I appreciate Eledrisi's thoughtful comments. I agree completely that a careful history and physical examination are clinically valuable and highly cost-effective in terms of avoiding unnecessary procedures and testing. The physical examination, especially of the heart, has never been more fun, since current imaging procedures now permit verification of the findings, as was the case in our patient. Furthermore, excellent computer-based teaching programs are available that show the heart with various imaging techniques and provide hemodynamic information, heart sounds, and murmurs, all in stereophonic sound and vivid living color. I understand that the American Board of Internal Medicine is preparing a section that incorporates the clinical examination as part of the board certification examination. Finally, and ultimately most important, skilled teachers are required to instruct physicians in the art of the physical examination. While a resident at Indiana University in the late 1960s, I was fortunate to have such teachers as Pat Genovese, Charles Fisch, Suzanne Knoebel, and Morton Tavel. Thanks to them, the duo for strings was not difficult.