In order to better understand the impact of communication failures, this qualitative study analyzed interview findings from residents at a single teaching hospital. Study participants identified 70 "mishaps" in which communication and patient management factors contributed the most to the associated events. Several anecdotes illustrate the role communication failures played in these mishaps and how common these situations are in daily practice. The authors conclude that barriers to effective communication are both individual and systemic and that there is a need for both educational and organizational interventions.