Ask the Half M.D.: what’s the best stethoscope?

July 15, 2008 at 10:47 am (Ask the Half MD)

All around the country premeds everywhere are anxiously awaiting the start of medical school at the beginning of August. They will bring with them many hopes and aspirations as they begin their careers toward becoming future MD’s. They will have many questions such as which organizations to join, whether or not to go to class, and who is going to kill the first patient. But nothing is more anxiety provoking at this time then trying to decide which stethoscope to purchase.

While there are many options to choose from, I would caution fresh medical students to stay away from the electronic stethoscopes. I have never use these devices. While I’m sure that their built-in microphones will help listeners catch even the faintest heart murmur, there is something to be said about learning the physical exam the old fashion way.

First and foremost you must buy a cardiology grade stethoscope. That includes a diaphragm, a bell, and a dual lumen tube. Instantly disqualified are the nursing-grade stethoscopes that your parents got you as a gift when you were accepted to medical school. You should plan to spend at least $100 on a quality model.

Currently, the most popular stethoscope amongst medical students is the Littman Cardiology III. there is no shortage of users willing to sing its praises. It comes in numerous colors, drug companies give away accessory products specifically designed for it, and it has the appeal of being able to say, “I went with the Littman.”

I don’t like it. I haven’t been able to hear as well with it as the marketing propaganda would claim. The fans will instantly cry out, “But it has a tunable diaphragm.” To which I would respond, “Do you even know what a tunable diaphragm is? And furthermore, if you pay any attention to the research that was conducted on stethoscopes beginning over 50 years ago, you’d realize that a tunable diaphragm is the exact feature that a stethoscope should not have.”

I prefer the Welch Allyn Tycos DLX. The sound quality is much, much better compared to the Littman. It has interchangeable ear pieces that come in various varieties of stiffness so that the user can choose based on comfort level. Finally, the diaphragm can be easily changed to a pediatric version. All I have to do is unscrew the adult version and then replace it with a pediatric one to convert my stethoscope into a listening device for the kids.

Take a look at the pictures below:

Adult version

Pedi version

What now bitches? I’d like to see you pull that off with a Littman. Its users will be required to buy two stethoscopes to follow both adult and pediatric patients. I know several people who purchased new stethoscopes just to go through the peds rotation. I took a more sensible approach.

Edit: I just found this exhaustive article that goes into detail about properly using a stethoscope. There is also this article that gives a comparison of multiple scopes.

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56 Comments

  1. joe said,

    What now bitches?

    Haha, really didn’t see that coming.

  2. nyublog said,

    [quote]What now bitches?

    Haha, really didn’t see that coming.[/quote]

    Hahahaha. Same. Made me laugh. :)

  3. Corey Gilmore said,

    I disagree with you on the electronics tip. I bought a Thinklabs off of Amazon and love it. Sound quality is great and you can even turn it into an acoustic scope.

  4. kiddyshrink said,

    Nope, you win. I can’t do that with my Littman.

    (Yes, psychiatrists use stethoscopes. At least, this one does.) :)

  5. halfmd said,

    Ah, but you can’t use an electronic stethoscope on the STEP 2 Clinical Skills.

  6. eneri said,

    you obviously haven’t tried running around on call with the welch allen — its damn heavy and hits against your chest with every step you take. as the night wears on, you feel its leaden weight more and more. besides the tubing’s of poor quality, it cracked after my first yr as an intern. Used to use the welch allen and now i swear by litmann Cardio III

  7. eneri said,

    btw the littman III can be converted to a paeds steth – the bell can be fitted with a diaphragm to become a paeds diaphragm

  8. Scrub Notes said,

    Another vote for Littmann Cardio III, and yes, I used it on my peds rotation and it worked fine using the conversion eneri notes above.

  9. EMT intern said,

    freak’n hilarous. Awesome ariticle. I am taking a class now, and was stressing about what stethoscope to purchase. I was wondering what the difference was between pediatrics and adult was, now I know. I have read other forums saying that Tycos & DRG Puretone (Doctor Research Group, also Bose designed the acoustics for this one) Stethoscopes were better than Littman’s acoustics.

    What do you think about the ultrascopes? I heard they are comparable to cardiology stethoscopes and lighter too boot. Unfortunately, I do not see the option to swap to pediatrics if you get the adult version for it (unless i missed something). Great tips for duel lumen, bell, and diaphragm. I’ll keep that in mind while shopping around.

  10. EMT intern said,

    nevermind, ultrascopes do have the option for pediatrics as well as neonatal.

  11. aw md said,

    First off, your right electronic is definatley not the way to go. However if you knew what a tunable diaphram was youd probably be using one. Also with the Littmann Master Cardiology (which littmann touts as its top of the line best cardiology scope) comes with an attatchment for pediatrics. Easy to use, and far superior to any scope Ive ever used tunable or not. A.W. MD 22 years in cardiology

  12. Critical Care said,

    The Littmann Cardiology III is not an acutal diaphram and bell stethoscope. It has two tunable diaphrams. One side is a pediatric and one side is an adult. This is the same as the master cardiology scope but gives you the option of having a peds scope available.

  13. Norman O Moser, DO, Pharm D, R.Ph said,

    Hello;

    I am an older physician who has tried many stethoscopes trying to find the best one. I finally tried the following test. Borrowing various stethoscopes from friends, I assembled quite a number of different stethoscopes. I then listened to just one patient and compared all scopes. I rated each scope on ease of use, durability and quality of sounds to “MY EARS”.

    I did the same experiment with 5 more patients refining my list of stethoscopes that worked best with me and “MY EARS”.

    I am now using the Littman electronic model 3100. I never listen to pediatric patients, so a pediatric scope is a mute point for me. The 3100 to me sounds great, looks great and is very durable. I have heard things with the electronic that I have never heard with an accoustic. By the way, my hearing is not failing.

    Choose the scope that works the best with “YOUR EARS”. Try many. Listening to advice from your friends and advertisements will help guide you, but your friends do not have “YOUR EARS” or your habits. you will probably have mutiple scopes throughout your career.

    Norman O. Moser DO

  14. Christophorus said,

    Littmann Cardiology III is the best!!! The electronic ones are for lazy guys.

  15. jurian said,

    my friends got another version of Littman and looks like the scope can rotate 180degree. The first side for adults and the back smaller side for paediatrics..
    hahahahaha… LOL.
    JFK.

  16. zsigaman said,

    I’ve got the Welch Allyn, too and I think it’s great. Very loud and clear. But the bell is a bit small and accordingly quiter, though crisp. So I’ve had a bigger one made and now it’s probably the best scope ever.
    But the best buy is the good old Sprague. Why? Because they’re cheap, have loud and crisp sound that practically rivals that of the Welch Allyn and come with much longer tubing, which makes for a more convenient examination.
    Littmans are much quieter than the above two, even the Cardiology III and Master Cardiology and gallops are a bit blurred.
    So that’s my take on the matter.

  17. Nick said,

    I have to agree with Dr Moser. Try lots of stethoscopes and find what works best for you. I’m a paramedic and have worked on ambulances, in airplanes and in hospital. After 11 years I swear by the Littmann Cardiology III. The thick tubing is very effective at canceling out background noise. The tunable diaphram does work very well (maby not quite as well as seperate bell and diaphram, but very well), and I often use the smaller side on peds and small, thin or frail elderly patients. I would probably make the jump to an electronic model (though I agree it’s best to start off acustic) except I have had the need on numerous occasions to disassemble and disinfect the entire thing. Another important feature often forgotten about is tubing length. The longer the better if your patients may include the bleeding, vommiting, coughing, stinky or unclean. Make sure you label your sthethoscope many websites offer engraving. The unwritten rule seems to be “the more expensive the ears, the more likely I am to set them down and walk off”

  18. A, RN said,

    Wow, thanks for the degrading comment about nurses, “Instantly disqualified are the nursing-grade stethoscopes”. I am an RN and currently also use a Littman Cardiology III specifically because it was required by my nursing school. Do you think it’s strange that RNs and MDs would use the same stethoscope? I don’t.

  19. CCU Nurse said,

    What is a nurse-grade stethoscope anyway? I work at a teaching hospital and apparently all students and most doctors have nurse-grade stethoscopes…What a bunch of BS.

    I have the same stethoscope as my husband who in fact is a cardiologist. Depending on what kind of nurse or doctor you are depends on what kind of stethoscope you should consider. My husband has lost his stethoscope to plenty of residents and medical students so don’t spend to much money as you will eventually need to buy another. We have always had littmanns and I would recommend the brand. Maybe are next purchase will be a Welch-Allyn to compare.

  20. CCU Nurse said,

    Apparently there is something called a single head nursing stethoscope…”interesting” you can buy it for about $6. Pretty sure these are the stethoscopes they put on isolation carts that get thrown away. I don’t know any NURSE who would ever purchase this.

  21. CCU Nurse said,

    http://www.forusdocs.com/reviews/Acoustic_Stethoscope_Review.htm

    this is an actual study, read conclusions and recommendation on page 7

  22. Reader said,

    Calm down. The remark obviously wasn’t intended to degrade nurses, only to show the the wide scope of stethoscopes available. As CCU stated, there is a “nursing stethoscope” and it is often given as a gift from people who don’t know any better.

  23. JJ said,

    Dear CCU nurse:
    Please go to medical school and become a doctor because you are obviously too insecure as a nurse.

  24. BB RN said,

    I am a peds onc RN and I came across this site to find a recommendation for a decent scope. I don’t think that MDs and RNs should be clashing here, aren’t we all working toward the same goal of performing the best assessment possible? In fact nurses spend the entire day with the patient and do multiple assessments throughout the day and share any changes with the MD. So it makes sense that a nurse should have an excellent stethoscope as well. The MD of course also needs the right tool to make a correct and accurate diagnosis. It’s just disappointing to see negativity whereas we should be focusing on how best to work together to improve pt outcomes. It seems that the Littman III is popular with physicians. I’ve been using a basic littman for a while until a resident snatched it! Kidding! But really it’s time I invested in a decent scope so I will try it. Thanks

  25. emt dude said,

    personally, l’ve tried several brands of scopes in my ambulance,and i swear by the adscope by ADC. Sound quality is awesome and the price is very reasonable as well. lts definitely worth trying.

  26. MG said,

    Do you still agree with your stethoscope recommendations? Curious b/c I am researching one for my partner who is graduating in may.

  27. JN said,

    EMT dude…you are not even remotely qualified to comment on the topic at hand. Carry on handing out band aids and 02

  28. Dr. Jackie said,

    I have been a RN for 40 years (nearly 30 years spent as a Navy Nurse) and I am buying this stethoscope as a gift for one of my students who will become a physician. His MCAT scores and GPA are exceptional. I have never known such a highly intelligent, warm, friendly person who wants to become a physician-his goal is to ‘help others.’ Thank all of you for being so sincere with your comments; your comments have truly helped me to make the appropriate selection based on my research. Thanks again!

    RN in Virginia who is now a College Prof

  29. Kaitlin Sherman said,

    Sir, you mentioned in your article, “…tunable diaphragm is the exact feature that a stethoscope should not have.” Can you explain it in a nutshell? I’m sure it would be time-consuming to look back at those 50 years of research. So, a brief summary from you would be great (or perhaps you can share the most notable ones?). Currently, I have the Littman Cardiology III (which I bought at http://www.stethoscopesforstudents.com) and it’s working greatly for me. I love the convenience that the tunable diaphragm gives me (not having to turn the chestpiece over). But you know, I would gladly consider other steths if the feature compromises accuracy of detecting important sounds. Thanks. :)

  30. Greg said,

    Hahaha! You hurt the sensitive nurses. Why shouldn’t they get the same stethoscopes as doctors? They do the same things. Oh, wait, they don’t? :D

  31. NICU RN said,

    Have any MD try living 1 day without nurses and then come back and tell us how it went. kr

  32. Greg said,

    Ha! Another nurse overcome by emotion. Thus, you missed the point of the argument. Don’t worry, not your fault. It’s your IQ’s. :D

  33. bynaturalmeans said,

    POMPOUS DRS! Nurse’s are not inferior. a lapse in judgment but all of you it seems. No, they don’t do the same things as drs but they certainly need to be able to hear a patient properly. how ignorant to assume that the nurses on this chatboard are “overcome with emotion”. And no, I am not a nurse. just a student, a very educated and informed student who appreciates what nurses do and what they will do for the future of healthcare. their job is beyond critical. every person who works in hospital is a critical component to the bottom line – helping others.

  34. sam said,

    I am an emergency department Dr, with a particular skill set. I have nothing but respect for nurses and EMTs who have their own unique skills and areas of expertise. To the gentleman above ‘JN’, I am assuming that you are a student and/ or an idiot, therefore have absolutely no idea what you are talking about. It takes incredible skill to rapidly assess, triage and initiate appropriate emergency therapy in a prehospital environment. Take a ride with some EMTs and see what they do, that is if they’ll have you.

    As for stethoscopes, I’ve owned a few – if you are a cardiologist, and need to be able to hear subtle murmurs and soft opening clicks, then spend a small fortune. If you need just need to take BPs, check HS, and ausculate the lungs, then a medium grade steth will do fine.

    the classic sprague rapport scopes are good in terms of sound quality, but the dual tubing can rub together producing artifact – not so good in the back of a moving ambulance. The maxiscopes from Ultrascopes are not bad – easily cleanable, and good when it’s noisy (EMTs), and only about 40 bucks.

    so there you go.

    PS a ‘Nursing stethoscope’ simple refers to the inexpensive scopes that hospitals buy en masse which sit on the BP machines to take blood pressures, which is usually a nursing responsibility.

  35. Dave said,

    Well. Loved all the comments. Now I’m I a different boat all together. I’m a flight nurse..and before the few egotistical doctors go all stupid on here, I’m a Gulf medic veteran, (part one), emergency and ICU nurse with 5 post grad cert’s and a masters, so please don’t belittle my skill as an RN, I have more skill in left toe than most residence have fumbling through their first 5 years. So my question is… I know my heart and lung sounds, but I’m in the back of a noisy chopper or fixed wing air craft. Do ano of you know if the electronic littmann 3100 are affective in this noisy environment? Cheers

    Dave

  36. Dave said,

    And I’m typing this on an iPad a 3 in the morning so excuse the typos !

  37. donver said,

    what’s the best stethoscope, I don’t know, but where is the cheap stethoscope manufacturer, I know, visit http://www.welisam-medical.com

  38. Jamie said,

    This has been so incredibly entertaining! Thank you Dr Sam for your awesome words. I happen to be a nurse in the ER. There are so many EMT’s, paramedics, RN’s, LVN’s, and Dr’s I would trust with my life independently. The team I work with is close knit and stellar. We all have to work together to get the job done. I appreciate pointers and thoughts, and my Doc’s appreciate the same from their Nurses (well, most of the nurses, lol. You always have the dummies). Dr’s with the attitudes and belittling comments have some major ego issues. You spend 12 hours with the same patients dealing with all sorts of issues, in addition to their current health complaints. And isn’t the nurses who calls the Doc to say, “This guy is about to crash, and this is my reasoning behind my hunch…” and then state assessment findings, which require stethoscopes. I’m just saying. I don’t want to be a Doctor. I chose to not be a Doctor. I work 3 12-hr shifts and go home at the end of the night/day. No one calls me. I get to live my life :). But I thank all of my Doctors, someone has to do the job, and luckily it is not me!

  39. claire said,

    Hey, just wondering how much was your adult and pediatric one that you prefer better?

  40. Donver said,

    please send me email at donver@welisam-medical.com, so that we can talk privately. thank you.

  41. Corinna said,

    I am an ICU nurse and I was given a welch allyn by a an MD that was sweet on me. The relationship didn’t last but my stethoscope is still going strong. I have to admit, Welch Allyn is the best stethoscope I have EVER had. I will NEVER go back to a littman again. I have been currently using this one for 6 years now and haven’t had to replace the tubing like I had to yearly with my littman. I have the dual head, it is light weight and has been very resilant. HIGHLY recommend a Welch Allyn. I will buy one again and again.

  42. Jane said,

    Hey there…I’m a real nerdy post-acute care nurse. I have an excellent ear and I hate my Littman low end model. I have been contemplating a Thinklabs digital that I can record waveforms with. Anyone have comments on this? Thanks! Jane

  43. DrWort said,

    As a paramedic the hardest part for me is finding a model that will keep the outside noise to a minimum as the back of an ambulance gets pretty loud. Especially if were priority 1. The litman did not do it for me I tried my friends WA and it was perfect. Even in my BSN classes it seems to be easier for me to hear abnormalities than my peers but that may be experience who knows.

  44. Simple Jane said,

    I just want to thank the garbage man for picking up the trash with my old stethoscope . Just being grateful in life for what matters!

  45. Daniel said,

    I was looking recently at purchasing a stethoscope and your article was spot on. Although electrical stethoscopes are much easier to use and detect even the faintest sounds with, i too appreciate the craftsmanship of using a stethoscope the old fashioned way and the richer experience you get.

  46. Steven @ Best Stethoscopes said,

    It’s rare to see someone recommending Welch-Allyn over Littmann when it comes to the best stethoscopes, but congrats for sticking to your own guns. As far as electronic stethoscopes are concerned, their price is on a downward spiral recently, and once they match the price of an acoustic stethoscope i do not see anyone who would not give them a serious thought. In my opinion the price is the only reason you should not get an electronic stethoscope at the moment.

  47. H. E. Sawyer, Jr. said,

    Hello, Folks. Well, I was a pretty good Psychiatrist in the U.S
    Armed Services, and got into the healing arts ( it ain’t a science ),
    as a respiratory therapist, then, just a little later, was a Physician’s Associate. Since 1970, I’ve owned about 50 ( fifty ) stethocopes. My first scope, was the Littmann Magnascope. I believe 3M’s
    item number was 2185. Compared to the original, the 2100, this
    was a much bigger guy, with a 40 % bigger diaphragm, and a
    HUGE, deep, bell. It was a sales failure, but it really did the job.
    It was the original Cardiology Littmann model. But, I also owned
    the 2100, and the chrome-plated feather-weight version of that
    scope. I purchased the H-P Sprague-Rappaport scope for $60 bucks in 1972, and chewed my nails, waiting to get mine. This
    H-P Sprague was a beautiful scope, but when I finally got mine,
    I actually could not hear spit with it; I literally could hear nothing
    with it. I gave it to a girlfriend, and went back to my Magnascope. Later, A now-defunct little company in Florida, Buffalo Medical, made a very fine, good-looking, heavy duty scope they called the ALLEN Mark X. It was $40 bucks, and I bought three. It was loud. And,
    accurate. In 1975, I bought a very expensive, well made scope
    that I’d read about: The Taylor-Harvey Triple Head, with double tubes, and the rotating turret chestpiece was HEAVY, and it was designed to be just that – heavy. It is chrome-plated brass. IT was designed by the late, W. Proctor Harvey. At $250 bucks, I expected this to do double-back flips, and believe me, it did !! This guy is WAY LOUD ! They sold several of these guys. If you’ve ever
    tried the Harvey types, you know they are loud, and accurate.

    They sold the Harvey designs to Welch-Allyn. Recently, I had
    a chance to purchase the Harvey Elite Cardiology model, for
    a tiny fraction of the MSRP, from an E-BAY seller. It’s a great
    scope. Very loud. Very accurate.

    Also, I bought a $13.95 Chinese knock-off of the Littmann
    Master Cardiology scope. It’s a beauty. It”s not as heavy,
    but in terms of loudness, it’s EQUAL to the original Littmann.

    I’ve used the Littmann Cardiology I, II and III. I thought, and still think, that they are FABULOUSLY over-priced.

    About three weeks ago, I bought a totally like-new HEINE Model 10, stethoscope, for $30, from an E-BAY seller in New Orleans. It’s a very fine instrument. Really loud and accurate.

    At this moment, I have a DRG Pure-Tone Adult Combination scope coming…. I remember years ago, when this thing hit the market
    in the States…they were the most expensive scope you could buy, except for the Harvey line, and the HP Sprague. I will be more
    than curious to see what the quality of this DRG scope.

    But, I agree with the other writer, in this thread: FOR THE MONEY, the little chinese generic Sprague-Rappaport is the BEST scope in the World. $9.95, to $19.95. Huge value.

    But, there is no substitute for knowing what you are doing when you are ausculting the human thoracic anatomy. Harvey taught his system of auscultation, and it’s the world bench-mark.

    If you don’t know the Harvey System, learn it. It’s certainly
    worth the time and trouble.

  48. best stethoscope said,

    I always trust Littmann. Had one since I was in college and tested colleagues and glad I don’t have cheaper ones.

  49. Nurseman said,

    I own a littmann 3100. Excellent auscultation of breath sounds and heart sounds in a quiet setting. If you turn the volume past 50% the slightest bump to the tubing, a patient cough, and background talking gets picked up and it hurts. I keep mine between 1 & 3 on the volume, and it works perfectly. Volume set at 3 bars is equivalent to the littmann master cardiology volume wise, I borrowed my friend’s master for a few days. The electronic is nice but isn’t worth the money IMO.

  50. Peter R said,

    I own a Littmann cardiology II SE stethoscope that I bought in 1997 after losing my Littman Classic II. It did not perform as well as the Classic II, and my listening experience went up when the tunable diaphragm disintegrated (left steth in sunlight for too long, I think) and I replaced it with a standard Littmann diaphragm. But it is still a rumbly stethoscope.

    My other stethoscope is an ADC Sprague Rappaport, which does well… and even better once I replaced the adult diaphragm with a thin aluminum alloy disc (salvaged from a thin walled soft drinks can – large diaphragm 39.5mm diameter, small diaphragm 26m diameter). You can’t hear a bruit? Difficult to hear a pleural rub or make out that both S1 and S2 are normally slightly split? Go play with your Sprague and a soft drink. The trendy mini-cans are better as thinner walled btw. I would ideally use thin stainless steel for a diaphragm, but dunno where I can McGyver that from!

    Next modification I did was daring to modify my Littman Cardiology II SE. I could not get myself to discard that lovely “L” for littmann diaphragm, but I did some high frequency preference mods to the diaphragm side. It involved gluing a piece of aluminium (aka aluminum) sheet over the sound hole, with a 1mm diameter hole bored through it. I filled excess space under the diaphragm with several layers of PVA glue, laid a few hours apart, to maximise internal pressure differences with diaphragm movement. I also cored out the ear olive exit hole so that it did not represent a narrowing in the sound path – so as not to selective attenuate high frequency sounds (cf. why we use the diaphragm in the first place!) The nature of the head modifications are suggested in this British article from the 1960s: heart.bmj.com/content/23/4/447.full.pdf

    Reading this article btw was what spurred me on to go have the balls to play with the modifications.

  51. Peter R said,

    Here is a TEST for the ability of your stethoscope to conduct sounds faithfully.

    It is a fact that the low frequency sounds do not need amplification, and they travel nicely through most tubing. In other words, most stethoscopes, at least if you use the bell, will let you hear the rumbles. It is therefore crucial how a stethoscope carries and protects the fragile high frequency sounds.

    1. Rub your fingers against each other by your ear. Note the high pitched rustle as well as the lower pitch rubbing.

    2. Put your stethoscope on. If the ear pieces fit you should not be able to hear your fingers rubbing against each other.

    3. Turn your stethoscope head to the OPEN BELL side and, without touching the stethoscope head, rub two fingers against one another by the bell opening.

    How well can you hear the high pitched component of the rubbing?

    If “no”, then that stethoscope is working against itself. It has a diaphragm to attenuate low pitch sounds (which otherwise drown out high pitched sounds), but then, further up the stethoscope, something attenuates those precious high pitch sounds! Duh!

    It is of course not a completely telling test cf. the airtight system behind the diaphragm, but all the same, I have noted much difference between stethoscopes.

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  53. Sean said,

    HalfMD,

    Question for you, does the tycos come with the peds head or did you order that separately?

    Thanks,
    Sean

  54. Dr. Sachin said,

    I never used Welch Allyn Tycos DLX, but I have Littmann Cardiology stethoscope and it works great for me. Though it is bit expensive but have great acoustic quality and many other features.

    I think I should have one Tycos DLX if my Littmann get lost or something like that.

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