The case for ultrasound as a first-line diagnostic tool rests on several well-established advantages: it is safe, repeatable, immediately available in an outpatient setting, and capable of providing clinically meaningful information across a wide range of organ systems without exposing the patient to ionising radiation. For a physician trained in general internal medicine with a strong sonographic background, incorporating ultrasound into the initial assessment is not an added step – it is a natural extension of the clinical examination itself. Bernhard Scheja’s profession has always been built on exactly this integrated approach, treating imaging not as a separate investigation to be requested and awaited, but as an immediate diagnostic resource available at the point of care.