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sued are not the quality of medical care (Entman et al. 1994), not chart documentation (ibid.), and not technical negligence (Harvard Medical Practice Study 1990), but ineffective communication with patients (Lester et al. 1993, Levinson et al. 1997),sued physicians after a perinatal injury to a child emphasizes ineffective communication. He found that 33% sued because they were advised to do so by a third party, often another health care provider; 24% felt the doctor was not completely honest or had lied to them; 24% needed money for the child’s future care; 20% couldn’t get anyone to tell them what had happened; and 19% wanted revenge or to protect others from harm. Many of those suing felt their physician would not listen (13%), would not talk openly (32%), attempted to mislead them (48%), and did not warn them of potential long-term neurodevelopmental problems (70%) (Hickson et al. 1992). In another major study, Gallagher looked at the attitudes of patients and physicians after a medical error. His findings highlight the mismatch between what patients want and what physicians provide after an adverse event or medical error. Patients want “basic information”: an explanation of what happened and why, the health implications of the error, and how the problem will be corrected so future errors can be prevented (Gallagher et al. 2003). By contrast, for understandable reasons, physicians tend to choose their words carefully, are likely to mention the adverse event but not that an error has occurred, and are unlikely to tell the patient what caused the error and how it might be prevented from recurring. Physicians are trained to diagnose medical problems, deliver bad news to patients, and discuss hard choices about treatment options. The communication skills physicians use in these tasks are helpful when disclosing a medical error or explaining an adverse event, but communication in such situations is more difficult, complex, and demanding. Mediators spend a great deal of time developing their active listening skills. Physicians, other health care professionals, and hospital administrators face an even greater challenge using these skills effectively. Whereas mediators are, by definition, neutral about the outcome of the discussion, health care professionals have obvious stakes in a disclosure conversation. A physician is also likely to be preoccupied with the medical reality of the situation and not be well equipped to concentrate on the communication needs of the patient or family. After an adverse event or medical error, the physician or nurse may experience strong emotions such as guilt, failure, shame, remorse, or fear about the impact on his or her career (Shapiro 2003). Thus, active listening during these critical times can be understandably extremely difficult for health care professionals. In the stress of the moment, physicians may not be able to evaluate whether a disclosure conversation has gone well. For example, at one training session, a hospital administrator described a physician who had been involved in a serious event. The physician had told the hospital administrator he was pleased with the disclosure conversation. A few hours later, the administrator received an angry call from the patient’s daughter. She was upset with the physician because she felt that he had talked “at” them, had not listened, and had not answered their questions. We recommend using a consult service model in which an expert communication consultant, who has been trained to facilitate disclosure conversations and to gauge the reactions of the patient and family, aids in planning and conducting disclosure conversations. After an adverse event it should be just as routine to call for a consult about communication process as it is in other contexts to call for a cardiology or geriatrics consult. It is the consultant who can make certain that the patient and family are clear about the next steps the hospital will be taking and about whom to contact with questions and concerns. The consultant can confirm the hospital’s commitment to openness and information sharing. The consult service may also be in the best position to link the disclosure conversations and what is learned during them to other institutional processes intended to improve patient