I very much appreciate the comments of my colleagues who have made excellent points.  Physical diagnosis has always been at the heart of medical practice and remains so today. The role of physical diagnosis has not changed. The findings have. Because of earlier diagnosis and more effective treatment, the physical findings of many diseases (e.g., rheumatoid arthritis) that used to be “classic” are now rare.  That's good. To teach rheumatology, I think that we have to be modern and describe the disease that we see today and not harken back to the past when advanced-and often untreated- disease was the norm and the findings so striking. Dr. Cush raises an important point about current medical training where students often begin their learning in tertiary hospitals where serious illness, advanced disease and “classical” physical findings abound. For physicians who go into general practice, the spectrum of illness is vastly different. Often, these individuals have never been taught how to manage common problems; nor are they taught how to evaluate early illness. That needs correcting. I think that, just as the pictures of medicine need updating, so too does medical teaching.