“People aren’t the problem. The problem is the problem.” I heard that sentence for the first time sitting in a circle of student desks in a restorative and transformative justice class two years ago. I didn’t know then that I was about to spend the rest of my medical training inside an institution that had reached the exact same conclusion decades earlier, and then largely failed to live by it.
In 1999, the Institute of Medicine published “To Err Is Human.” Most people remember the report for its staggering estimate that between 44,000 and 98,000 Americans die each year from preventable medical errors. But its most important conclusion wasn’t statistical. It was philosophical.
These deaths were not, for the most part, the work of bad doctors or careless nurses. They were the predictable consequence of good people working within flawed systems: systems shaped by communication failures, poorly designed processes, fragmented teams, and cultures that too often made it difficult to speak up or admit mistakes.
Medicine had discovered something restorative justice scholars have understood for decades: People aren’t the problem. The problem is the problem. And yet, when harm occurs, medicine still responds as though it never learned that lesson.
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Walk into many hospitals after a serious medical error and you’ll find one of the oldest models of justice there is. Find the person responsible. Assign blame. Lawyer up. Go quiet.
Malpractice law is built for adversaries, not repair. Morbidity and mortality conferences, despite their educational mission, can too easily feel like public trials, with the resident in the dock. Disclosure to the patient is often filtered through risk management before it reaches honesty. And the clinician involved is left to carry the emotional weight alone; this is what patient safety researcher Albert Wu famously described as the “second victim.” Two people have been harmed. One adversarial process fails them both.
There’s a reason that sentence found me in a restorative justice classroom before it found me in a hospital.
In 1989, New Zealand transformed part of its justice system by drawing on Māori traditions of restorative practice. Instead of asking who deserved punishment, the process brought together those who had been harmed, those responsible, and the broader community to answer a different question: What does repair require?
The distinction seems subtle until you see what it changes. Punishment asks us to isolate wrongdoing inside a person. Restoration asks us to understand harm inside a relationship. One ends with blame. The other begins with accountability.
Trauma researcher Bruce Perry has spent much of his career demonstrating a similar truth in medicine and psychology: Relationships are what heal trauma. Yes, not protocol, not paperwork, but relationships. Yet our response to medical harm often severs those very relationships at the moment they’re needed most. Patients lose trust. Clinicians retreat into shame. Institutions retreat into legal strategy. Everyone becomes more isolated, even though isolation is the opposite of what healing requires.
The remarkable part is that medicine has already shown itself another way.
In 2001, the University of Michigan Health System adopted a policy of promptly disclosing harmful medical errors, apologizing when appropriate, and offering fair compensation without waiting for litigation. Critics predicted more lawsuits and greater financial liability. The opposite actually happened. New claims fell by roughly one-third. Lawsuits dropped by nearly two-thirds. Costs decreased. Cases were resolved faster.
That’s not idealism. It’s one of the clearest demonstrations medicine has that honesty, transparency, and repair can outperform silence and defensiveness.
And none of this means abandoning accountability. It is quite the opposite. Accountability should mean understanding why harm occurred, repairing what can be repaired, supporting everyone affected, and changing the system so the same mistake becomes less likely tomorrow. Punishment has a role when there is recklessness or willful misconduct. But most medical errors are not born of malice. They are born of human fallibility meeting imperfect systems. Responding as though every mistake demands a culprit may satisfy our instinct for blame, but it rarely makes patients safer.
So here’s what I’d ask of the profession I’m preparing to enter. Run morbidity and mortality conferences less like tribunals and more like opportunities for collective learning. Teach disclosure and apology as clinical skills, with the same seriousness that we teach procedures. Build peer support for clinicians into hospital infrastructure instead of treating it as an afterthought. When appropriate, create space for patients and families to participate in conversations about what happened and what meaningful repair might look like.
I’m a medical student, not a hospital administrator. I don’t pretend these changes are simple. But I do know this: Medicine has spent more than twenty-five years carrying a diagnosis it still struggles to treat.
“To Err Is Human” taught us that the greatest threat to patient safety wasn’t simply bad people. It was broken systems responding to inevitable human fallibility. The prescription was written in 1999. We just never filled it.
Author’s note: The author’s thinking on restorative justice was shaped in part by a course in Restorative and Transformative Justice Practices taught by Professor Josh Staub at Rutgers University.
Shaan R. Mody is a medical student.
