Milestones are often seen as opportunities for reflection and reminiscence. As this edition of the journal coincides with the 10th anniversary of my consultant appointment I hope readers will forgive a couple of paragraphs of self-indulgence. The phrase: ‘Where did all that time go?’ will probably be familiar to physicians at a more advanced stage of their career. With medical students now returning as specialist registrars, and former house officers appearing as consultant colleagues, the passage of time is increasingly apparent. I recently realised that our current third year students were born in the year I clerked my first patient: surprisingly I still remember his name, age and diagnosis, unlike many of those (and all of the students!) who I have seen since. On a more positive note, there have clearly been a lot of changes over these ten years: at the time of my appointment in June 1999 there was just a small handful of ‘acute physicians’ in the UK. SAM meetings attracted barely 100 delegates, despite providing free admission, and most of us had planned our escape route in case the acute medicine concept went ‘belly-up’ before our retirement. Now, with several hundred acute medicine consultants, similar numbers of trainees, and ‘full speciality’ status rapidly approaching, job security should no longer be a major concern. Indeed, the last 12 months has seen a further considerable expansion of the speciality; all of the first cohort of acute medicine trainees in Wessex have secured consultant positions, and I am told that SAM now has close to 700 full members. What the next ten years will bring remains to be seen, but with an ageing population and year-round pressures from rising emergency admissions, acute medicine will surely continue to strengthen. As I indicated last time, an increasing number of research-based submissions will be trickling into the journal over the next few editions. The impact of alcohol on the Health Service is a subject which has been at the top of the political agenda in recent months. So it is timely to include an article highlighting its impact on the Acute Medical intake in a busy Teaching hospital in this edition of the journal. The finding that one-in-five patients admitted to the AMU were considered ‘hazardous’ drinkers will probably come as no surprise to acute physicians working elsewhere in the UK. In fact this figure may have been an under-estimate given that the number of units consumer per week was not documented in 30% of clerking records. The demographic shift away from the stereotype ‘middle-aged male’ drinker is also apparent with large numbers of females aged 40-59 falling into this category. Recent editions of this journal would not seem complete without mention of training in practical procedures. In this issue the SAM trainee representatives have summarised the recent trainee survey in this area, providing some recommendations which will hopefully be incorporated into the new curriculum. Readers who are becoming tired of this subject can be reassured that this should be the final article relating to this for the time being! I hope this edition provides interesting reading and please keep the submissions coming – although the review articles are usually solicited by the editorial team, we will continue to consider any submitted article for publication, provided there is a clear teaching message for those working in the field of Acute Medicine. Any feedback on the articles included in this or previous editions would also be welcome, and may be included in a future ‘viewpoint’ or ‘letters to the editor’ section.
The Minimum Environmental Perturbation Principle: A New Perspective on Niche Theory