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Wolffe Nadoolman, MD, MBA
Salt Lake City, Utah

JAMA. 1997;278(21):1739.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—While I strongly believe that cardiac auscultation is a skill worth honing, I disagree with the conclusions of Drs Mangione and Nieman¹ that a deficiency in the skills they tested might be a serious problem and that board-certification examinations for primary care specialties should include evaluation of these skills.

Any physician practicing rural medicine or who has visited Third World physicians knows the value of keen physical examination skills—especially auscultation. However, where most physicians in the United States practice, the rules are different. While this study examined the ability of residents to identify specific cardiac sounds, it did not show what proportion of those residents tested either did not notice any abnormality or did not generally recognize a pathologic sound. This ability to identify the presence of an abnormality is much more important that the ability to identify what the abnormality is. Even presuming the auscultation . . . [Full Text PDF of this Article]

Footnotes
Edited by Margaret A. Winker, MD, Senior Editor, and Phil B. Fontanarosa, MD, Senior Editor.

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