We have to be

In the eight months since we put out the call for papers for this special issue of the BMJ devoted to medical errors, the landscape has changed considerably. In Britain the Bristol Inquiry has continued to focus professional and public attention on patient safety in a manner unprecedented both for its depth and for the extent of professional involvement.1 In the United States the recent publication of the report To Err is Human by the Institute of Medicine of the National Academy of Sciences2 received extraordinary media coverage as well as prompt responses to its recommendations from the President and Congress.3

The error prevention “movement” has clearly accelerated. As the papers in this issue bear witness, major changes are occurring in the way we think about and carry out our daily work. For practising physicians, some of the ideas and practices described here may be mind bending, or at least mind stretching. But most of the insights and solutions will, we think, have resonance for all those who strive to provide safe care for patients. All physicians, after all, have had the unwelcome experience of becoming what Wu calls “the second victim,” being involved in an error or patient injury and feeling the attendant sense of guilt or remorse as responsible professionals. Lucian Leape and Donald Berwick are the guest editors of this theme issue. 4 Familiar, too, are Helmreich's findings that doctors, like pilots, tend to overestimate …