An article starting with a quote from Sherlock Holmes always grabs my attention and Burns' article is no exception. ^{Reference Burns1}

We made the in-patient/out-patient split in Greenwich in 2006, which resulted in my relinquishing my in-patient work. Initially, I was not at all keen on the idea, for the very reasons laid out by Burns. As time has gone on, however, I have completely changed my mind.

The main positive feature for me is that one has the benefit of a very experienced consultant colleague reviewing the case, including the diagnosis and the management plan. When there is agreement, I feel reassured and move on with improved confidence. When there is a difference of views, I have the opportunity to examine what is being said and to learn from it.

I thought many patients would hate it, but in the 4 years that have elapsed since the change, only one or two have complained to me about it. It has been a helpful change.