There is a school of thought that believes that if something is going right then the downturn is just around the corner! As work progressed to get Acute Medicine recognised as a sub speciality there were many occasions when it was felt that we could still stumble as we came to the final hurdle. Happily that did not occur and by July 2003 Acute Medicine was officially recognised as a new sub speciality within General Internal Medicine. Can we expect any further hurdles? It is often appropriate to recognise the challenges which occur and regard them as opportunities that have to be used for our advantage. Sometimes this is very difficult. [download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]