I decided to take a chance and go with the MDF ER scope instead of the Littman. I think I did okay. It has an excellent range of sound. I was able to auscultate some abnormal heart sounds on some nursing home patients much better with this scope than others I have tried (without even using the cardiac adapter that comes with it). It is well constructed and comes with the free parts for life which covers the ear pieces and diaphrams. I'm sure there are better scopes out there, but for the money I think it was a good long term purchase.