EDITOR—Forgacs's review provides an excellent picture of the unpleasant reality of acute medicine, as practised at present.1 The Royal College of Physicians is well aware of the need to cost future improvements in increasing the number of hospital doctors and to provide evidence of the likely benefits. The latter will be a difficult task but must be tackled. Indeed, a working group of the three Royal Colleges of Physicians is currently reviewing all aspects of the problems regarding acute medicine.

As chairman of the group which produced the document “Consultant physicians working for patients” and main author,2 I (JDW) can assure readers that I have had experience, on many occasions, of handling more than 20 acutely ill patients during a 24 hour period of acute medicine as a general physician in Sheffield. Our working group realises that hundreds more consultants tomorrow and much smaller numbers of “take patients” is unrealistic. We do know from several sources that doctors are working 14-16 sessions per week and close to a 60 hour week. We know that consultation times in outpatient departments have been pared to the bone. We know that clinical governance in all its guises will place further demands on consultants. If we do not state our requirements now for an expansion in …