Suregeons are said to be able to cut out everything except cause, and Health Minister Leo Varadkar is beginning to learn the same lesson.
He is determined to make a real impact in a department that has proven to be political cul de sac.
In the face of an imminent election he has sought to concentrate hearts and minds by raising the prospect of 'rolling heads' unless progress is made in the trolley crisis. Normally, one makes progress by moving from the particular to the general, but the difficulty with the trolley impasse is that you can't unpick that problem without addressing the myriad problems that lie behind hospital overcrowding.
With an ageing population and a legacy of years of neglect in investment, our health system is creaking from top to bottom.
As noted elsewhere in these pages, the minister's options must be informed by the fact that our health spending is now below 2006 levels.
At the same time, our population is growing and living longer. Ultimatums may be understandable, but only a sustained long-term vision matched with spending to meet the scale of need will make a real difference.