Diagnostic Sets

[Guest Lancet]

Hey Ian,

We just had the equipment reps show their stuff and I'm still as confused as ever. Money wise, the Heine portable mini-set looks like the best buy. However, the Welch Allyn people made it seem like you really weren't getting a good deal with a 2.5V because it was harder to learn on and couldn't be adapted to use other pieces.

 

Also, I still don't even know if I should buy a diagnostic set at all. If we're going to need one in second year I might as well get one now, but I still haven't recieved a clear answer. I've talked to a bunch of people in second year and it seems to be about 50:50 as to whether or not I should buy one at all.

 

Currently, I don't see myself entering family practice but of course I'm still not sure. I read your equipment review and it clarifies things but I was wondering if you could give me your personal opinion on 1) whether or not I should by a set at all and 2) should I go with a full size or mini since the price differs by ~$200.

 

Thanks in advance

 

ps. do we really need a tuning fork and tendon hammer?

[Guest Ian Wong]

Hi Lancet,

 

I just added a new article to the Reviews forum regarding purchasing medical equipment. We wrote it for the 2004 class. Is this the one that you read? Have I posted it somewhere else, and forgot about it?

 

pub44.ezboard.com/fpremed101frm32.showMessage?topicID=32.topic

 

Very few people in my class bought Heine. I'd say of the people who bought a diag. set, (probably 50% or so), around 90% of those bought the full-size Welch-Allyn. As you can see, very few people bought the pocket-set.

 

In reality, I sincerely doubt that you will be carrying either diagnostic set on the wards, pocket-size or full-size. The reason is that you have so much other crap in your pockets: PDA Handheld, pens, keys, wallet, ward books, and possibly some stuff you've swiped from the nursing station like tape and scissors and stuff. Don't buy one with the expectation that you will use it on the wards. That's just plain wrong.

 

The only reason that buying a diagnostic set would really be a benefit to you is if you are reasonably sure that you would be disciplined enough throughout the first two years to practise using it on family members and friends. The ophtho guys say that you really have to look at a thousand eyes before you really get comfortable using the ophthalmoscope. The ENT guys are similar when it comes to examining ears and tympanic membranes because, heck, if anyone could just pick it up and start doing it, we wouldn't need either ophthalmologists or ENTs!

 

You really shouldn't ask me for my personal opinion, because if you ask any of my classmates who's the guy that spends the most on books and stuff, invariably it will be me. I bought the diag set, and I think I've gotten some good use out of it. Of course, I'm currently set on applying to ENT, and so being proficient in using the otoscope is something that I'm intent on mastering.

 

The reality is that in BC, we pay the cheapest tuition of any medical school outside of Quebec. Sure, the cost of living is high here, but I think that if the Ontario guys can survive paying $12,000+ per year, you can spend $500 on a top of the line diagnostic set once, and still be laughing. As a result, if I were doing it again, I'd buy it again, but there's many people in my class who haven't, and wouldn't, and are perfectly comfortable with their decision.

 

The other thing is that being able to do a good clinical exam on the eyes and ears (well, eyes especially), is something that most medical students are weak on. Pretty much anyone can slap a stethoscope on a chest, or test for reflexes, but doing a good fundoscopic exam is something that I bet less than 5% of my class can do with any skill whatsoever. Examination of those areas (eyes in particular) come up quite frequently in Ophtho and ENT (duh), family med, Emerg, Neurology/Neurosurg, Internal Med if you're worried about vascular problems (hypertension, diabetes, migraines/seizures) or high intracranial pressures and probably a few other areas that I'm not thinking about right now.

 

So, if you buy a set, I'd spend up for the full-size. It's convertable to a wall-mount. Also, be aware that many senior med students are willing to sell their diagnostic set. You could either wait for a for sale email, or else post a wanted message on the list-serv. This also means that in a couple years, if you are set on getting some money back, you can probably sell it for $350-$400 if you bought the $500 model.

 

Finally, confirm with the rep that you'll get lots of free specula to practise with on the otoscope, should you end up purchasing one.

 

The tuning fork isn't that useful, and the ones that you get are crap. I snapped mine in half while goofing around with it. Oops. Tuning forks are useful in ENT when assessing hearing (Weber and Rinne tests), although I've not encountered an ENT who doesn't automatically do a full hearing test in a sound box if there's any doubt as to the cause of the hearing loss. Also, to use tuning forks to maximal advantage, you would really need a 256, 512, and 1024 Hz, not just one of them .I've never seen a family doctor use a tuning fork. You also use them when assessing peripheral nerve function following spinal cord injury or peripheral neuropathies, oten secondary to chronic diabetes. If it's a throw-in, take it, otherwise you aren't missing out by not having it.

 

Tendon hammers are useful. The Queens hammer is easier to elicit reflexes, but the ones you get through Stevens are pretty cheap (the shaft tends to snap at the junction where it inserts into the head), and because the things are too long to carry comfortably, you often end up throwing them into your bag, where it's likely that the handle will be torqued enough to snap it. I suppose you could saw down the handle, but that defeats the whole point, because you are losing the leverage.

 

The tomahawk that you can get is also pretty flimsy, and it looks like the head is ready to snap right off the supports, but mine's held up really well. If you get the hammers as a throw-in, then pick the Queens hammer because it's the more expensive one, and you'll have an easier time getting the reflexes until you break it. The tomahawk sells for about $7 at the VGH bookstore.

 

One quick word on stethoscopes. Get the Cardiology 3. Virtually everyone in our class got one (probably 2-3 people didn't, and a few others had already received stethoscopes as gifts). The Master Cardiology is overkill, and doesn't have a pediatric head. Everything else is underkill. You will also never find it as cheap as you can get it from Stevens, and Littman has a really strong service here. Just this summer, a Littman rep was at the bookstore, and all of the hospital staff that heard about it went down. Many people got new earpieces, others new diaphragms, some people even had the tubing replaced, all for free. You can't beat that kind of service. Don't go cheap on stethoscopes, because it's hard enough hearing those sounds already.

 

BP cuffs, as Travis mentioned in his email, aren't really worth it. I bought one anyway, and practised with it a fair amount. However, I had a great family doctor in first year who forced me to do BP's on every patient that came in, so I got really good at it that way. If your family doctor will let you do BP's on everyone, then getting this is a waste of money, unless, again, you think you'll be practising on friends and family.

 

Lab coats: go to VGH Uniform Services. They're much cheaper to borrow there, versus buying from the bookstore. Keep in mind that these are the short clerkship coats that you will use in Clinical Skills, and that I will be using on the wards; you'll want to purchase a long lab coat for Anatomy.

 

Hope this helps, feel free to refer any of your classmates to this thread if they are also having trouble deciding. In the end, it's only money, right?

 

Ian

UBC, Med 3

[Guest Ian Wong]

Just to add a few additional cents to the mix. I just finished my 1 week Ophthalmology rotation, and it seems like most of the local docs have a Welch-Allyn 'scope.

 

By the end of the week, I actually felt nearly competant with an ophthalmoscope; I managed to see a bunch of things like drusen, skewed cup:disc ratios, a flame hemorrhage or two, and part of a large retinal detachment. I think the key here was spending essentially one week doing nothing but looking into people's eyes using an ophthalmoscope, and getting some good directions in the beginning (thanks to a very helpful Med 4 doing his Ophtho rotation).

 

As a result, seeing that I'm now pretty comfortable with the 'scope, it's something that I think now that you probably don't need quite as much time to master it as I did before, which means that purchasing it and practising with it might not be that crucial in Med 1 and Med 2. Of course, if you have any designs on Ophthalmology, or perhaps Family Practice, then getting good at using the darn thing is still pretty crucial, and the earlier the better.

 

You'll impress a lot of people if, on your first day of your Ophtho rotation, you can already see optic discs and maculas on demand, without initial instructions.

 

Ian

UBC, Med 3

[Guest Jeff Ku]

Where to purchase?

 

Hi, I am not a med student, however, I would like to purchase a Stethoscope for a friend as a gift who is in med school.

 

I have heard that the Littman Stethescopes are best and as I have read you said that the Cardiology 3 version is the best.

 

Where can I go to get one and for the best price?

 

I live in Toronto, Ontario.

 

Thanks!

 

Jeff

[Guest Ian Wong]

I actually would try to have your friend buy it. Med students, at least in Canada, all seem to get package deals straight from a medical equipment distributor, the Stevens Company. As a result, the price a med student gets is very significantly cheaper than what you could probably purchase it for. (Yeah, it sorta "dilutes" the surprise of getting a gift".

 

Otherwise, you could contact the local hospital medical bookstore that is affiliated with that medical school. They will almost certainly have many models of stethescopes to choose from. Finally, if all else fails, the cheapest place to buy new stuff is usually on the internet, given that many web e-tailers have much less overhead expenses than a regular brick and mortar store. Of course, shopping through the internet is riskier than picking something up in person, and could certainly take longer (if you were in a rush).

 

Ian

UBC, Med 3