When life gives you graffiti, make graffitiade

Marc Jacobs <i>v</i> Kidult.

In case anyone was unsure as to whether Marc Jacobs had achieved international success through some mere fluke or astonishing levels of business acumen, then its faceoff with a graffiti artist in New York should help make their mind up.

The New York Observer has been reporting on the showdown for the last week (1,2,3,4), and the whole saga is worth reading, but here are the edited highlights.

Last Wednesday night, street artist Kidult vandalised/tagged/improved (take your pick) the front of a Marc Jacobs store in SoHo, New York City. You can see it above.

Marc Jacobs' response was to own it. First, they tweeted out the picture with the caption "Art by Art Jacobs". Next, they went hipster, with an Instagrammed close-up and the tagline "Art Jacobs @ Marc Jacobs Collection":

Then they put it on a T-shirt and sold it for $689.

Yes, $689. Not a typo. And yes, they're actually selling it.

Not to be outdone, Kidult is selling his own T-shirt, with a picture of him in the act, for $10.

It's probably a better picture, actually, and it's definitely not 69 times worse.

The whole affair is rather fascinating. As the Observer put it:

Jacobs, in this situation, has made one hell of a commentary about the absurd commoditization that some street art has yielded, and how easily ostensibly subversive art can actually be subverted, facile as it so often is.

He has also shown exactly what it takes to dominate the New York fashion work. Nerves of steel, no inclination to take shit from anybody, and the ability to sell anything for hundreds of dollars.

"Art by Art Jacobs". The Marc Jacobs store in SoHo. Photograph: Marc Jacobs

Alex Hern is a technology reporter for the Guardian. He was formerly staff writer at the New Statesman. You should follow Alex on Twitter.

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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