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In designing a web-based tool to evaluate the knowledge and attitudes of foundation doctors in relation to patient safety, Jean Robson and her colleagues highlighted a fundamental disconnect between junior doctors and the organisations in which they work.1 In this pilot study, published in the November 2011 issue of the journal, trainees who reported patient safety incidents were ‘an unusual occurrence’; 48% of trainees surveyed believed that most safety incidents were due to things that they could not do anything about. Perhaps this is not surprising as a similar proportion reported that they had failed to be involved in any subsequent discussions about the prevention of similar events and only one-third had received any feedback following the incident's investigation. The author's proposal that an annual attitudinal survey would provide valuable information which to build more effective patient safety incident reporting structures may be missing a more fundamental point. The problem is deeper rooted than that.
Writing in the Journal of the American Medical Association last year, Robert Brook argues that physicians need to work beyond the reactive scope of traditional clinical practice …