Arrogance, denial, blame, messenger-shooting, averting-gaze, a failure to consider systems, and passive learning - these are the "seven deadly sins" of the medical profession as defined by the chief medical officer for England.
Prof Liam Donaldson has spearheaded the drive across the British health system to identify and dramatically reduce the incidence of medical error and the consequent injury to and death of patients.
The reaction of the Irish medical profession to revelations of the alarming extent of medical error in this country could be encompassed by most of Prof Donaldson's deadly sins.
The consultants are "outraged", according to the current issue of the Irish Medical News. Sadly, it is not the reality of such widespread error and its tragic consequences that has provoked their fury. Their ire has instead been focused at a recent Prime Time programme which analysed the likely extent of injury and death caused to patients by medical mistakes.
However, the scale of the problem was not news to consultants. In October 2002, at the annual general meeting of the Irish Hospital Consultants' Association, a risk management expert informed the assembled medics that up to three patients each day could be dying needlessly in Irish hospitals, not because of their illnesses, but as a direct result of preventable medical error.
In fact, since 2001, the Department of Health has considered that the number of deaths may be much higher. It publicly accepted an estimate of 2,000 preventable deaths a year in Irish hospitals, or almost 6 people dying every day because of avoidable mistakes made in the course of their medical treatment.
These figures derive from an extrapolation to Ireland of various studies carried out on patient treatment and outcomes in the United States. The first and most significant of these was undertaken by the Harvard School of Public Health in 1991. It provided concrete evidence of an alarmingly high rate of death and injury due to medical error, but, inexplicably, its results produced little public reaction in America.
It took a further eight years for the US finally to wake up to the fact that it had a serious problem. The key factor in prompting this realisation was the political leadership provided by then president Bill Clinton, who identified tackling the estimated 98,000 American patient deaths a year caused by avoidable medical error as a key priority for his administration.
In the UK, their own seminal study emerged in 2001. Undertaken by psychology professor Charles Vincent, it examined the outcomes for patients in two large London hospitals. It found that a staggering one in every 10 patients had an adverse outcome; in other words, 10 per cent of patients emerged from hospital worse than they went in, directly as a result of their treatment.
UK experts now fully accept the one in 10 figure as applicable across their health service, and some consider that it may be even higher. They have now become world leaders in devising mechanisms to tackle the problem. As in the US, the key impetus has been political - Prime Minister Tony Blair has made dealing with medical error one of his primary objectives for reform within the NHS.
This kind of political leadership has so far been noticeably absent in Ireland. While there has been an unprecedented focus on reform within the Irish healthcare system, all of the recent reports (Brennan, Hanly et al) have concentrated on structures, staffing, efficiency and accountability.
While many of their recommendations will, if implemented, undoubtedly benefit patients, their primary purpose has not been to deal with the very considerable risks to patients from the healthcare system itself. And given the severe structural inadequacies which these reports identify - the conflict between the public and private work of consultants, the non-policing of the consultants' contracts, the lack of accountability, the splitting of resources across too many small treatment centres - there is every reason to believe that the Irish casualty rate due to medical error may be considerably higher than even the UK's 10 per cent.
Amidst such a plethora of reports, there is a sense that no one is prepared to face this most fundamental issue, least of all the doctors themselves. Incredibly, there has been no Irish study or report on the extent of medical error here or its consequences. And until this is carried out, the medical profession will continue to deny that there is a problem.
The consultants appear far more interested in trying to force the Government to subsidise their own private practices. Both the IHCA and the Irish Medical Organisation have threatened to disrupt the health service unless the State (i.e. the taxpayer) provides insurance/indemnity cover to consultants in respect of their work in private hospitals. So far, the Minister for Health, Mr Martin, is standing his ground against them.
Perhaps his backbone might remain firmly enough in place to provide the kind of political leadership that is now saving patients' lives in the US and Britain, by forcing the healthcare system in this country to learn from its very costly mistakes.