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Commentary: Let's Think About Human Factors, Not Human Failings

Dr. Mossman is Director, Glenn M. Weaver Institute of Law and Psychiatry, University of Cincinnati College of Law, Cincinnati, OH, and Volunteer Professor, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH. Address correspondence to: Douglas Mossman, MD, UC College of Law, Clifton Avenue and Calhoun Street, Cincinnati, OH 45221-0040. E-mail: douglas.mossman{at}uc.edu

Doctors typically think about medical errors as potential causes of malpractice litigation, as failures by individuals, and as evidence of personal incompetence that may deserve sanctions. Other professions take a different view: designing of safer systems, rather than criticism and punishment, is the way to prevent unintentional mishaps. In his article, Jeffrey Janofsky shows how psychiatrists can think about making care systems safer for patients. He also provides a splendid example of how forensic psychiatrists should conceptualize legal and medical problems encountered in clinical practice.