Tubing is extremely short! You would have to be against patient's face to be able to evaluate heart sounds. ???? Stethoscope works well, as promised. No paperwork or instructions for 7 year warranty included. I just can't describe the difference in sound quality and transmission. After a pair of these, cheaper scopes are just awful to listen to. This was purchased as a gift for my Niece when she started medical school. She went through her internship residency graduation and it's still working. I did not realize that this stethoscope had the slightly shorter length of tubing. As I recall, this was the length that was on the original but they found that there were many... Littman makes the best stethoscopes. exellent product Working as an ER nurse in EMS, the environment can tend to become very noisy. This Littman Master Cardiology stethoscope is worth its weight in gold! Be careful what stethoscope you buy! This one was a bit short and awkward to use when I was treating my patients! I decided to return it and buy a different 3M Littmann.