$100 for a somewhat specialized, durable medical device that has to meet regulatory standards and will be used daily, possibly for years, by healthcare providers to do patient assessments?
A 3D printed option is going to require a 3D printer, appropriate filament and should be unit tested to ensure it's within spec. The durability is going to be suspect no matter what. It's an awesome project and I'm sure would be a welcome addition to the 'boostrap humanity' catalog of 3D printed parts, but for everyday doctors plunking a hundo on a good tool is going to be a no-brainer.
A commercially sold hospital stethoscope is a legally marketed medical device made under a manufacturer quality system, with labeling/instructions, device listing/registration obligations, adverse-event/complaint processes, cleanability expectations, liability, warranty, consistent materials, and repeatable acoustic performance.
An open-source 3D-printed stethoscope is a cool project, but unless it is produced and controlled as a medical device, it is not equivalent to what hospitals are buying for daily patient care.
Personally, if I was a hospital or a doctor, it would be a no-brainer for me to go with the commercially sold stethoscopes. All those factors I listed above, if neglected, can end up costing a lot more in terms of consequences. I would rather pay a fixed extra overhead price per unit to sleep well, knowing I don't have to worry or think about those factors at all. And, I would assume, most of the patients would be in favor of that as well.
I know nothing of this, but it looks like stethoscopes are Class 1 medical devices with 501(k) exemption, and fall under the "Good manufacturing practices" guidelines of Quality System Regulation (21 CFR 820), but that seems pretty squishy.
> $100 for a somewhat specialized, durable medical device...
And one which is treated as a status symbol, at that. Part of the reason a good stethoscope costs more is because it looks nicer, not just because it works better.
There are cheap, generic scopes (Sprague-Rappaport types) that are very sensitive but the double tube also causes a lot of noise. There are knock-offs of the Littmann scopes in the market. Then there are the scopes doctors usually buy, which are Littmann, Harvey (made by Welch-Allyn) and Heine, and a few smaller makers. No marketer of a high-quality scope wants to sell it at a $30 or less price point, and if you're going to go higher, might as well place it in the same market as the Littmann ($115+). I'll be honest, for emergency medicine use, the Littmann lightweight scope is good enough and cost about $45 when I bought it. But if I actually want to hear the subtleties in a chest, I'll use my personal scope (a Littmann Cardiology IV). Why choose this one? I already know it and they are very consistent. It doesn't feel cold to the patient and it has the right level of sensitivity without much noise. It is a little heavy. If a dog is bucking around, it can go flying and hurt if it hits someone.
I have a littmann cardiology 3 I bought in 2010 and the diaphragms wore out in 2019. By that time, they stopped selling official kits for the 3, so I repaired it with an off brand kit and was given a 4 for Christmas. The off brand diaphragm lasted only a couple years. My colleague has had the rubber tubing wear out. They say if you wear a collared shirt it lasts forever hanging on your neck but if it sits on your skin it wears out, and she always wears scrubs.
My first stephoscope lasted about 10 years until the tubing became brittle and started cracking. It's the oil on your skin that does it apparently. It went through a couple diaphragms and I lost an ear piece but used a replacement one.
Fair enough. My medical classmates regularly used stethoscopes that were purchased by their parents for the parents' own studies but I understand there may be differences in build quality.
Years ago I had my blood pressure taken by a nurse; this was when they did it manually, squeezing the pressure cuff bulb by hand and listening with a stethoscope. The doctor came in later, saw the numbers and frowned, and took my pressure again. She (both were women) ended up with a reading much more within my normal range.
I asked, joking, “So are you just better than her?” “No,” my doctor replied, “She’s better. She gets more practice. I have a better stethoscope.”
The pressure cuff + stethoscope combo is called a sphygmomanometer. It's a pretty fascinating piece of technology: A heartbeat is only audible in the earpiece when the cuff is compressing between someone's systolic and diastolic pressure.
To use it, you get the cuff pressure high enough that you stop hearing a heartbeat in the earpiece. Start releasing pressure slowly. As it comes down, take note of where on the dial you start hearing the heartbeat. That's systolic pressure. Keep listening, and take note of where you stop hearing the heartbeat. That's diastolic pressure.
And if you use a mercury sphygmomanometer, you can actually see those pulses appear and then disappear. (It's harder to see them with a gauge-based one.)
I'm an anesthesiologist; we will sometimes use a pulse oximeter below the cuff as a quick estimate. With practice you can estimate SBP to within 5 mm Hg or so, which is more than enough for our needs.
I have a much higher BP when I first go to the office than after I'm sitting in the exam room for a bit.
Usually they call me back to the hallway where they check my weight, then have me sit in a chair and check my temperature, pulse ox and BP, with maybe only a minute sitting down before they do the BP check. My BP is usually in the "hypertension" range there.
But, if they come back to the exam room after I've been sitting in that quiet room for 5 or 10 minutes and check my BP , it's almost always in the "normal" BP range (same as what I see when I check it at home).
Doctor calls it "white coat hypertension", I call it "rushed BP check in the hallway".
Then you will notice when your HCP ignores those instructions, like wrapping the cuff around your shirt-sleeve, or prompting you to talk while the measurement is taken, or allowing you sit with your legs crossed.
BP monitors are often poorly calibrated. The instructions for my home monitors suggest bringing the device into the clinic for calibration, and then the clinician says "we don't do that!"
Manual sphygmomanometer readings won't have an automatic digital readout, and require the human HCP to interpret, announce and record the numbers.
If the nurse got a reading well outside normal range she should have repeated it to confirm, especially if it was inconsistent with your overall presentation.
People buying stethoscopes tend to be reasonably affluent. Some of the pricier ones just look better and people usually buy them when you get into med school (at least this was the case for me), it's somewhat symbolic so why not splurge.
There does seem to be a difference in quality though. It's much easier to hear the important things with my littman than with the cheap generic stethoscopes I usually find lying around in clinics.
It’s funny, most physicians agree that the cheap disposable stethoscopes in isolation rooms are the best, mostly because they are so loud it’s difficult miss anything with them. However, I am not a cardiologist so they may have a different opinion.
I've actually found them pretty terrible. I can't hear subtle findings at all with those. My usual stethoscope is an older-model Littman Cardiology III with stiff rubber and a dual pediatric-adult head. I've had it for over 25 years.
I guess it's different strokes, because I can definitely hear subtle sounds much easier with them. In fact normal sounds sound like it is going to blow out my ears. The only issue I have is consistency; it's difficult to gauge how much something has changed over time with different stethoscopes, especially pulmonary edema and wheezing.
I would really disagree as a physician that's used a lot of random crap stethoscopes when I don't have one or in an iso room. Those disposable ones are different in what they pick up, some findings are louder others not detectable. Sure I can pick up some stuff like rubs and systolic murmurs but you aren't going to get more subtle findings like diastolic murmurs and fine crackles. Probably a combination of certain frequencies responding and also me being used to mine.
I mean self repair without renting proprietary equipment, having to soften glue with heat, etc. I used to be able to swap batteries in seconds without tools. Some laptops could do it without shutting down.
The Apple status pages (both of them) are some of the worst of the big league offenders, perhaps second only to Microsoft.
Full disclosure, I operate a product that compares official outage acknowledgment to actual outage impact times. (Which I won't mention to avoid self-promotion.)
For this specific incident, I saw the alert come across my Slack at 19:02 UTC. We received over 100 reports of this outage before the official acknowledgement was posted by Apple on their status page at 21:37 UTC.
Shortly after their acknowledgment, the reports fizzled out and then Apple marked the incident as resolved about 20 minute later.
The whole outage lasted about 4 hours from first report to last and wasn't acknowledged by Apple until 3.5 hours into it.
I thought so, too. I randomly found this on Reddit and it struck a chord with me, especially as an urban dweller that absolutely despises litter and litterers.
