A questionnaire study was carried out among cardiologists, internists, general practitioners, and final year medical students in Hong Kong concerning cardiac pacemaking. The response rate was 11.2%. Salient results include the misconception on the part of 40% and 12% of physicians, that general anesthesia and thoracotomy respectively, are commonly required for permanent pacing and that the procedure is associated with significant mortality (14.2% of physicians). Most would offer permanent pacing to patients with symptomatic complete atrioventricular block, but advanced age appeared to be considered as a barrier to permanent pacemaking. There was confusion about the need to pace asymptomatic sick sinus syndrome and bundle branch conduction diseases. Oral isoprenaline was still used to treat bradycardia by 16.6% of physicians. A similar deficiency in knowledge was found among the students. It is suggested that misunderstanding of cardiac pacing is common and may be a reflection of the lack of emphasis in undergraduate teaching. This deficiency may have prevented some patients from receiving the benefits of permanent pacing.