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IN response to the joint letter from Margaret William and Liz Walke in the Observer (September 14), modern hospitals are complex institutions and it must be almost impossible for those who have not worked in them to have a detailed understanding of how the various parts function.

Liz Walke and Margaret Williams, while saying that they have no wish to make personal comments, criticise me for living in Eastbourne and working in the Conquest.

In effect they accuse me of deliberately putting patients at risk by my working arrangements, and cite the example of a patient with acute asthma who might need immediate expert attention.

In the first place I would point out that when I am working as an acute physician I am always on site and never more than about 90 seconds away from any of my patients.

For historical reasons I do also take part in on the on-call physicians rota, when I am required to be available from home.

I am pleased to be able to reassure your readers that immediate expert medical attention is available, and will continue to be available to patients such as those cited by Liz and Margaret, by virtue of the resident on-call team of specialist doctors in medicine, emergency medicine and intensive care.

This team has the skills required to resuscitate and stabilise a sick patient: what a consultant physician can add to this team is the ability to sift complex information, interpret test results, and deal with uncertainty in order to make accurate diagnoses.

By definition, this skill set is required less urgently, and indeed can often be utilised by providing telephone advice rather than being present in person.

That is why my patients are not at risk when I am on call by virtue of the travelling time from Eastbourne to the Conquest, and why my employers are content with my domestic arrangements.

I am of course available for immediate telephone advice at all times when on call, and also have immediate access to telemedicine, which allows my virtual presence in the resuscitation departments of both hospitals, and which allows me to review x-ray and scan images immediately without the need for travel. I hope this will prove reassuring to all concerned.

DR ANDREW LEONARD

Consultant Physician

Acute and Emergency Medicine Clinical Unit Lead

East Sussex Healthcare NHS Trust