“…[15][16][17][18] However, there are diverse and potent factors that impede a physician's willingness to disclose errors to institutions, patients, and colleagues. 5,6,12,16,[19][20][21][22][23][24][25] Recommendations to address these impediments by changing professional culture 7,8,[25][26][27][28][29] are accompanied by sobering descriptions of the tension between the transparency promoted by the patient safety movement and the silence induced by the malpractice system. 30,31 The number and variety of variables affecting a decision to disclose an error pose serious challenges for those trying to design systems and promote practices that increase disclosure.…”