What stethoscope should I buy?

The Littmann Cardiology III.

Oh, you actually want to read a treatise on stethoscopes? Well then don’t let me stop you!

A reasonably good stethoscope is the one (and I mean one) and only piece of medical equipment that every medical student should purchase. You will use it during the preclinical years for training and OSCEs, and starting third year you’ll use it almost every day (possibly for your entire career). Stethoscopes aren’t like ophthalmoscopes; you really need to have your own, and it is absolutely worth it to have one that works well. But there are an overwhelming number of models at a huge variety of price points.

You say the word stethoscope, and the response you’re most likely to hear is Littmann. But even then there are a lot of choices. My recommendation for most health care professionals is to buy the Littmann Cardiology III.

From first hand experience, there really is a difference between cheap and expensive stethoscopes, period (even to some extent within the Littmann line of products). I actually used and continue to use an old Littmann Lightweight that was my mother’s. When it went missing briefly, I used a pink cheapo one that my wife had upgraded from. In both cases, I thought I was hearing the right things. I could hear a heartbeat. I could hear breathing. However, there’s a significant difference between hearing the heart and breath sounds and being able to hear diagnostic sounds. I thought residents were lying about hearing faint murmurs or bibasilar crackles. ((Sometimes they were, but that’s beside the point.)) That’s because even with my old Littman, the amplification and frequency response simply wasn’t that good. Everything was muffled. Moreover, the tubes on cheap ‘scopes are so poorly insulated that any slight movement (even chest movement, patient hair, etc) is enough to obfuscate any actual physiologic noise.

My wife has the Cardiology III (a fun present to get from relatives, as it costs around $150), and if I were in the market for a new stethoscope, it is the model I would buy without question (update: my vintage stethoscope broke during intern year; I replaced it with the Cards III). When I first borrowed it my mind was essentially blown. I had no idea what I’d been missing. The Cardiology III strikes the right balance of features and price for essentially any physician. ((If you don’t want/need a pediatric head or a dedicated bell and do need to look awesome, then perhaps the Master Cardiology is for you (see the comments below.) ))

• Tunable heads mean that you can assess both high and low frequency sounds by altering pressure. Once you practice with a tunable diaphragm, it’s actually a great feature as it allows you to rapidly get a full sonic picture of a location in space without having to futz with the stethoscope
• Double (both adult and pediatric) diaphragms (the peds one can be switched to a standalone bell as well, which can be nice if you want to ignore the tunable feature). Some schools require you to have a double-headed model so that you can “switch” modes when taking standardized exams, and this is the model in the cardiology series that is double-headed. This also means that no matter what you do later, this one will get the job done.
• Excellent (I mean excellent) external noise attenuation. You hear what you want to hear.
• The only con is that is a bit on the heavy side. The up-side of this con is that you can easily use the head to test reflexes.

Someone may come to your school to try to sell you a digital/electronic stethoscope (like this Thinklabs one several of my classmates were conned into buying). Outside of increased amplification for the hearing impaired, most digital stethoscopes (while kinda cool) are stupid for a variety of reasons: bulky, most can’t fold properly for a pocket nor easily wear around your neck, need for batteries, etc. I have yet to see a compelling reason to buy one unless you are an educator, as the second-listener feature is great in a classroom setting.

Some people hate Littmann’s “new” tunable stethoscopes. And while essentially everyone I’ve ever worked with carries a Littman, there are some folks (especially old school docs) who swear by a couple of other models, particularly the Harvey Elite, which is even pricier but is universally acclaimed by its users.

In addition to a good stethoscope itself (and certainly the cheaper/lighter Littmann Classic II gets the job done), many of my classmates and fellow residents also swore/swear by their holster, though I myself just bear with the neck strain.