Abstract The article by Holger Pfaff of Cologne, Germany that follows is the ninth and final paper of the BJS series of leading articles on patient safety; in it he considers the problem of surgeons' often excessive workload. Those who would like to read the series as a whole should start with the April 2004 issue of the Journal. A trainees' viewpoint of safety issues has been considered along with safety lessions from the airlines. Infections, patient volume, the nature of adverse events and information technology have been highlighted in separate papers, and the importance of an evidence-based approach has been recognized on both sides of the Atlantic.