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Marsh H. Bulletin 2015;97: 339–342

With insight and remorse that is real, the author who is a neurosurgeon, but now retired from operating, recounts the care of three patients whose treatment went terribly wrong. In the care of the first patient, the 'framing effect' (avoid risk when a positive frame is presented but seek risk with a negative frame) by the patient's husband and the high opinion he admitted he had of himself ('optimism bias'), all contributed to a tragic outcome. For the second patient, he delegated an operation to a senior trainee because of the 'halo effect' ('positive feelings in one area cause ambiguous or neutral traits to be viewed positively'). Sadly there was severe haemorrhage from the saggital (sagittal) sinus and the patient died. In mitigation, the author explored the tension between the responsibility he had to that patient at that time, and the future responsibilities he had to patients cared for by that trainee. Thirdly, he recounts operating on the wrong side as a consequence of 'anchoring' (relying too heavily on the first piece of information given).