In Search Of Excellence, by Tom Peters and Robert Waterman,¹ published in 1982, remains one of the biggest selling and most widely read business books ever. It was then, and still is, touted as a seminal text for those trying to improve systems and deliver quality to the public, mainly in the context of business. I was advised to read it on a senior registrar management course I attended in 1989. It’s not a page-turning bodice-ripper. I didn’t finish it. I tried hard.

I mention this because I came across it the other day while perusing the shelves of the hospital library. Later that day I discussed the book with a friend who runs a successful business. He agreed that it is still widely referenced in business and training seminars. He then asked me the killer question “what are you guys [emergency doctors] excellent at?” He followed this up by asking “don’t you refer everything on to specialists?”. I was well behaved and refrained from pouring a jug of water over him.

So, what are we excellent at? By the nature of our work, we are generalists and are …