When I first read the article by Paley et al,4 I mentally recognized that “I knew it all along.” As a teacher of medical students, house staff, and cardiology fellows I have become increasingly aware that there has been ever decreasing time spent teaching the basic skills of history taking and physical examination, especially cardiac auscultation.5,6 As a cardiologist, I see less attention paid to these basic skills and especially to auscultation, considered by many no loss since echocardiography has been developed. It is impossible to argue against a technique that is more accurate than auscultation in diagnosing cardiac diseases and helpful in designing an approach to treatment. However, in an era when amazing imaging can determine a diagnosis and practice guidelines for management of most diseases are available, the physician, as opposed to the technician, adds only 2 things that are indispensable in caring for patients: the physician-patient relationship and informed judgments in making therapeutic decisions. The physician-patient relationship is formed at the time of initial contact during the taking of an attentive history and the performance of a careful physical examination. When the time comes to deciding that the patient needs surgery or an expensive or uncomfortable diagnostic study, without the confidence that the physician is knowledgeable and completely involved in their problem, it is likely that the patient will seek other opinions until they find someone they trust.