David Miliband leaves the front bench

He has announced that he is leaving so as not to be a "distraction", and will continue to "support f

David Miliband has announced that he is not standing for the shadow cabinet to avoid being a "distraction" from his brother's leadership.

Justifying his decision to BBC News just now, Miliband said:

"I want to give him the freedom and the space to drive the party forward as he sees fit and support him from the backbenches. Ed needs a clean field to lead the party forward."

He also refused to rule out returning to front bench politics eventually, but said that he would always make the decision with the interests of the country and the party first. When asked whether his brother had asked him to stay, he said "that's a private discussion."

From his statement to his constituency party in South Shields:

On the day that nominations closed for the Shadow Cabinet, I think it right to explain to you and party members why I think I can best support him (Ed) from the back benches. The party needs a fresh start from its new leader, and I think that is more likely to be achieved if I make a fresh start. This has not been an easy decision, but having thought it through, and discussed it with family and friends I am absolutely confident it is the right decision for Ed, for the party, and for me and the family ...

This is now Ed's Party to lead and he needs to be able to do so as free as possible from distraction. Any new leader needs time and space to set his or her own direction, priorities and policies. I believe this will be harder if there is constant comparison with my comments and position as a member of the Shadow Cabinet. This is because of the simple fact that Ed is my brother, who has just defeated me for the Leadership. I genuinely fear perpetual, distracting and destructive attempts to find division where there is none, and splits where they don't exist, all to the detriment of the Party's cause.

You can read his full letter to his constituency party here.

Caroline Crampton is web editor of the New Statesman.

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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