Their eyes grow wide each time I pull the machine from my shoulder bag. Patients often point out that they have never been examined so thoroughly, while students and residents ask the same things: “How do I get one?” and “How much do they cost?” The “wow” factor is powerful with the latest generation of pocket ultrasound machines. The ability to connect to tablets and smartphones and to be carried in a pocket or bag makes the machines revolutionary for working on the inpatient medicine wards. There is no question that my patients and learners welcome insonation as part of the physical examination. This has been true since I began doing point-of-care ultrasound 10 years ago. In that time many authors have predicted that an ultrasound revolution was around the corner. Nevertheless, the revolution has been very slow to arrive, but why?