If you asked nurses or doctors what type of stethoscope they need, most wouldn’t know. Most would pick a type of 3M Littmann stethoscope and call it done. However, many different 3M Littmanns are listed on the site. Which do you need? How can you tell? There are also different manufacturers. Are there some that are better than others?
Marc Leavy, MD, is a primary care physician of 40 years at Lutherville Personal Physicians and the owner of A String of Medical Pearls. He believes that, “Cheap instruments are cheap. A painter will not use a cheap paintbrush. You need a tool that allows you to perform up to your best expectations.” Even with the cheaper types of 3M Littmanns you can get good sound merely from the way they are made.
Does this mean that everyone should own 3M Littmans or that they should have the most expensive type? Not necessarily. Dr. Leavey goes on to state that “if you are just doing blood pressures in a clinic, you can spend that kind of money, but you really don’t need it. You can also drive a Mercedes to the store to get milk, but you don’t need to. There is a world full of people who will take your money, but sometimes there is no net gain.” The question is: How do you make the decision about what you need for the good of your career . . . and your patient?
Which Brand to Choose
It doesn’t have to always be a 3M Littmann. Morton Tavel, MD, Clinical Professor Emeritus of Medicine (Cardiology) at Indiana University School of Medicine and owner of Mortontavel.com has a great deal of experience choosing stethoscopes. “Some of the generic brands can be pretty good. I have tested one or two, and they aren’t bad but they wear out quickly due to substandard materials.”
Some have two air tubes, but the rubber can deteriorate and the diaphragm can go bad. When he has tested the 3M Littmanns against other models, he has found they hold up well, but it doesn’t depend on the stethoscope as much as the practitioner listening to the sounds. He is passionate enough about this to have a complete heart sounds course available on his website.
Dr. Leavy has had different experiences. “I had an off brand, and the chin piece snapped. I’ve never had a 3M Littmann do that. Will the cheap one last? You could use it as throw away.” He notes that the latex tube can develop dry rot and the earpieces don’t fit well. Nurses should weigh whether it will last long enough to justify buying it for the short term.
For newer nurses, having a cheaper one may be preferable until you see what you need from your nursing job. Some of the other companies that produce stethoscopes are American Diagnostic Corporation, Allheart, Prestige, and Welch Allen. The stethoscope has to fit snugly in the ears, be long enough for you, and possibly have both a bell and a diaphragm, depending on specialty.
Choosing a Stethoscope Based on Specialty
The type of stethoscope you need is largely based on the type of nursing you are doing. Mihai Toroiman, BSN, RN, Director of Nursing for Abcor Home Health, Inc, strongly believes in quality scopes for higher acuity patients. “The higher the acuity, the more you want to have an expensive stethoscope. The life of the patient could count on that stethoscope. If the quality is not there and the sounds are not clearly defined, you could jeopardize the life of the patient.” Other nursing units like same day surgery may not need as powerful a stethoscope, but it is another set of eyes for the nurse. Nurse Toroiman states, “It has to be reliable and accurate, function well, and provide confidence that the nurse can definitely diagnosis what they hear.”
Critical care seems to be the area that requires the more advanced stethoscopes. Trauma is another specialty that depends on the stethoscope’s ability to hear fine sounds that may not be obvious with other stethoscopes, even some of the cheaper 3M Littmann types. School nurses, same day surgery, and endoscopy may not need the equipment that runs into the hundreds of dollars, but those who depend on hearing minute sounds–such as cardiology, telemetry, and critical care–certainly require a more advanced stethoscope for the patient’s safety.
Dr. Leavey recommends sane evaluation of stethoscope selection. “In ICU or trauma, when you need to hear things well, then spend the extra money. You can hear better with the more expensive stethoscopes. When you hear a murmur, it is important to diagnose it expertly. When in critical care, you have to bear the expense because it is important to the job. A school nurse who takes blood pressures doesn’t need more expensive stethoscopes because they will refer patients to a facility. You need to appreciate changes in patient. You don’t want to be unsure. You should have that tool for precision.”
Newer nurses are often bewildered by the amount of stethoscopes available on the market, and that is a normal feeling. With the differences in brand and even the differences within a brand, it can make it difficult to know what to buy. When you are in school, opt for a less expensive type that will help you to get to know your basic breath, bowel, and heart sounds. You don’t need the prestige of a 3M Littmann that early in your career.
When you have been on the floor for a while and have seen the types of stethoscopes out there, then it is time to make a decision. Choose a stethoscope that meets your needs and is the safest for your patient. But, as Dr. Tavel states, knowing what you are listening for is far more important than what type of equipment you use. By knowing what a murmur or an extra heart artifact sounds like, study the sounds through the use of classes. See this link for an expert’s view on heart sounds, what they sound like, and how to identify them. Then determine the type of stethoscope you need.
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