David Brand is Federal President of the Australian Medical Association.Don Hindle makes some reasonable points in his editorial on what has become a notorious case of breakdown in performance review resulting in unnecessary deaths. The worst aspect of that event was the very long delay between the initial complaint and the commencement of a reasonable process to inquire into the problem. If the Bristol Royal Infirmary had had a satisfactory mechanism to deal with concerns about the performance of individual surgeons, much harm could have been avoided. I am seeking to make the quality of health care in Australia a major focus of my presidency of the Australian Medical Association. Accountability is at the core of a free profession. I want to focus on the whole health system, not just hospital practice. A key issue is the involvement of the general practitioners in the maintenance and assessment of quality of health care. We lack the resources, the measures, the clinical guidelines, the coding and computer systems but most of all, a government and health community with the will to make something happen. In this respect, I agree with Don Hindle: the problems are wider than medicine -and the weaknesses in medicine itself are more a consequence of government policy and community values than of the nature of the profession itself.Increasingly, health care services are provided in the community. We cannot ignore hospitals but nor can we ignore the community. Considering the hospital, we need an open medical culture and open quality management systems. Our adversarial legal system makes human error in medicine a matter of great public consequence and embarrassment. This reinforces prevailing attitudes not to admit to mistakes. The medical profession can do much to address this, going right back to the university, but the culture of other parts of our society also needs to change.