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I've really good the discussions or hope after that so I live in two worlds one is you know I hope I'm and applied to human physiologist and I'm really interested in the science of this and the other one is as a quality improvement person within the health service and this editorial which will hopefully be coming out soon with my myself and Karim in so I think summer on it is the situation at the moment with regard to the perioperative period management what we teach it as a science we write textbooks that way it's practiced by people who believe it's an artful they believe that their heart is it's and they're good at it but the evidence suggested is random and chaos and it's random chaos associated with very significant clinical harm and that's what we have to try and fix and if we get as far as the science that would be fantastic but if we could just get a grip on the chaos that would be a good start so here&

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