A working party for the Federation of Royal Colleges of Physicians of the United Kingdom was established to make recommendations on ways of improving the quality of care for patients admitted with medical emergencies, and also to “re-invigorate” physicians who carry the burden of the acute workload. Before commenting on the report,¹ consider these two scenarios.

Scenario 1 A multiply injured patient is in the resuscitation room. The response is well practised, senior anaesthetic, surgical and orthopaedic doctors attend and under the direction of a senior accident and emergency (A&E) team leader the treatment plan is instigated.

Scenario 2 There is a critically ill patient with an acute medical condition in the emergency department. An acute medical care team assemble including a senior physician, an intensivist and A&E senior staff.

The first scenario is a reality in many hospitals. The second may be a vision of the ideal but few …