To create a universal culture of patient safety, physicians must first take action against the adversarial legal environment that promotes the practice of defensive medicine instead of a transparent culture where physicians are empowered to communicate openly without fear of legal retribution. Perhaps the only feasible way to accomplish this is through political means. As long as the threat of litigation exists, health care providers, particularly those in “high risk” specialties, will be less likely to report adverse events. A pertinent example can be seen in How Hospitals Can Fly, where Will expresses disbelief that the surgeons at St. Michael’s would tolerate 6 video cameras being placed in the OR to monitor and record their behavior. Personally, I cannot imagine many surgeons in the real world being amenable to this idea, despite the implications it has in improving the quality of care they can provide. The paradigms of medical malpractice and patient safety must be distinctly separated before universal progress can be made in American healthcare.