Your editorial [1] regarding the relative value of the physical examination stirred memories: During my internship, my students and I spent one night examining a newly admitted patient who had a systolic murmur. Textbook review led us to dynamic cardiac examination techniques, including squatting and the Valsalva maneuver. By rounds the next morning, we presented a diagnosis of idiopathic hypertrophic subaortic stenosis and were prepared to back this up with rather elegant physical findings. The attending physician, a recently trained cardiologist, then spent 5 seconds listening to the heart and recommended an echocardiogram, noting that "this will give us a quick answer". Needless to say, the same physician was involved in reading echocardiograms at that hospital. I also recall neurologists whose standing admission orders always included magnetic resonance imaging and gastroenterologists who felt "they wouldn't be seeing me if they didn't need endoscopy".

If more appropriate role models were provided in teaching institutions, more physicians would be oriented toward physical examination techniques in order to arrive at a proper diagnosis in a cost-effective fashion, rather than looking for an easy, high-tech answer.