes of listening to breath sounds and to see if the heart is beating regularly, don't waste your money, use a 20 dollar cheapo scope. If you are interested in learning how to listen to the heart properly, invest some money, and more importantly, invest the time and effort. Find someone at your school who is interested in teaching you this stuff properly and who hopefully can hear these things themselves (look for a cardiologist). It is frustrating at times-some of these things are really quite difficult to hear! But they can change your patient management in certain circumstances.
I'm glad this was necro bumped so I could read this comment.Don't get a stethoscope. Take a piece of paper, roll it into a cone, and stick it in your ear. That's what we do in KY/WV.
(just to clarify, put the small part of the cone in your ear)