Editor -I do not always agree with Ben Lawton, but on this occasion I think I really must defend him from the response by Suzanne Slater to his recent article.¹ Lawton raises a contentious issue which has been misinterpreted by Slater.² I agree with her that there is a profound difference between blame and responsibility, but I would also hope that she will come to some measure of understanding of the vast difference between a medical error and medical negligence.

According to the recent report Making Amends by the chief medical officer in England, Liam Donaldson,³ if a true medical error has occurred in any clinical situation then there should be no issue of blame. In fact, doctors should be encouraged to report these mistakes so that lessons can be learned and practices changed-"the primary aim must be to reduce the number of medical errors that occur."

Following the 1950s Bolam test case, a doctor "is not guilty of negligence if he has acted in accordance with the practice accepted as proper by a responsible body of medical opinion."3 However, if proved to be negligent then the doctor responsible should be reprimanded in respect to the grievousness of their actions, by the General Medical Council or the police. The chief medical officer's report suggests that "the individual who has suffered harm as a result of the health care they have received must get an apology, a clear explanation of what went wrong, treatment and care, and where appropriate, financial compensation."

I don't believe that huge sums of money should be given as compensation for an iatrogenic injury unless it can be shown to be caused by negligence. If a child is born with a disability, as a result of a medical error or otherwise, then our society should have systems of support, both financially and practically, for the child's parents, making there no need for a cash lump sum. This would seem far more sensible and remove any notion of parents "stinging their local hospital." At present in the United Kingdom these financial support systems to provide continual care and rehabilitation are woefully inadequate. Money paid out in compensation claims is diverted away from these systems and stretches already tight budgets.