Views on the Littman Master Cardiology?

[cardsurgguy]

What are people's view of the Littman Master Cardiology?

Any experiences positive or negative?

How do people like the feature where you don't have to turn over the chest piece and can hear the high and low frequencies just by changing the pressure on the chestpiece?
Does this work well?

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[tRmedic21]

I've got one... I wish I had gotten the model below with the double bell.

Just my $0.02

 

[cardsurgguy]

I've got one... I wish I had gotten the model below with the double bell.

Just my $0.02

Why? Does the feature to put varying amounts of pressure on the scope to change the frequency heard not work well?

Which other model are you talking about? I didn't see anything below your post.

 

[Firebird]

trmedic meant the model below what s/he bought.

I have the Master Cardiology. Now, I am just a second year, and I haven't really had that much experience auscultating...but I have noticed that the slightest touch to either the bell or the tubing creates a very distracting noise. Most of the time the pt's breathing is enough to move the bell against my hand and cause the noise. Maybe this is common with all stethoscopes...like i said, I'm just MS-II and I have never used another type of stethoscope. Maybe someone could comment on this...

 

[Firebird]

bump

 

[cardsurgguy]

I've got one... I wish I had gotten the model below with the double bell.

Just my $0.02

Just wondering if you could elaborate a little bit on why you wish you would have gone with another model...


What don't you like about the Master Cardiology?

 

[cardsurgguy]

trmedic meant the model below what s/he bought.

I have the Master Cardiology. Now, I am just a second year, and I haven't really had that much experience auscultating...but I have noticed that the slightest touch to either the bell or the tubing creates a very distracting noise. Most of the time the pt's breathing is enough to move the bell against my hand and cause the noise. Maybe this is common with all stethoscopes...like i said, I'm just MS-II and I have never used another type of stethoscope. Maybe someone could comment on this...

I'm not in med school yet, but I have worked clinically on hospital floors (high majority of them being cardiac floors) and have used a scope all that time
technically, the only thing I need it for is the occasional manual blood pressure, but I auscultate heart and lung sounds on patients just for my interest and curiousity

I have a Sprague type stethoscope

What your describing seems pretty normal about touching the tubes or the bell
For example, if I rub my finger very softly on the tube while I'm listening, I hear a loud scratching noise

So, at least from my experience with my scope, it's probably normal

 

[tibor75]

this discussion is a waste of time.

There is a new generation of stethoscope that has made the Littman obsolete. It's called the echocardiogram.

 

[ariwax]

I don't think tunable diaphragm scopes should be the first one you learn to auscultate with. My first was the Master Cardiology, I got the all-black one because I thought it was cool. After it inevitably got stolen, I did some research and got a DRG, the PureTone Cardiology Ti-Lite, which they developed in collaboration with the Bose people. It's a non-tunable bell-and-diaphragm design, light titanium, really much louder and more sensitive, and they designed the tubing to dampen noise from rubbing from fingers, clothes etc. There are a lot of little touches which I like.

You could make the argument that the Master Cardiology is the best scope ever made, but that I just didn't know how to use it correctly. I would say that might be true, but that most med students trying to learn how to auscultate don't know what it means to press lightly and press hard, or what pressing too hard does, and they can't know unless they have some frame of reference from a traditional scope.

 

[Mumpu]

The best scope (alas, apparently out of production now) is the Phillips/Hewlett-Packard Sprague-Rappaport (very much not the same as $10 "Sprague"-type scopes).

If you must choose between Littmans, I'd go for the one with a real bell (and take off that stupid plastic rim). Tunable diaphragms are NOT bells and you will get **** from every old-school attending and resident if you don't have a bell. Remember: you can hear everything with a bell. All the diaphragm does is filter out the low-pitched sounds.

Echo can take 2-3 days to get the results back and can cost several thousand dollars. A three-minute thorough auscultation can give you the same results for free.

 

[jimmyhoffa24]

i agre, rappaport.

By the way, you once talked about a Craddock/Pelham bell......

Im a swedish doctor verry interrested in obtainning one of these big bells......
do you know where i can buy one

 

[medoc]

this discussion is a waste of time.

There is a new generation of stethoscope that has made the Littman obsolete. It's called the echocardiogram.

This statement is profoundly ignorant.

 

[tRmedic21]

Sorry. I should have been more specific about why I would have liked the Cardiology III rather than the Master. I actually used to use the II when I was a medic, since that was what the service put on all our trucks. It worked very well for us, and I got used to it.

When I went to med school, my crew pitched in and bought me a Master. I didn't use it for the first two years (sat in a drawer), and when I started clinicals I began using it alot. Of course, my ear had become significantly less attuned over the intervening time, and I didn't properly use the Master. So, this last month or so (since I saw this post, actually), I began to steal my wife's Cardiology III (also a gift from her crew at work when we left for med school... is this the only med school gift people can imagine? lol). I thought that having the bell and the removable smaller diaphragm might help me hear things like bruits and pediatric heart and lungs sounds better... I was wrong. After becoming accustomed to the Master for the last year and a half, I really did not like trying to learn how to use the Cardiology III. My wife now has her ears back.

I think I have learned through experience how to use the Master over time without really realizing I was getting better, and I was simply thinking back to the "good ol' days" in EMS with more nostalgia than they really deserved. Now that I have gone back and compared the Cardiology III with the Master Cardiology, I think I like my Master better. I've tried that pediatric bell adapter thing for the Master, and find it useless.

However, my tubing is now cracked at the base, so I need to send it in and have it replaced.

So that's my new and improved opinion, for what it's worth.

 

[tibor75]

This statement is profoundly ignorant.

Spoken like somebody who is completely ignorant and clueless as to what cardiologists do and what they diagnose in the 21st century.

What the earpiece is connected to is meaningless. What's between the earpieces makes all the difference.

Come back when you have something intelligent to contribute.

 

[medoc]

this discussion is a waste of time.
There is a new generation of stethoscope that has made the Littman obsolete. It's called the echocardiogram...

Spoken like somebody who is completely ignorant and clueless as to what cardiologists do and what they diagnose in the 21st century. What the earpiece is connected to is meaningless. What's between the earpieces makes all the difference. Come back when you have something intelligent to contribute.

According to your initial statement, it is abundantly clear that you think your earpieces (as well as what lies between?) is obsolete. Res ipsa loquitur.

I have yet to meet a competent echocardiographer/cardiologist who would support your claim that ECHOs should replace the physical exam. My intelligent contribution to this thread is to make public knowledge that many contemporary clinicians using cutting edge technologies value the history and physical exam more than ever, especially in cardiology. Auscultation along with the other aspects of the physical exam is absolutely necessary in the evaluation of cardiac patients. The ECHO is an excellent diagnostic tool, but it is NOT a replacement to the physical exam as you have proposed. I have performed hundreds of echocardiograms (transthoracic as well as transesophageal) and cardiac catheterizations, as well as numerous coronary angioplasties. How many have you performed? Rather, I would consider a discussion with you regarding the merits (or your perceived lack thereof) of cardiac ausculation if you were facile at both ECHOS and the cardiac physical exam. Unfortunately, your initial statement has verifyed to me that this discussion is an exercise in futility.

I wish you much luck in your medical career. If its in cardiology, you're gonna need it.

 

[tibor75]

According to your initial statement, it is abundantly clear that you think your earpieces (as well as what lies between?) is obsolete. Res ipsa loquitur.

I have yet to meet a competent echocardiographer/cardiologist who would support your claim that ECHOs should replace the physical exam. My intelligent contribution to this thread is to make public knowledge that many contemporary clinicians using cutting edge technologies value the history and physical exam more than ever, especially in cardiology. Auscultation along with the other aspects of the physical exam is absolutely necessary in the evaluation of cardiac patients. The ECHO is an excellent diagnostic tool, but it is NOT a replacement to the physical exam as you have proposed. I have performed hundreds of echocardiograms (transthoracic as well as transesophageal) and cardiac catheterizations, as well as numerous coronary angioplasties. How many have you performed? Rather, I would consider a discussion with you regarding the merits (or your perceived lack thereof) of cardiac ausculation if you were facile at both ECHOS and the cardiac physical exam. Unfortunately, your initial statement has verifyed to me that this discussion is an exercise in futility.

I wish you much luck in your medical career. If its in cardiology, you're gonna need it.

Ugh.. Of course, I was only half joking with my comment about the uselessness of stethescopes.

But a discussion about comparing the best stethescopes IS useless. And no doctor beyond medical school would ever have it. Because doctors, unlike medical students, realize that one stethescope (beyond the MRSA or nurse stethescope level) is not better than another, and getting a fancier and more expensive one, just makes you look foolish and clueless.

Stethescopes were around before all this fancy technology existed. And while they are still useful and necessary, their importance has greatly dimished and only somebody who has no experience in medicine would argue about "which one is best"

 

[Firebird]

Maybe the question would be best stated, "which one is worst."

 

[tibor75]

Maybe the question would be best stated, "which one is worst."

usually it's the MRSA stethescope hanging in the isolation rooms. Of course, most of time, you can't hear anything in those patients anyway.

 

[Firebird]

Yeah, I'm just saying maybe the person should be asking, "what stethoscope should I not buy?" As in...if I'm going to be an EM physician, what level of stethoscope will not be sufficient for me to use in clinical practice. Everyone is going to argue over what is the best...but there should be a fair general consensus that says a plastic stethoscope from fisher-price is not good enough...

The fisher-price thing is only anecdotal. I'm just saying most people would agree that an entry level stethoscope is probably not the best thing for a Cardiologist. There's always that story about the old doctor who could use a coke bottle on the end of a string and appreciate S4's with it, but in the real world, most people need a certain level of quality to appreciate the less than basic sounds.

 

[medoc]

Ugh.. Of course, I was only half joking with my comment about the uselessness of stethescopes.

But a discussion about comparing the best stethescopes IS useless. And no doctor beyond medical school would ever have it. Because doctors, unlike medical students, realize that one stethescope (beyond the MRSA or nurse stethescope level) is not better than another, and getting a fancier and more expensive one, just makes you look foolish and clueless.

Stethescopes were around before all this fancy technology existed. And while they are still useful and necessary, their importance has greatly dimished and only somebody who has no experience in medicine would argue about "which one is best"

What fund of knowledge and personal experience gives you the authority to be so dogmatic? You can try to soften your initial wording, but you have already professed prejudice against the utility of auscultation (and thus the physical exam) in modern medical practice. Good cardiologists integrate the knowledge from advanced diagnostic and imaging modalities (such as hemodynamic catheterizations and ECHO) to augment their abilities to diagnose at the bedside. Recent studies (Vukanovic-Criley et. al. Arch Intern Med. 2006;166:610-616 for one) have shown that physical exam skills (especially cardiac auscultation) are on the decline. Practicing medicine attendings are no better at identifying basic valvular conditions than third year medical students. So when you say "no doctor beyond medical school" would pay mind to stethoscope choice, I am swayed little.

 

[P Diddy]

You may choose to count my years in cardiology at the Brigham as "no experience in medicine".

so how was Utah?

p diddy

 

[tibor75]

Recent studies (Vukanovic-Criley et. al. Arch Intern Med. 2006;166:610-616 for one) have shown that physical exam skills (especially cardiac auscultation) are on the decline. Practicing medicine attendings are no better at identifying basic valvular conditions than third year medical students. .

PE skills are on the decline because they simply aren't that useful anymore.

20 years ago, you needed to tell the presence and severity of mitral stenosis based on physical exam.

Now, all you need to hear is a murmur and the echo will do the rest.

Physicians are smart people. They allow skills to erode which aren't very important anymore.

I'm willing to bet the physical exam skills of most cardiologists isn't much better than medicine attendings. And will continue to get worse as the years go on.

And I had to LOL at your "Brigham" reference. I just love message board minions who have to toot their own horn so that people are impressed with them. Pathetic.

 

[medoc]

so how was Utah?

p diddy

Hehe. Now you're just picking on me. I must sound like I take myself too seriously, so I apologize to everyone for my polemicism. But, I can't emphasize enough the importance of the physical exam in modern medicine, and I fully disagree with those who would perpetuate the opinion that diagnostic imaging technologies supplant the exam rather than complement it.

Cheers.

And no, I did my cardiology training at the BWH in Mass.

 

[medoc]

PE skills are on the decline because they simply aren't that useful anymore.

20 years ago, you needed to tell the presence and severity of mitral stenosis based on physical exam.

Now, all you need to hear is a murmur and the echo will do the rest.

Physicians are smart people. They allow skills to erode which aren't very important anymore.

I'm willing to bet the physical exam skills of most cardiologists isn't much better than medicine attendings. And will continue to get worse as the years go on.

And I had to LOL at your "Brigham" reference. I just love message board minions who have to toot their own horn so that people are impressed with them. Pathetic.

Listen, you're the one who accused me of being "clueless and ignorant of what cardiologists do," so I am more than justified to share my training background in response. I would, for example, consider it a fair response if you were to say that you were an oncologist from Sloan Kettering/Dana Farber/MD Anderson if I were to accuse you of knowing nothing about cancer. As for your wager that cardiologists' exam skills are not better than medicine attendings, the study I cited demonstrated that cardiology fellows consistently performed in the highest tier in the cardiac exam, surpassing all other groups (however, there is admittedly room for improvement).

I am sorry to get you so worked up that you need to resort to personal attacks. In this public forum frequented by students and doctors in training, I think it is important to give response to your misguided opinions, however sincere you feel about it.

Good luck in your medical career.

 

[tibor75]

I am still waiting to hear from what vast personal expertise you can support your vehement claims that the physical exam is "not very important anymore". Are you saying that you are a consummate clinician with superior diagnostic skills without the use of physical inpection and auscultation?\.

Uh, let's see....medical care is better than it's ever been...and physical exams by all criteria are poor. So, it's quite common sense that physical diagnosis skills have little if anything to do with being a good or great physician.

 

[medoc]

...it's quite common sense that physical diagnosis skills have little if anything to do with being a good or great physician.

Sigh... I initially thought that participating this forum would be a nice way to educate or share with students and residents who were interested in a career in cardiology. I was obviously wrong. My time is utterly wasted here.

Goodbye.

 

[deleted87716]

getting a fancier and more expensive [stethoscope] just makes you look foolish and clueless.

As you've shown us, you don't need a stethoscope in order to accomplish that.

Medoc is right on target, and it should be obvious to anyone reading this thread which of you is an authority and which is not. The posts speak for themselves.

Medoc, if you're still there, I hope you'll change your mind about leaving. The input of clinicians is actually quite valuable here, and as you've seen, much needed.

 

[cardsurgguy]

Thanks for the replies, but I decided against any of the Littman's or any other newer ones for that matter.

I winded up going with the Rappaport Sprague. I luckily found one on Ebay and then bought all of the replacement parts that Philips still sells.

A cardiologist I know who has practiced for about 25 years advocated for a separate bell and diaphragm and highly recommended the Rappaport Sprague, which in his personal opinion was the best scope ever made.



I may not be the right person to say this considering I'm starting med school in the fall, but I've worked on various ICU's at an academic medical center for the past several years, so there's technology all over the place monitoring patients, and physicial exam skills are used everyday by the doctors I work with.

After all, how do you know if your patient needs a technological intervention without catching the various signs indicating that intervention? A simple example--patient all of the sudden starts posturing when they weren't before, so you'd get a head CT. That requires physical exam skills and an eye for the patient and any status changes.

 

[Firebird]

Posturing vs. subtle murmurs or weird heart sounds is apples vs. oranges. EMT-b's can tell you when a pt. needs a CT from posturing. I think everyone agrees that people are getting less and less astute with the nuances of the physical exam, probably even moreso outside the realm of internal medicine (they always seem to be obsessed by PE, and perhaps for good reason). Ask around in the EM room and see how much of a physical exam they perform on a daily basis. It's a use-it-or-lose-it phenomenon.

I think the echo was a good example of how technology is taking over the PE. The CT is the same way...in the ED you know the person has had a stroke...you could either do a full neuro exam and take 20 min to figure out exactly where the lesion is, and then send them to CT to confirm, OR you could just send to CT since you're going to do that anyway.

I was at the optometrist the other day, and they were checking my peripheral vision. Do you think that the tech stood in front of me, covering her eyes, and swinging her hand around in the "big H" confirmation? No, she stuck my head in a maching that had blinking lights. Did my optometrist use a ophthalmoscope as the exclusive means ot look at my retina? No...he took a picture of it, showing the entire field, and was able to look at it on a computer screen while he was showing it to me, too.

I'm not slamming the PE, it's just the previous poster is right--technology, like the Echo, is displacing it from useful practice. But that doesn't mean we shouldn't learn the techniques as well as anyone else has.

 

[cardsurgguy]

Posturing vs. subtle murmurs or weird heart sounds is apples vs. oranges. EMT-b's can tell you when a pt. needs a CT from posturing.

True, I didn't mean to imply they were equal. That was a bad example on my part.

I was just trying to point out that the physical exam is important.

There's much better examples, but I'm too lazy to actually bother to think of any...

I think the echo was a good example of how technology is taking over the PE. The CT is the same way...in the ED you know the person has had a stroke...you could either do a full neuro exam and take 20 min to figure out exactly where the lesion is, and then send them to CT to confirm, OR you could just send to CT since you're going to do that anyway.

I was at the optometrist the other day, and they were checking my peripheral vision. Do you think that the tech stood in front of me, covering her eyes, and swinging her hand around in the "big H" confirmation? No, she stuck my head in a maching that had blinking lights. Did my optometrist use a ophthalmoscope as the exclusive means ot look at my retina? No...he took a picture of it, showing the entire field, and was able to look at it on a computer screen while he was showing it to me, too.

I'm not slamming the PE, it's just the previous poster is right--technology, like the Echo, is displacing it from useful practice. But that doesn't mean we shouldn't learn the techniques as well as anyone else has.

I didn't mean to say technology wasn't important. The PE is obviously less important in cases where you're going to refer the patient for a test regardless of doing a PE or not as in the stroke example you gave.

However, I wonder sometimes of how many technological exams are done that may not be necessary with a complete old fashion physical exams.

Obviously, an echo would be more accurate in an absolute sense relative to a cardiologist's exam. BUT, on a cost effective basis, a cardiac exam from the average cardiologist probably provides much more benefit per dollar than echos.

This gets back to the old question, which is a whole other thread, of whether or not a society wants to maximize benefit and that's it, or maximize benefit per dollar (which inevitably would lead to a lower amount of raw benefit relative to maximizing benefit only).

I've heard from various sources that physicians in England, where they have near the cheapest healthcare per capita on the face of the Earth, they haven't lost the importance of the physical exam, simply because the payor (the government through the NHS) restricts utilization so much.

Due to this, it's a necessity that they have good physical exam skills b/c there may not be the technology to back it up.

I've actually heard that it's a running joke with English doctors about how American doctors order CT scans for everything. Oh well, that's another thread too...

 

[BlondeCookie]

Because doctors, unlike medical students, realize that one stethescope (beyond the MRSA or nurse stethescope level) is not better than another, and getting a fancier and more expensive one, just makes you look foolish and clueless.

OK, I have to respond to this also. Just because someone has, what you think is, a fancy or expensive stethoscope that does not mean that the person is foolish or clueless. Thinking that an individual is "foolish" or "clueless" just because they have a nice stethoscope is a bit arrogant and quite judgemental. That's all I have to say about that.

 

[Firebird]

This gets back to the old question, which is a whole other thread, of whether or not a society wants to maximize benefit and that's it, or maximize benefit per dollar (which inevitably would lead to a lower amount of raw benefit relative to maximizing benefit only).

You are absolutely right. Americans don't want cheap healthcare, they want the best healthcare that medicine has to offer. Part of the problem is that we are so sue happy that the standard of care has become the highest technology available. Then the same culture complains because healthcare costs so much. I truly believe there is no way around all our health care problems. Fixing one thing, causes another issue. One of the best things that could be done is to stop frivilous and/or excessive lawsuits.

Just as a side note, I could almost guarantee that Healthcare will be a major topic in 2008.

 

[tibor75]

Sigh... I initially thought that participating this forum would be a nice way to educate or share with students and residents who were interested in a career in cardiology. I was obviously wrong. My time is utterly wasted here.

Goodbye.

 

[tibor75]

OK, I have to respond to this also. Just because someone has, what you think is, a fancy or expensive stethoscope that does not mean that the person is foolish or clueless. Thinking that an individual is "foolish" or "clueless" just because they have a nice stethoscope is a bit arrogant and quite judgemental. That's all I have to say about that.

yes it is. Any of major stethescopes will do fine. Upgrading to the best model just indicates a doctorb most likely trying to compensate for a lack of something between the ear pieces.

 

[Qtip96]

PE skills are on the decline because they simply aren't that useful anymore.

Physicians are smart people. They allow skills to erode which aren't very important anymore.

or just plain lazy

Uh, let's see....medical care is better than it's ever been...and physical exams by all criteria are poor. So, it's quite common sense that physical diagnosis skills have little if anything to do with being a good or great physician.

the only docs i've seen who trash the physical exam are the ones who don't see patients and da ones who ain't got the skills.

so let me get this straight. you want all of us to take your advice about stethoscopes even though you keep tryin to tell us that you think auscultation is an obsolete skill... man, you've lost all credibility bra'

 

[Qtip96]

yes it is. Any of major stethescopes will do fine. Upgrading to the best model just indicates a doctorb most likely trying to compensate for a lack of something between the ear pieces.

chill out bra'. why you got to get your panties in a wad?

all the decent stethoscopes are around $150 bucks anyway so the difference in price is just chump-change. for crissakes, kids are spending more money on their freakin' ipods, so why you gotta get on our case for givin' up a little cwon for a sparkly steth? looks like i've only got to worry about judgemental doctorbs like you, and i don't give a ****.

lets see...

a really nice stethoscope from Steeles... $150
ipod... $200
some cards fellow from UPitt tellin' everyone to ditch the cardiac exam... priceless.

peace!

 

[suckstobeme]

Hey guys-
I'm not a cardiologist or anything, but how 'bout some love for the Welch Allyn Harvey models. I've used to have a Cardio3 wich got stolen. I loved that scope, but after I lost it, I got a Welch Allyn and I think its a little better. I think the sound quality is only slightly better than a the Cardio3, but it has the bell and diaphragm, which I like better than the tunable diaphragms that Littman has. Though, the poster that brought up the Rappaport Sprague is right on. I had a friend who's Dad was a radiologist and gave her his old one when she started med school and I borrowed it a couple times. Its like an orchestra. Good luck finding one though.

 

[Llenroc]

Running out and buying the most expensive stethoscope is a waste, unless you actually happen to be a cardiologist.

Why? Because they get broken or lost frequently. If the stethoscope salesman at your med school tells you that his product will "last you well into practice", he's lying to you because you'll probably lose at least a couple of stethoscopes in that time.

 

[deleted87716]

I'm not a cardiologist or anything, but how 'bout some love for the Welch Allyn Harvey models.

The Harvey Elite is probably the stethoscope I most recommend to anyone who asks. The old Littmann Cardiology/Cardiology II runs a close second, but it's no longer made, ditto the HP/Philips Rappaport-Sprague. You can find them on eBay, but if you want a brand-new current model stethoscope, I think the Harvey Elite is the one to beat (hey, that rhymes!)

 

[deleted87716]

Running out and buying the most expensive stethoscope is a waste...Because they get broken or lost frequently.

That's a pretty lame excuse to use a crappy stethoscope. If you applied this same "logic" to your other purchases, you'd live in a really crappy house ('cause it might burn down), drive a beat-up old heap of a car ('cause you might wreck it), wear nothing but thrift store clothes (because you might spill something on them), etc. Makes no sense, does it?

To prevent theft, have the thing engraved, and never let it out of your sight. It's really not that difficult. I've never had a stethoscope stolen in my life.

 

[Qtip96]

Running out and buying the most expensive stethoscope is a waste, unless you actually happen to be a cardiologist.

Why? Because they get broken or lost frequently. If the stethoscope salesman at your med school tells you that his product will "last you well into practice", he's lying to you because you'll probably lose at least a couple of stethoscopes in that time.

i don't think fear of losing a diagnostic tool should be an excuse for skimping out, especially something we use all the time like a steth. for crying out loud, a really good one is not even that expensive (like $150 on internet). you're just as likely to lose your cell phone, ipod, pda, etc., all of which is in the same ballpark for price (or pricier). most people who lose ipods buy another ipod (or better) and not a tapedeck for replacement. . even though tibor75 is a disgrace of a cardiotron for ditching the P.E., at least he's got the nuts to object on principle (however idiotic it is) and not for fear of losing something.

and suckstobeme,
Harvey DLX triplehead...
and if you don't like it, you can use it as a sledgehammer

 

[Llenroc]

That's a pretty lame excuse to use a crappy stethoscope. If you applied this same "logic" to your other purchases, you'd live in a really crappy house ('cause it might burn down), drive a beat-up old heap of a car ('cause you might wreck it), wear nothing but thrift store clothes (because you might spill something on them), etc. Makes no sense, does it?

To prevent theft, have the thing engraved, and never let it out of your sight. It's really not that difficult. I've never had a stethoscope stolen in my life.

Who said buying a crappy stethoscope is the only alternative to buying an expensive stethoscope? That's like saying the only cars you can buy are a Cadillac and a really old Cadillac from the 1970s.

A good, middle of the range stethoscope is the best choice.

 

[Qtip96]

Who said buying a crappy stethoscope is the only alternative to buying an expensive stethoscope? That's like saying the only cars you can buy are a Cadillac and a really old Cadillac from the 1970s.

A good, middle of the range stethoscope is the best choice.

it's one thing to not shell out the extra $25-50 because the difference in acoustics is negligible for you.
it's quite another thing to not shell it out 'cause you're a wuss.

hope you lose your ipod.

 

[Mumpu]

So $300 for a mega-PDA/cell phone/camera/mp3 player toy is okay but $150 for a diagnostic tool is too much?

Physical exam is free. An echo is $2000 and is a limited study in many ways, particularly in terms of showing regurgitation where there is none, and not being able to detect sclerotic valvular disease until it's quite severe (I hear many murmurs with a normal f/u echo ... if I hear pathognomonic TR and the echo is normal, guess what, the patient has TR). Yes, I still get echos to flesh out the details cardiologists want (valve areas, gradients, etc.) and because people with no exam skills won't believe the dx until they see a report but most of the time I already have the major diagnosis at the time of writing the order. This has two benefits:
1) I am impatient. I like to know the dx now rather than 3 days later when the echo gets read.
2) I take pride in my work and it feels great to know that I made a diagnosis using my skills and training. There are no kicks to be had in a diagnosis made by a cardiologist in a dark room on the other end of the hospital.

 

[Qtip96]

Who said buying a crappy stethoscope is the only alternative to buying an expensive stethoscope? That's like saying the only cars you can buy are a Cadillac and a really old Cadillac from the 1970s.

why you gots to be dissing KentW? he is like THE MAN. he's always tellin' it like it is, and always tryin' to help. only thing is, he's a moderator so he's got to be nice. i don't have to be...

you, on the other hand, are a cheapskate who doesn't value physical diagnosis skills. you and tibor75 deserve each other. you guys should get together and party, ... maybe have a romantic dinner , then have yourselves a couple of cheap POS stethoscope kiddies, lose them, and start all over again!

 

[deleted87716]

A good, middle of the range stethoscope is the best choice.

Don't pay attention to the MSRP. You can find excellent stethoscopes, like the Welch-Allyn Harvey Elite, brand new on eBay practically every day of the week for around $60 or so, like this one: http://cgi.ebay.com/NEW-Tycos-Harvey-Elite-Black-Cardiology-Stethoscope_W0QQitemZ7629839218QQihZ017QQcategoryZ11824QQssPageNameZWDVWQQrdZ1QQcmdZViewItem

 

[Mumpu]

What's with all the plastic-rimmed bells? Does the patient care more about a slight chill or the physician being able to hear that diastolic rumble? Haven't tried Elites but we got Harvey Deluxes from the alumni association and they were pretty hideous.

Also ask yourself why Harvey Elites sell on Ebay far below MSRP while a Phillips/HP Rappaport-Sprague sell far above the MSRP. Hmmmmm....

 

[deleted87716]

Also ask yourself why Harvey Elites sell on Ebay far below MSRP while a Phillips/HP Rappaport-Sprague sell far above the MSRP.

Supply and demand. The Harvey Elite is still manufactured, and widely distributed. The HP/Philips Rappaport-Sprague has been discontinued, and is much harder to find. It continues to be quite popular, and has something of a cult following (I'm sure you'll agree with that). Since a stethoscope could conceivably last one's entire career (assuming you could still get spare parts, as the tubing and plastic parts on the RS have a limited lifespan), people are willing to pay big bucks for one. The last one I saw on eBay sold for $400.

 

[BlondeCookie]

What's with all the plastic-rimmed bells? Does the patient care more about a slight chill or the physician being able to hear that diastolic rumble? Haven't tried Elites but we got Harvey Deluxes from the alumni association and they were pretty hideous.

"Hideous"?! What? You don't like the 3 headed design?