For Murdoch and friends, sorry is the easiest word

For Rupert, Rebekah and David, contrition has finally arrived. But where's the shame?

Rupert Murdoch is very sorry. He's very sorry that he didn't know anything about what went on at his newspapers, which was wrong but not the fault of the people in charge of those newspapers, and he's very sorry that those people who were in charge, but didn't know anything about the wrong things that were happening, have now had to resign.

Rebekah Brooks is sorry. She's sorry that although she was in charge of newspapers for which despicable acts took place, she knew nothing about it, having been on holiday when many of these incidents took place, and not having known about it otherwise. She's sorry that she said that her organisation had paid police, when what she meant to say was that her organisation had not paid police. These things happen, when you're in a high pressure situation. You can end up saying things you didn't mean to say.

David Cameron is sorry. He's sorry that he gave someone a second chance. He's sorry that the second chance, which he gave someone, by giving them a second chance, didn't work out as well as he might have hoped. No-one warned him that by giving this someone a second chance, it might not be the best outcome in the history of the world, although some people say they did warn him, and that he must have either not even read those warnings, or not listened to them, or proceeded anyway.

Everyone's sorry. Everyone is sorry that what happened happened, and that even though they were in the kind of positions where you might expect them to know about what happened, they didn't know about what happened. No-one knew anything, and were quite right to dismiss all the investigative work on the phone hacking story as boring lefty troublemakers doing some yawnworthy tedium, until the tale about the hacking of a dead teenager's phone came out - at which point it actually mattered.

It mattered because the story went beyond the BBC, or the Guardian, or the usual suspects - it went everywhere, and wasn't going to go away. It wasn't just being read about by the kind of people who'd never buy your papers; it was being read about by exactly the kind of people who do buy your papers, and are disgusted with you for having run the kind of paper where this kind of thing happened. Then it mattered a lot.

Then, everyone who is now sorry was as shocked as everyone else. Imagine the shock. The surprise. Imagine not having known about anything, all that time. Imagine employing someone - giving them a second chance, if you want to use that phrase - who was rumoured to be involved in some dodgy dealing, and not having sat them down and forced them to tell you exactly what they knew and didn't know. Imagine that.

Would you feel sorry, or would there be another feeling running through you? Not sorry, but something else... shame. Shame that you should have known, but didn't know. Shame that you didn't ask the right questions of the right people. Shame that you didn't know where any of this information came from, and just paid people for it anyway. Shame that you were in charge, yet weren't in charge. Shame that you took the absolutely enormous salary, yet didn't know what you were doing, apparently.

Everyone's sorry, and everyone involved in this grubby mess hopes that a simple sorry will make everything all right again. Just a simple sorry, and hope that the fuss dies down, and then up pops the Sun on Sunday on August 7, or thereabouts, and it's the football season and there'll be a massive preview and free gifts and other lovely things for you to look at, and everyone will just shrug their shoulders and think, oh well, I suppose we'd better give them a second chance, hadn't we? It's important to give people second chances. And that will be that. Crisis averted. Ed Miliband foiled. Everything carries on, much as it did before.

Unless people aren't prepared to tolerate being fooled again. And unless people aren't prepared to think that a simple sorry will get Murdoch and friends out of this sorry mess.

Patrolling the murkier waters of the mainstream media
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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