Tweet made me ask myself ' why has it taken so long for healthcare in general, both here in the UK and elsewhere, to come up with a safety intervention which is as basic as a simple preoperative check in?' It is a reflection of the complete lack of empowerment for patients who had no choice where they were treated and hubris on the part of the medical profession who thought they could do no wrong. It was a catalogue of disasters and fear of losing market share that the American airline industry started to do something about it in the early 1980s . It was more than 10 years later that safety started to become an issue in healthcare with this report from the US and more than 20 before the simple check list was devised. I suppose it took the 'depaternalisation' of medicine and patient education, outcome publication and patient choice to become embedded before genuine change could take place.