We should also point out why the innocent murmur group was chosen as a comparison sample for the chest pain patients. As noted above, pain is a subjective experience that is first noted by the patient and then communicated to others. It is then reacted to in various ways by those in the child's environment. In contrast, a child with a heart murmur is not the one who first notices the symptom and then communicates it. Instead, the patient with a murmur is told that they have the symptom by a pediatrician, family practice physician, or other health care provider. This tendency to notice and interpret pain in a particular manner is an essential component in the history of the children and their families who report to cardiology clinics for an evaluation of the etiology of chest pain. Such noticing and interpretation is fundamentally a psychological process.