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Hilary Mantel and the duchess’s new clothes

I was present for the author's so-called "attack" on the Duchess of Cambridge. It was nothing of the sort.

"Venomous" was how the Daily Mail chose to describe Hilary Mantel’s so-called attack on the Duchess of Cambridge, in which the celebrated, Booker-winning author supposedly dismissed Kate Middleton as a “plastic princess”. Other papers joined in, and even the Prime Minister clucked disapprovingly. Mantel’s words were, he said, “hurtful” and “completely wrong”. The crime that inspired all this outrage? Mantel delivered an hour-long lecture on 4 February, since republished in the London Review of Books, on the subject of “royal bodies” and dared to wonder whether Britain should still have a monarchy.

Not only was the lecture, running to some 5,500 words, a subtle and precise exploration of the subject (I was present for it) but it was in no way venomous. I sat in the audience that evening marvelling at Mantel’s knowledge of her subject and the honesty of her argument. As in her fiction, she was incisive to the point of cruelty and expected her listeners to keep up with her; as she told the New Statesman’s Sophie Elmhirst last year, “You simply cannot run remedial classes for people on the page.” But she was never malicious.

Sadly, it’s not unusual for someone with a complex and nuanced set of ideas to have their words slyly twisted after the fact. Yet what is interesting about Mantel’s case is that it was done in a way that demonstrated exactly the point she was making.

Her central thesis was concerned with how we scrutinise and sacrifice our royal women. Discussing Marie Antoinette, Anne Boleyn, the Queen, Diana and the Duchess of Cambridge, she advanced a hypothesis for how royal women’s public personas are constructed and sustained entirely from the outside. It was in this context that she described Kate as “a jointed doll on which certain rags are hung” and spoke of the duchess’s “only point and purpose being to give birth”.

Like it or not, royal women have always been wombs on legs. We just now happen to live in an age in which it is finally becoming unacceptable to consider any woman, royal or otherwise, as an ambulatory incubator for future children. In spite of this, the essential purpose of royal womanhood remains unchanged – it is the tension between the two that Mantel was exploring.

It’s hard to accept the outrage about Mantel’s “hurtful attack”, coming as it does from the same media outlets that daily train their cameras on the duchess’s stomach, revelling voyeuristically in any hint of rotundity. Royal women are and always have been a vehicle for our petty prejudices and problems, and in the case of the Duchess of Cambridge much of this emanates from the very publication that was so eager to traduce Mantel. However, as befits her calm and lucid lecturing style, she didn’t point fingers or name names. She has more class than that.

Caroline Crampton is web editor of the New Statesman.

This article first appeared in the 25 February 2013 issue of the New Statesman, The cheap food delusion

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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