Consistency (by John Richmond)
by Emma Knape on 30 April 2015
Ah, today I am going to write about consistency which is a tricky one for me. I think we can all say that we have at times done things that were not consistent but usually we have justified that to a lesser or greater degree in some way - although I can hear some people saying - ‘No, actually John, I have never done that - that's just you!' - I'm sure it's not just me…there are 7 billion people on the planet, it can't be….
Also, I would say that people are probably on a scale from thinking consistency is all important to thinking that dealing with the current situation in its uniqueness is the real key. I tend towards the latter, however, there is a relevant story in the aircraft industry that I use to temper that tendency.
Despite the terrible stories we hear about crashed planes and the risks we perceive since 9/11, it is also a fact that we hear regularly that the aircraft industry is one of the safest. It is not least that way because it needed to dispel doubts about its safety to make it commercially viable i.e. to get people over their fear of flying. To that end one of the interventions brought in by the aviation industry was the introduction of the black box flight data recorder device. This was introduced to planes before its widespread adoption and to test whether it would be effective as a way to make flights safer. It was introduced to planes without the pilots' knowledge and it was seen that they tended to ‘fly about a bit' and take some minor risks possibly to make their job a bit more interesting. After the official introduction of the recorder all the pilots stuck to the flight plan and adverse event and near miss events dramatically decreased.
So, for safety, consistency is key, and again this harks back to the importance of accountability. As an aside, our black box datarecording device is pretty much the medical record.
Consistency is also important for fairness which is a powerful emotion that should not be tampered with lightly. It is important for our patients that they can be assured that when they see someone from Delphi that the message we are giving them, and the treatment that they get, is consistent, so they know where they stand and know what is expected of them. We know this is not easy as there is often a lack of evidence around some types of treatment and not everyone fits into a particular ‘research' category.
That is why our peer groups and clinical meetings are so important. We need to talk, even if we don't have the answers. We need to share our concerns and see what everyone else thinks. We need to be honest with our patients, admit when we have doubts, but explain to them the necessity of consistency for us to reach understanding in the future.
Without explanation, and admission of unknowns, consistency can come across as rigidity. And rigidity, quite rightly, should be avoided - I'm quite rigid about that!
Ultimately, the most important thing, is that we should be consistent to, and about, our values.