Those are the fortunate physicians who recall the pleasure of observing the cardiologists trained by Harvey and Perloff as they methodically and meticulously conducted their cardiac examination of the patient with perfection (like Toscanini conducting a Puccini opera) as they proceed through the four basic steps of their quest (not the impossible dreams of Don Quixote): inspection, palpation, percussion, and auscultation. Over the past 20 years, those pleasures have become almost nonexistent. A typical daily example recorded on the chart by attendings and consultants regarding the presence of a mitral insufficiency (regurgitation) murmur: “heart sounds normal, soft systolic murmur,” or slightly better –“heart tones normal, grade 2 systolic murmur at apex.” Shortcuts often occur, but the proper response should be as follows: the rhythm is normal sinus, first and second heart sounds are normal, with no abnormal splitting, no premature beats or gallops, a grade 2/6 soft, blowing, long (if not holosystolic), high-pitched systolic murmur, heard maximally at the apex, with slight (or no) increase in the left lateral position, with faint radiation toward the pulmonic area and heard faintly in the epigastrium (if such was the case). A murmur has intensity, duration, frequency, quality, configuration, timing, and radiation. Inspection, palpation, and percussion are either dying or dead. A properly performed cardiac physical examination can lead one to varying diagnoses: valvular heart disease, nonvalvular obstructive disease, congenital heart disease, ischemic heart disease, pericardial disease, various cardiac arrhythmias, cardiac decompensation, peripheral and central thromboembolic disorders, and offer clues to some metabolic and infiltrative disorders. Various reasons (or excuses) have been offered for the decline in cardiac auscultation and examination. Foremost among them are the following: the overlecturing and underteaching of clinical medicine, the displacement of clinical skills by technology, the lack of structured teaching of cardiac examination in most residency programs, the lack of teaching of physical examination skills in the training of medical students, the absence of third party payment for phonocardiography, and lastly but certainly not least, the decline in the presence of senior teachers and master clinicians.7–9 As stated by Adolph,10“We must remedy the situation before it is too late. When the senior teachers are gone, who will then teach?” In an excellent review on this subject, Craige11 stated, “The present trend toward the denigration of auscultation may soon leave us with a whole new generation of young physicians who have no confidence in their own ability to make worthwhile bedside diagnoses.” Unfortunately, his prophetic wisdom has come to pass. Cardiac auscultation is an art and a science. This is one of the few pleasures that can be derived from the ever-changing practice of medicine. It stimulates acquisition of a good doctor-patient relationship and provides a satisfying alternative to many of the idiopathic inconsistencies and inadequacies of medical practice. It is unquestionably an art and skill that must not be allowed to succumb to the way of the impossible dream of Don Quixote.