Patients expect to be informed promptly when they are harmed by medical care. However, when such injury is a result of an error, patients are rarely informed. Hospital regulators, accrediting agencies and governments in the US, England and Australia are developing standards, training programmes and regulations to encourage transparent communication between providers and patients. While many doctors want to be open about their errors, fear of litigation, embarrassment and uncertainty regarding the best way to disclose such information lead to a professional ethos of discretion or even cover-up after harmful errors. Yet, despite such fears, studies have shown that aggressive disclosure policies may actually reduce malpractice claims.