The proportion of patients harmed by medication errors is small but when harm does occur it can be catastrophic, including death. The primary physical harm is only the tip of the iceberg as long-term psychological, emotional, and financial impacts are added to physical injury. These secondary effects are aggravated by failures to respond to adverse events in a caring, compassionate and transparent manner, fulfilling what we have called “the next promise”. The approach of the clinicians and institution involved in a harmful medication error is critical to recovery, and requires 1) full and transparent disclosure of all known causes for the error; 2) an apology that includes empathy and emotional support, a listening at length to the patients and their families without any attempt to deflect blame or downplay the impact; 3) appropriate and rapid compensation; 4) accountability; and 5) regular feedback to all regarding ongoing investigations into the event, and interventions that have been made to prevent this event happening to another patient. There is an excellent body of knowledge to guide institutions and their inter-professional clinical teams about how to design and implement a communication and resolution program that is ethical, patient centered and provides emotional support not only to patients and their families, but also to staff involved in the error.