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A very good article and my congratulations to Helen. I agree with all her views as I have had an ongoing association re patient safety for some years. Focusing on Commonwealth health jurisdictions across the globe, patient safety factors relate to the hierarchical nature of doctor relationships, for example, a general practitioner is not meant to call a specialist and a senior surgeon dictates the procedure despite best practice guidelines. In most cases, an appendectomy in Perth is not exactly the same procedure as that done in Sydney. Enforceable guidelines and check lists are another essential factor. On a more chronic level, I believe that many general practitioners incorrectly prescribe drugs because they ignore the longterm damage that vey often occurs. An example is Prednisolone a vey effective drugs with huge dangers. All the best.