What we have sought in this collection of ‘Top Tips’ (how to do it) and ‘Caveats’ (how not to do it) is to compile the Pearls of Wisdom that have been passed down from colleagues all around the world. These are the small details of practice which we have come to rely on when the going gets tough. Most of them are too obscure or even downright strange to make the main stream text books. Many are not ‘evidence based’. We are not seeking to rival the Cochrane database but do believe that, worthy as the scholarly collection may be, there is still a place in medicine for skill, artistry and individualism. We are merely trying to spread the word slightly further and perhaps add another string to a few bows, for those times when the available options seem a little limited.