We appreciate each of the correspondents' kind words about the Quality Grand Rounds series and agree that forthright discussions of medical errors are needed in order for individual physicians, and the systems we work in, to learn from our collective mistakes.

Dr. Sandroni laments present-day nursing systems, which frequently dispense with the traditional head nurse role. The absence of this "point-of-service management presence," he argues, may create a communication or advocacy gap that contributes to errors. Dr. Sandroni's suggestion that patients enter the hospital accompanied by an advocate is indeed a rueful indictment of the status quo. Not all patients can or will have such an advocate. They should also be asking hospitals what systems for patient protection are in place to make such steps less necessary.

We agree with Ms. Rice about the importance of the physician–patient relationship. At the level of individual patients and providers, the evidence is increasingly convincing that the physician's relationship with the patient is a major determinant of whether injured patients (or their families) file malpractice claims. A recent study, for example, demonstrated a dramatic association between patient complaints about physicians and the frequency of lawsuits (1). In addition to the obvious therapeutic benefits derived when physicians cultivate open and honest relationships with patients, strong relationships enhance patients' trust, making them less likely to seek redress through the legal system when things go wrong.

We concur with Dr. Gallagher that open discussion of errors at the institutional level would greatly improve safety. Regrettably, the current tort system promotes secrecy. Our experience producing Quality Grand Rounds has taught us that when providers and hospitals are assured of anonymity, they are willing to discuss their errors. This experience, and the feedback we have received about the series, tells us that all participants in the system are hungry for opportunities to share, and to learn from, their mistakes. Malpractice laws probably require modification if we are to realize the twin goals of compensating patients who are harmed while decreasing the rate of medical errors (2). Our seventh article in the Quality Grand Rounds series, which is slated to run in spring 2003, will focus on the tension between patient safety and the malpractice system.