If you seek advice on to how to get out of a difficult situation, a wise respondent will tell you not to start from where you find yourself. This is particularly the case for operative complications. If you consider how to get out of the problem only once it has occurred, you are going to be faced with significant difficulties. Other chapters deal with the issue of consent, but issues such as training, staffing, and equipment availability all should be considered. However, even with these preparations, all surgeons will have complications. Those who do not fall into the three Ps: perfect-there aren’t any surgeons we know ofin this group; Pinocchios-those who are economical with the truth or at best forgetful; and permanently on holiday. It is against this background that we consider preventable harm and how it should be addressed.