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malpractice cases. Some cases are only about money; the plaintiff does not want to interact with representatives from the hospital and is focused exclusively on obtaining sufficient funds to take care of her family. However, many cases are about both money and being heard. Plaintiffs want to recount what they experienced and want to ask questions; hospital representatives want to explain what happened and even to apologize. Focusing only on a dollar agreement limits the salutary effects of mediation. At the beginning of mediation, one does not know how fully the process will be used by the participants at the table. But given the range of concerns the parties may want to discuss, the decision to focus only, or primarily, on money should be made by the participants, rather than being predetermined by the mediators’ method of conducting the mediation. In the ADR Project model, mediators used a range of facilitative skills to assist the participants to share information, to ask and answer questions, and to express feelings. Participants were encouraged to talk with each other during both the initial and the later joint sessions. The mediators’ focus was on helping the parties gain an understanding of their own and each other’s interests, assess and reassess the strength of their positions, and engage in joint problem-solving. ADR Project mediators did not see their job as evaluating legal claims but were prepared to engage in “reality testing” to help the participants be more realistic about the strengths and weaknesses of their cases. Retired judges and practicing trial lawyers rarely have sufficient training in the facilitative techniques that tend to be most effective at discovering underlying interests and drawing out information useful for changing hospital systems and policies even if it is irrelevant to questions of liability. Nor are they likely to have patience for or comfort with the expression of strong emotions by the parties. Drexel University College of Medicine established a mediation program in February 2004. While the program is described as “Rush-style,” it differs in significant ways from the Rush model. Both patients and physicians attend and speak, the focus appears to be on repairing the physician-patient relationship, and Drexel’s general counsel, Carl Tobey Oxholm, reports that Drexel is considering offering mediation much earlier in the process, perhaps even before a lawsuit has been filed. The program is similar to Rush model in that its mediators are drawn from the medical malpractice bar (Oxholm 2005). The lines drawn between the two styles represented by the Rush model and the ADR Project model are not absolute. In a particular case, a facilitative mediator may respond to a party’s request for an opinion of the case’s value or, after some hours of work, make a mediator’s proposal. It is less likely that an evaluative mediator will be able to expand her style to include areas of inquiry used by a facilitative mediator. It is important for physicians, hospital leaders, and their lawyers to be aware of the benefits of different mediator approaches, to resist the temptation to select the evaluative approach because it seems familiar, and to choose mediators with the skills to match the needs of the parties and the case. Three years after the Pennsylvania legislature passed the MCARE Act, the national press is still actively covering proposals to curb medical malpractice costs. At the same time, articles appear about patients who have been severely harmed or killed by a medical error. Both problems are serious, both will be difficult to resolve in a way that is fair to physicians and patients, and it is unlikely that either problem can be solved without addressing the other. Error disclosure using mediation skills has the potential to help. Creating an expert communication consult service to plan and facilitate disclosure conversations, providing communication training to heighten physicians’ and other caregivers’ awareness of the complexity of disclosure conversations, offering apologies when appropriate, and using facilitative mediation soon after an error all have the potential to decrease the volume of litigation, reduce the cost of settlement, and turn unhappy events into opportunities to learn from patients and families how to improve care and safety. When medical care does not