The bad news in today's US jobs figures

Only 58.1 per cent of the US population is in work, the lowest level since 1983.

The latest US job figures may have been better than expected but they're still far from encouraging. 117,000 new jobs were created in July but the unemployment rate was little changed at 9.1 per cent (down from 9.2 per cent in June) and even this fall can be largely attributed to the fact that more people have simply dropped out of the labour market. Perhaps the most sobering statistic, as the New York Times notes, is that only 58.1 per cent of the US adult population is in work, the lowest level since 1983. Little wonder that the "relief" provided by the figures was decidedly temporary.

All of which doesn't bode well for Obama's re-election chances. No US president since Roosevelt in the 1930s has won re-election with the unemployment rate above 7.2 per cent, and it is estimated that by November 2012 it will be 7.8 per cent. So, how worried should Obama be? It all depends on context. FDR was able to win a second term because unemployment was falling, not rising. When he ran for re-election in 1936, unemployment stood at 17 per cent but this was still down from 22 per cent in 1934 and 25 per cent in 1932. The public were satisfied because the figures were moving in the right direction. Similarly, as the NYT has previously noted: "Ronald Reagan won, despite 7.2 percent unemployment in November 1984, because the rate was falling and voters decided he was fixing the problem."

Thus, Obama's challenge is to reduce unemployment to a level that voters, given the global economic context, are willing to tolerate. The Roosevelt precedent suggests that this could be significantly higher than 7.2 per cent and, in the absence of a credible Republican candidate, the smart money is still on Obama celebrating his 54th birthday in the White House.

George Eaton is political 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