This is rather unfortunate because this leads to poor practice and teaching of this remarkable skill of auscultation. Most of the yesterday physicians are proud of their diagnostic ability- in using eyes, hands, and stethoscope in the ways they learnt from their 'giant' teachers. In the present day training programs, very little emphasis is placed on the mastery of physical examinations, as they require time and skill, while the knowledge of the true condition of the heart can be obtained with new diagnostic modalities like echocardiography with hardly any investment of personal skill. It is true that physical examination has limitations. The assessment of severity of valvular lesions by this method is not always accurate.
Early cardiomyopathy is difficult to recognize.
Diagnosis of pericardial effusion has never been strength of physical examination. All these are best recognized and assessed by echocardiography. Cardiac auscultation is a skill acquired over years of training. Cost factor is very important for a developing country like ours. Auscultation also provides a source of information of independent clinical value and this can be illustrated by a few examples.