Sketch: Nick Clegg's speech

Members should “prepare for vitriol and abuse".

When Nick Clegg revealed his message to his members was to go back to their constituencies and “prepare for vitriol and abuse" observers wondered why wait that long.

And thus the sound of blades being sharpened on handy rocks from Brighton’s sand-less beach provided a useful indicator of the welcome being prepared for the Lib Dem leader as he prepared to tell his party that they would not be reaching the sunlit uplands any time soon.

Obviously aware of the threat to their leader the lights in the conference centre were switched off before the speech to allow loyal and ,one assumes, fully frisked members to gather on stage to provide a safe, if staring, background to his end of the conference speech.

With party support now in a place where the doldrums would be a plus and half the MPs in the hall heading for the dole the audience brought a whole new meaning to enthusiasm.

Thankfully for Nick his path had been smoothed yesterday by the decision of Danny Alexander’s mum to allow her youngest a day trip to Brighton to make his own speech.

Still masquerading as Chief Secretary to the Treasury, Danny had plundered the “Greatest Scottish jokes of all time” annual for 1908 to remind party members why they were as deep in the odure as the opinion polls suggest.

Whether this was a deliberate attempt to remind delegates just how worse the situation could be is unknown but Danny was certainly given a prominent position as his leader addressed the faithful.

Having spent much of the parliamentary season in mournful contemplation of the turn-ups in his trousers it was a slightly surreal scene as he strode onto the platform to be announced yet again as the Deputy Prime Minister.

As half the members in the hall joined the party confident in the belief that they would never be in power the reality is clearly a shock but Nick made it clear that having got a sniff of it—and what goes with it—for him at least not to mention Danny’s mam, there would be no going back.

And he turned the history of the Lib Dens on its head by declaring if people wanted protest not power they should vote Labour which, sadly for him , most are apparently already doing.

The past is gone and is not coming back he told the delegates as he announced the last leader but three, Paddy Ashdown, would be getting them ready for the next general election.

And talking of which there was no mention of the other one with Prime Minister in his title busy getting ready for tonight’s appearance on Letterman in New York.

One can only hope that if the” Pleb” story comes up Letterman will seek to confirm with the PM whether his Chief Whip Andrew Mitchell prefers to be called “Thrasher” after his time at Rugby school or by his other favourite title BSD , ‘Big Swinging Dick.”

But that is for conferences to come but meanwhile back in Brighton where

days past a chauffeur-driven was only a dream a party leader’s speech would go on and on as pledges never to be fulfilled were made.

But Nick needed just over the half hour in the new world to tell them they would need binoculars to see the good times coming.

“Imagine yourself standing on the doorstep in 2015”, he asked them.

They did and he left to slightly hysterical applause.

Nick Clegg and wife. Photograph: Getty Images.

Peter McHugh is the former Director of Programmes at GMTV and Chief Executive Officer of Quiddity Productions

Christopher Furlong/Getty Images
Show Hide image

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