John Kadzielski and James Herndon
An article published in the New England Journal of Medicine focuses on personal responsibility for medical error, suggesting that restoring the balance between personal accountability and a ?noblame? system is the key factor in eliminating medical error [1]. The authors of this article write as if there has been a ?no-blame? system in place and that it is now time to reinstitute personal responsibility. We believe the opposite has been true. The current medical culture of blame, malpractice and reactionary punishment?all of which are based on the idea that one human or a team of humans is responsible for an error?has been in place for decades and has failed to improve safety [2]. The concept of personal responsibility and liability has been in place from before the IOM report on medical error in 1999 and things have not changed [3].
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