Whither the acute medical patient?

The continual change in NHS structure demands reappraisal of both the services provided and the allocation of resources to ensure appropriate standards of care. Unfortunately this equation never seems to balance. Although the overall goal is to have an excellent standard of care, the necessary resources nearly always are lacking. As a consequence "we" often have to critically analyse and change clinical practice to achieve this goal. Nowhere in medicine is this point more pertinent than in the management of acute medical emergencies. This article examines not only how the changing face of medicine influences this situation but also possible solutions to the question who will manage these patients in the future.