Thatcher the gay icon

'There are many gay Tory men who would like to sleep with David Cameron but it is Lady Thatcher whose portrait hangs over their bed!'

Central London was awash with celebration the other Sunday afternoon. On Horse Guards Parade Falklands veterans marked the Silver Jubilee of Mrs Thatcher's glorious victory and in the Ritz Hotel the Conservative Leader of Westminster City Council sealed his civil partnership with his fellow Councillor and Chief Whip.

In a vision in fuchsia pink Mrs Thatcher was the only dignitary to receive an ovation as she arrived on the reviewing dais and as she left the Victoria Memorial later in the afternoon (on the arm of Tony Blair) she was mobbed by ex-soldiers and the crowd in a slightly sedater version of Tom Cruise working a Leicester Square Premier.

At the Ritz over the jam and scones, Tory Grandees, ex-lord mayors, young, thrusting Westminster City Councillors and the odd Rabbi joined Sir Simon Milton and his partner Councillor Robert Davis' family and friends to wish them well and to prove how the Conservative Party has embraced the Gay equality agenda. In Sir Simon's speech he revealed that they had been a couple for 19 years having met at the height of the Thatcher Government.

In my experience many of the gay Politicians in the Tory party (a not inconsiderable number) joined the Conservative party and became active during the Thatcher years. Whilst her government acquired an unfortunate reputation for not being gay friendly, the notorious and unnecessary Section 28 (under which no one was ever prosecuted) did serious damage to the equality agenda.

However, whilst the underlying ethos of Thatcherism (based on individual liberty) might well be pro-gay it was Mrs T's personality which attracted so many homosexual men to the party. In a profession dominated by men with dandruff and hair coming out of their noses or women who appear to have been dragged through a hedge backwards (a la Shirley Williams), the pure elegance, feminine perfection, perfect dress sense, and sheer determination to change society drew many gay men to the Iron Lady.

Whilst her government might have had an anti-gay aura there was simply nothing in her personal attitude to demonstrate any prejudice, she appointed gay ministers including the tragic Earl of Avon (son of ex-Prime Minister Anthony Eden) who was one of the earliest victims of Aids.

On the subject of Aids it was her government with Norman Fowler as Health Secretary which faced the issue head on and refused to take a "moral" tone on public information and prevention work.

Since Lady Thatcher was stabbed in the back by a cabal of straight men in 1990 she has gone through her "Norma Desmond" phase ("it was Politics that got small" and has emerged as a worthy successor to the late Queen Mother as the Nation's favourite relic of a bygone era. In that pantheon of gay icons, abused by straight men, that includes Marilyn Monroe and Judy Garland, Margaret Thatcher has it all, beauty and brains.

There are many gay Tory men who would like to sleep with David Cameron but it is Lady Thatcher whose portrait hangs over their bed!

Brian Coleman was first elected to the London Assembly in June 2000. Widely outspoken he is best known for his groundbreaking policy of removing traffic calming measures
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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide