Stethoscopes for Clinical Years

Initially written on 10 December 2006, 11.23pm, this was brought forward for an addendum.

Introduction

Recently, there was a medical instruments fair held outside of the dean’s office. Unsurprisingly, the majority of students thronging the fair were from the final pre-clinical year. They should be stalking the wards relentlessly from May 2007 and what good hunter would go out without proper equipment?

In this school, there are three available brands of stethoscopes: Welch-Allyn, 3M and unidentified $6 China-made stethoscope. Unsurprisingly, the main battle is between the 3M Littmann series and Welch-Allyn series.

In the "good ol’ days", practically every doctor was using a Littmann Classic II SE ($95).? J.’s family general practisioner uses a grey Littmann Classic II SE.

Now however, the stethoscopes that are in vogue are the Littmann Cardiology III ($220) and the Welch-Allyn Harvey Elite/DLX ($222/$243 respectively).

The irony is that most medical students now carry better stethoscopes than their tutors, not that most tutors of surgical discplines really mind though. (Senior surgeon to house officer/ medical student: "Pass me your stethoscope.")

Factors

1. Audibility

The general consensus is that the Cardiology III and Welch-Allyn Harvey Harvey stethoscopes (Elite/Deluxe) have roughly the same loudness and clarity with the large diaphragm, both of which are [marginally] better than the Classic II SE or Welch-Allyn Professional ($91).

2. Colour

Welch-Allyn has a richer, deeper tone, compared to the bright, shiny sheen of 3M Littmann. There are certain colours you probably shouldn’t get.

One is the grey colour of 3M, especially if you’re getting the Classic II. For some strange reason, the wards stethoscopes tend to come in grey, so that might get a bit confusing. Guys, please, red doesn’t make you look metro. It looks weird.

3. Comfort

For many, many, many years, the stethoscope will be essential to the medical student/doctor. Many hours will be spent with the stethoscope. Therefore, it is important to optimise every aspect of comfort. Please, try the stethoscopes before you buy.

Little things matter. The way the ear pieces fit into your ear and whether they’re adjustable. A good, comfortable, tight fit will minimise pain and help filter out ambient sound, allowing you to hear that 2/6 diastolic murmur.

Unless you have neck muscles like J.’s buff bald classmate, the Welch-Allyn Deluxe is likely to be a bit on the heavy side, especially when compared to the Littmann Classic II SE.

The Welch-Allyn Harvey DLX’s brass head is solid and may double as an offensive weapon.

In general, the Welch-Allyn tubes tend to be stiffer than those of 3M, which are more flexible. This can be a source of annoyance to some doctors/medical students.

Try before you buy.

4. Paediatric Use

This is important… and sadly underrated.

Both the Welch-Allyn DLX/ELITE stethoscopes have diaphragm/bell that may be detached at will, and both comes with a paediatric diaphragm attachment. (See below for J.’s view of the quality of the paeds heads)

The Cardiology III has an adult diaphragm and a paediatric diaphragm which may be converted into a bell (albeit with slight inconvenience)

The Classic II SE has no paediatric diaphragm.

Summary

Buying an expensive stethoscope because you don’t want to lose out is an absolutely ridiculous reason. Unless you’re buying a China-made $17 stethoscope, there’s almost no loss in skills of cardiovascular/respiratory/etc. examination with a $95 Littmann Classic II SE compared to the rest. Don’t let your friends pressure you into this.

That said, J. supports the 3M Littmann Classic SE, and not because it has tradition on its side. It is light, bendy (knots can be tied in it), of good quality, available in grey and most importantly, way cheaper than its more illustrious counterparts.

And of course, J. refuses to cave in to herd mentality: "everyone’s using at least a Cardiology III, mustn’t lose out!"

J. would avoid the Welch-Allyn Harvey DLX stethoscope.

Cost-benefit analysis, folks. Are the benefits of the Cardio III/ Welch-Allyn Harvey Elite/DLX worth the whopping 130% increase in price? Is it necessary for medical students to own such a fantastic stethoscope, given that few will go into a field that requires such high sensitivity? Do medics need every edge they can get, or is what’s between the earpieces most important?

They’ll ask their seniors for advice, but when it comes to stethoscopes, every medic has to make his own decision.

Addendum to summary:
Having compared the various stethoscopes, including the paediatric heads, when it comes to hearing heart sounds, J. has come to the conclusion that the Welch-Allyn Harvey Elite is pretty awesome at hearing a continuous murmur on the left infraclavicular space (due to patent ductus arteriosus) when compared with Welch-Allyn Harvey DLX, 3M Littman Classic II and unnamed paediatric stethoscope. J. finds it mildly better than the Cardio III.

Both the Welch-Allyn Harvey Elite and DLX have exchangeable paediatric and adult diaphragms, but frankly, the corrugated surfaces of the DLX’s diaphragms, and in particular the paediatric diapgrahm, seem to be slightly inferior despite the DLX’s higher price.

If you’re going to spend money on a better stethoscope, J. would go with the Welch-Allyn Tycos Harvey Elite.

Addendum 25 Nov 2007 (contributed by plhu):
additional note: The paediatric diaphragm for the Classic II SE costs $15 before GST. I had to go to the warehouse to buy it; but perhaps they’ll be selling it at the fair too.