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 …