I was doing my oldies review. As well as managing their goals of care, multiple medications, diabetes control, asthma control, blood pressure control and reducing delirium. I was asked to review a ‘skin tag’ It wasn’t a skin tag but an bleeding ulcerated amelanocytic melanoma Now what… Refer to surgery outpatient clinic 230km away? How will they get there, do they want to go? What’s the wait time? 1 month, 2 months? Private insurance. What about plastics or derm $1000? $2000? Well, none of the above. I took them through to ED and wide local excision and closed skin to skin. It’s now in a pot. One minute writing a drug chart to next removing a deadly melanoma in the space of 5 minutes. Make me wonder how many other ward rounds stop and act like this and why despite all we do in extended skills, care and ability we are still not universally respected as actual specialists or seen to have any inherent value beyond ‘do you bulk bill’.