Stethoscope/Diagnostic Set/Misc. Equipment Review

[Guest Ian Wong]

Stetho-scoop: Essentials of Equipment Purchase

 

-Dana Haaf and Ian Wong

 

Hello Class of 2004! As the Equipment Representative for the Class of 2003, I've tried to provide you with a brief synopsis of the different pieces of medical equipment that you as med students may wish to purchase. You should look to tailor your purchases to your personal situation, as finances, and professional interests may play a large role in determining what equipment is right for you. By the time you receive this article, you will probably have received other equipment information, from either UBC directly, or by the equipment reps. In addition to the equipment you can buy via the reps, you have also been advised to buy a microscope, lab coats, and a dissecting kit. We’ll cover that in this article as well. Finally, if you’re a dental student, and you want a stethoscope for Clinical Skills practice, there are some lower-cost suggestions towards the end of this article.

 

Diagnostic Sets:

 

The diagnostic set usually consists of an electrically-powered handle, along with several head attachments. These could include attachments to convert the handle into an otoscope (for ears), an ophthalmoscope (for eyes), or a rhinoscope (for the nose). The handles may run using conventional batteries, or may be rechargeable, in which case a wall-plugin charger is also included with the set. The diagnostic set, in the event that you purchase one, will be the single most expensive piece of equipment you will buy. Most diagnostic sets that we were shown were listed at between $300-$500 Cdn. For the students that bought a set, the most popular seemed to be the Welch/Allyn 3.5V HPX Halogen Diagnostic set (Model #97200-SM), which listed at $489.00 Cdn.

 

However, a more important question is to ask whether you really need one. In the hospital, there will be wall-mounted pieces of equipment to use. In Family Practice (FMPR), your tutor doctor will certainly have the equipment. The biggest use for the diagnostic set (besides impressing friends and family with what is essentially a $500 flashlight), is to practice your techniques on those aforementioned people. Nevertheless, it is not a requirement that you purchase this set for first year. Many people in this year's class did not make the purchase, opting to save the money for future use. It is possible that in a few years, there will be newer models introduced. Is the set worth buying immediately? Probably not if you are a dental student. If you are a medical student, talk to your second year buddy before deciding.

 

For those interested, here's some important points about diagnostic sets:

 

- The first important point is power (eg. some people say that a 3.5V light is better than a 2.5V). The argument is that the brighter light makes it easier to learn on. However, both lights will suffice, except that the 3.5V increases your available range. Regardless, many upper year students state that they have gotten along just fine with the 2.5V sets. Additionally, I am told that it is unusual for one to use the stronger models at full power…simply because it can hurt, or be uncomfortable for the patient.

 

- Another important consideration is portability. If you don't carry it, you can't use it. Personally, the full-sized Welch-Allyn in the soft case looks very portable. With the new lithium rechargeable handle, it is significantly lighter than the older, conventional battery-type handle. Other people swear by the "pocket set" types. When looking at the overall size, remember that in third and fourth year, you will have various reference manuals, Twinkies wrappers, and other debris taking up your lab coat pocket-space as well.

 

- Further to the size issue, the company reps will tell you that a portable set is harder to learn with. However, there are many upper-level students and doctors who dispute this. Despite this, there are definite advantages to the full size set, especially if you plan on entering family practice. These sets will last you forever, and can be converted to wall-mount models.

 

- A thoughtful feature can be found on the diagnostic sets that can accept both a rechargeable handle as well as a conventional battery handle. Should you accidentally drain the rechargeable handle, just pop in the other handle and you are ready to go. In addition, should you find yourself travelling, or doing medical work in an area that doesn't accept the charger, you can still go about your business.

 

- Some other features to look for include: an ophthalmoscope head where the diopters setting goes up in levels of one, all the way up to ten (at least) on either side of zero. Also look for an otoscope head with an insufflator port which allows for a bulb to be attached.

 

- Don't worry too much about the gimmicks. The diagnostic set is, after all, just a really expensive flashlight. For example, I've been told that the rhinoscope is rarely used because the otoscope can do double duty. In addition, most doctors use the otoscope as a throat illuminator as well, so that piece is also redundant. If you still want the pieces after your initial purchase, you can buy them as accessories later.

 

- Finally, pay attention to the feel of the instrument (no, this isn't me getting "Artsy" with you). Try out all the models that the equipment reps will be bringing, and try out the differences in balance, weighting, access to controls, and the case supplied with the instrument.

 

The companies:

 

There are two major companies that make diagnostic sets (listed below alphabetically). Both have outstanding reputations, and are sold through our distributor, BC Stevens Company.

 

Heine:

International reputation (German manufacturing center), award-winning optical engineering, easy to use products, unconditional guarantee during medical school and residency, more accessories available for future purchase. Service is offered world-wide, maintenance-free, with a lifetime guarantee for workmanship.

 

Welch Allyn:

Long-time name, good reputation, easy to use products, maintenance-free, lifetime guarantee for workmanship, unconditional guarantee during medical school and residency, found widely in North American hospitals, more accessories available for future purchase.

 

Stethoscopes:

 

The stethoscope is pretty much a mandatory purchase if you are a medical student. You'll use it during both Clinical Skills and Family Practice for the first two years, and it will be even more heavily used during third and fourth years in the hospital. For that reason, you should consider your stethoscope purchase as an investment. As a result, in my opinion, you should really opt for the best stethoscope you can afford. Trying to distinguish all the various sounds that you are trying to detect is difficult enough without having to fight your equipment. The stethoscopes that you will be shown range in price from around $60-$170 Cdn. The stethoscope purchased by the majority of the class was the 3M Littman Cardiology III, which sold for $155.00 Cdn.

 

For the dental students, it probably doesn't make much sense to buy an expensive model, and later I'll discuss two reasonable alternatives available at the Health Sciences bookstore at VGH. Also, consult with the dental upper years to see how often you really need access to a stethoscope. It may be used occasionally in Clinical Skills, but it's likely the most important use will be for you to practice taking blood pressures. Currently, the Anatomy computer lab provides a few stethoscopes that you can use to practice.

 

The most well known, and arguably the best brand name, is Littman. Their products are made by 3M Canada. Other companies that make stethoscopes are Welch-Allyn, and Heine. Now, here are some points to consider:

 

- The most important point is the fit of the stethoscope. Everyone's ears are different, so what might feel comfortable to one person might be painful to another. Therefore, be sure to try out all the demonstration models and styles before you buy.

 

- Next, consider the tube length. The literature indicates that the longer the tube is, the more sound is lost traversing that distance. However, a shorter tube requires you to be significantly closer to the patient, which might be uncomfortable for either of you. In the end, this comes down to personal preference, with many people suggesting the sound lost from longer tube is negligible.

 

- Never forget about the head, the part of the stethoscope placed on the surface to be auscultated. Traditionally, stethoscopes have come with both a diaphragm and a bell, which are more sensitive to high and low-pitched sounds respectively. Newer single-sided chest pieces combine the diaphragm and bell into a single head. An example of a single-sided chest piece is the Littman Master Cardiology, which has one single-sided chest piece designed for adults. The Littman Cardiology III, in contrast, has two single-sided pieces, one for children, and the other for adults. In essence, it has a pediatric bell and diaphragm, in addition to an adult-sized bell and diaphragm.

 

- There are two main tube designs: the two tubes in one design vs. single lumen design. In the two tubes in one model, there are two internal tubes inside the stethoscope, one leading to your right ear, and the other to your left. In the single lumen design, the sound for both ears is carried within a single tube (one lumen) until the tube diverges to reach your ears. The sound quality is better preserved in the two tubes in one design.

 

- Depending on your professional goals, it may be worth looking at a stethoscope that supports a pediatric adapter. It may be well worth the investment now to spend a little more money for the increased versatility.

 

For the dental students who are interested in buying a stethoscope, a few lower cost alternatives can be found at the VGH Health Sciences bookstore. For $7.50, you can pick up a dual-head (both diaphragm and bell) single lumen stethoscope imported by Almedic (The bar code on the price sticker is 6006426 007504). I bought one to try out, and it will actually suffice for taking blood pressures. I was told by the clerk that VGH nurses will often use these as disposables if they are working around highly infectious, or immuno-compromised patients. The major disadvantage to this stethoscope is the hard plastic ear-pieces. Using it is literally a pain! Also, whipping it out when all the med students are brandishing their new $150 purchases calls for some intestinal fortitude.

 

A slightly pricier alternative can be had for $21.95 (Almedic code# 6006506 021956). This is a dual head, double tubed (not single lumen) stethoscope. It does everything that the cheaper model does in addition to coming with softer rubber ear tips. As well, the head is threaded, and the stethoscope is supplied with different attachments so you can customize the scope. The stethoscope comes with a pediatric bell and diaphragm, and an adult bell and diaphragm. It even comes with a bell listed as an infant's model. Again, I bought this model to test it out, and the sound seems decent; it's certainly good enough for blood pressures.

 

This model is fairly heavily constructed, weighing nearly as much as my Littman Cardiology III. However, it is weak in the following area, its major disadvantage. The bells are all made of plastic, and will probably crack if you mishandle them, or leave the scope in the bottom of your knapsack. Both diaphragms consist of a round plastic sheet which looks like it could be easily crushed, and if it does, cannot be fixed. As a result, this stethoscope is a bit more fragile than either the cheaper, or more expensive alternatives. A little trivia fact is that John Carter often wears the black version of this stethoscope on ER. If you look at older re-runs, many of the staff carried them slung over their shoulders. I guess they can afford the Littman stethoscopes now…

 

Sphygmomanometers:

 

The sphygmomanometers (blood pressure cuffs) are an optional purchase. You will always have access to them at the hospital or during family practice. They were also supplied this year in the Anatomy Computer Lab so that students could practice with them. Most of the class did not buy a BP cuff this year, doubly so if you are a dental student. If you really want one, you could look into buying one per DPAS group, and then selling it to next year's class. The prices on BP cuffs ranges from around $55-$185 Cdn.

 

Tendon Hammers and Tuning Forks:

 

There are two major types of tendon hammers. The first is the Queen's tendon hammer, which is a heavy weighted disc mounted to the end of a handle (it looks a little like an open umbrella). The other type is the Tomahawk, where a soft plastic triangle is embedded in the head of the handle. Both hammers are quite popular, with the Tomahawk being smaller and more portable. Try them both and see which you prefer. Costs are between $2-$4 Cdn, so personal preference wins here.

 

For tuning forks, the most important feature is to get one tuned to 256 Hz. Other frequency forks are at 128 Hz, or 512 Hz, but neither of these is really necessary. Tuning forks cost between $4-$6 Cdn. Neither tuning forks, nor tendon hammers are really needed by dental students.

 

Microscopes:

 

You might have received a notice or invitation from the faculty to purchase a microscope for the first two years of study. Whether you are a dental student or a medical student, the advice is the same: do not buy a microscope. You will have access to a shared microscope with a class-mate during your histology labs. Since all the slides and the UBC microscopes are stored together in this lab, you will always have access to a microscope if you have access to the slides.

 

Anatomy Dissecting Kit:

 

This might be a useful purchase. However, most of the class managed just fine without buying a kit. There are common instruments available at the front of the lab, and thus no real need to bring your own. Also, the instruments that you will be using have a tendency to walk to neighboring tables…

 

Lab Coat:

 

Medical and dental students both share the Gross Anatomy labs, as well as several Clinical Skills sessions. You will need a long lab coat for the anatomy labs; it doesn't have to be new or pretty, because it sure won't be at the end of the year! For anatomy, you can use an old coat, or purchase one at either the UBC, or the VGH Health Sciences bookstores. In addition to this however, you will want to have another lab coat as they are mandatory during the second term physical examination Clinical Skills sessions. These can also be purchased at the bookstores. Most students bought a short lab coat, which denotes being at the bottom of the medical hierarchy; the rumor goes that you earn the right to wear a longer lab coat as your seniority increases.

 

However, a second option is to buy/borrow one from Laundry Services at VGH. They are located in the basement of Heather Pavilion, just across the street from the VGH bookstore (you might need to ask around as it's hard to find the first time). There, you can purchase a lab coat outright for $14, or rent one for the year for the same price (you have the option of keeping it afterwards). Your lab coat will be labeled as a VGH coat, and you may drop it off for free laundering at any time. This works for medical students, but unfortunately I don't know if dental students can also take advantage of this opportunity.

 

Last point, never be afraid to ask questions. Talk to the reps, talk to each other, and also consult with your buddy. After all this, you should be armed with the information to make the right decision for yourself. Happy spending!

[Guest Ian Wong]

Here's some further information regarding purchasing the above items from msJAMA, the medical student version of the Journal of the American Medical Association:

 

www.ama-assn.org/sci-pubs/msjama/articles/vol_281/no_21/equip.htm

 

Ian

UBC, Med 3

[Guest Carolyn]

A thought for those thinking of buying a stethoscope anytime soon...

 

This week I kept forgetting my Littman's III stethescope and borrowed my buddies Littman II. #1 I absolutely could NOT hear a difference -- i.e. I heard everything I needed to hear and #2 (more importantly) It was WAY lighter - - now this sounds silly but after wearing a stethescope for 24 hours you might find that your neck gets a little tired - like wearing a little weight around your neck -- the II version totally alleviated that.

 

Hope that is helpful!

 

Carolyn