In Reply.—The dialogue in Dr Hersher's letter will doubtless remind many pediatricians of problems that they have had with innocent heart murmurs, especially when trying briefly to explain one to the understandably distraught parent or anxious teenager.
To minimize referral of children with innocent murmurs to cardiac centers, Dr Hersher urges pediatricians to take the extra time required to perform a thorough cardiovascular, especially auscultatory, examination.
It is asking a lot, Dr Hersher, to expect the busy pediatrician to perform a complete and thorough cardiovascular examination on every patient with a presumably innocent murmur. It not only takes time but also requires virtually daily practice to perform the examination expertly. Once physicians start looking for innocent murmurs, one or more such murmurs can be heard in practically all children, and certainly in half of them. The fact is that most pediatricians accurately spot the common