Here is another essay lamenting the decline in basic clinical skills. More and more we hear about how the marvelous advances in technology can supplant old fashioned physical examination. Sometimes it's true. Thoracentesis, for example, is better done by ultrasound guidance than by percussion. But the fact remains that without the underpinnings of basic clinical skills high technology is at times rendered useless, even dangerous. Nine clinical anecdotes in the article illustrate the case well.