Healthcare professionals have an ethical and professional responsibility to report medical errors. Doctors in particular are duty bound to consider the best interests of their patients and 'do no harm'. Medical errors are rarely due to individual human error but are often systems based and in many cases are avoidable. Reporting and learning from medical errors improves the safety of patients. It has been over ten years since the reports To Err Is Human and An Organisation with a Memory highlighted the scale of preventable medical errors. These statistics, stimulated worldwide health organisations to prioritise patient safety. Both reports recommended the implementation of a voluntary near-miss reporting system and mandatory reporting of serious adverse incidents that had caused physical or psychological harm or death. Currently in Scotland reporting of all errors is voluntary and there is no sharing of information between Health Boards. Studies have demonstrated failings of the voluntary system and preventable medical errors are still occurring in Scotland. The UK Government in England as of April 2010 has changed the voluntary system of reporting serious adverse events to a mandatory obligation. Failure to report may result in a fine of £4000 to the Trust. Patient groups wish the system in Scotland to become mandatory with public disclosure. This would ensure openness, honesty and autonomy for patients. This article reviews the controversial issue of mandatory reporting and whether or not this would improve the safety of patients. In conclusion, Scotland would benefit from mandatory reporting of serious adverse events and voluntary near-miss reporting.