I usually agree with Dr Spence, but not this time. Of course we should do the best we can for our patients, and most of the time that will mean getting the right investigations done as soon as possible. But sometimes clinical skills are all we have - for such as sick elderly patients in remote rural areas who don't want to go to hospital, or for frail terminally ill people at home or in a hospice who want comfort and symptomatic treatment with minimal disturbance. For those circumstances I think with practice you can improve your skills at distinguishing LVF, say, from infection or effusion; and your patients will be glad of it. And I'd rather be treated by a careful, listening doctor with a stethescope than some of the dead-eyed box-tickers [not usually their fault].

Competing interests: None declared