My patient, a middle-aged woman with advancing chronic kidney disease, works in a medical school and has heard a lot about patient safety: mistakes in care, wrong diagnoses, and unintended consequences of care. As I discussed her treatment alternatives, she asked me, “What will you do to keep me safe?” As she considered in-center hemodialysis she asked, “What are you doing to prevent mistakes and bad outcomes in the dialysis unit? What should I be thinking about?” This was a sophisticated question that I am not often asked, but a critical one.