But who will hold the retractor?

In the UK, the number of paediatric trainees is strictly (many say too strictly) controlled and NHS hospitals may not afford the luxury of certificated specialists. The government takes a keen interest in the possibilities for transferring clinical tasks to others, especially nurses. US and Australian readers will already be familiar with this process.

A team from Southampton, on England's south coast, have compared patient “clerking” (obtaining a history and conducting a physical examination) by paediatric surgical trainees and specially trained nurses (page 223). The outcome measure was the safety of children about to undergo day case surgery or minor orthopaedic surgery. On the whole, nurses did a little better than doctors, identifying fewer non-existent concerns and failing to detect abnormalities less often.

Not addressed were issues for paediatrics generally. Experienced clinicians would argue that the first person to take a …