Cycling through London's "neo-Victorian boom"

..and realising it's time to leave.

“Neo-Victorian boom.” An expression that started to appear around a year ago is becoming something of a feature in writing about the city of London. The FT have gushed about “the world's leading city” as if it were an official contest or accolade, a recent issue of the Economist showed London at dusk, above a headline of “precarious brilliance". So long as the Olympics go off without too many G4S-style glitches, it’s hard to imagine them not strengthening the modern myth that London is developing for itself. Neo-Victorian boom. Apparently.

Look a little closer and all is not so well. In ever more bars, cafes and clubs you find increasingly stern advice to watch your belongings and use the bag hooks… thieves, it would seem, are operating in more and more areas of a city with the highest rate of wealth inequality in the developed world. Boris Johnson, newly returned as Mayor by only 15 per cent of the total electorate, was last month tending to self-promotion in New York, loudly repeating his old pledge that London will not be sterilised. As still more private sector developments lay claim to public space, each with a now-familiar range of prefabricated franchises, Johnson seems to have confused an opposition to sterilisation with affection for London’s stunning inequality.

In all this, there’s an awful lot of newspeak to cut through for those who want the truth. The now well-heeled borough of Hackney was recently celebrating a reduced rate of poverty amongst its residents. The town hall is quieter about the likelihood that this has been caused by a displacement of poor residents who can no longer afford to live in the borough. Across the city the boast of “recession proof” continues to linger like a bad smell. London property prices have indeed remained buoyant, but it’s a moot point that a 7 per cent climb in areas like Marylebone have been enough to bury the stutters in the likes of Dagenham and Romford, London’s emerging banlieu.

The Shard has become a newly popular metaphor for this gulf. London’s latest tallest building waits impatiently for its insides to be wired up, towering over the once low-profile south bank as it does so. Qatari-owned, the Shard has come to represent not only the brash arrogance of the financial sector, but also a tendency towards a city owned by those far away, people whose only concern for London is as an enduring cash cow. The most telling thing, in both name and design, is that the Shard seems remarkably comfortable in appearing outwardly mean. Cycle safety campaigners have highlighted the staggering rate of casualties caused by the Shard’s endless construction traffic, Simon Jenkins fumed that the Shard "has slashed the face of London for ever.'' Mercifully… “forever” is a long time, as is evident in the crumbling ruins of London Wall, the last Roman infrastructure project, completed in the second century to hem-in the city. The wall's ivy-strewn remains are a heart warming evidence that empires bigger than the Qataris have come and gone, together with their monuments... but still… it’s worrying when you have to find comfort through such a long view of history.

In short… and what I’ve been meaning to say all along… is that that it’s time for me to leave. I’ve always traveled by bicycle… around London, around the world, and a handful of times across Europe. It’s across Europe that I’m escaping this time, a ride of some 2500 miles to Istanbul, a route that I last took as a new graduate five years ago. With a financial crisis and a eurozone crisis separating now from then, I’ll go back to my familiar politics by bicycle, slow travel through nations that still wait to either enter or exit the European club, or who try to beat a new path inside of it. As the UK’s attention turns from Leveson and a corrupt media, and looks anew at Libor, HSBC, and a corrupt banking system, I pack my panniers and pump up my tyres, and return to watching Europe from the vantage point of a beat-up, leather saddle.

This article first appeared here.

Photograph: Getty Images

Julian Sayarer is cycling from London to Istanbul, he blogs at, follow him on Twitter @julian_sayarer.

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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