Digging for dirt


In Paradise Lost Milton was of the devil's party without knowing it. Channel 4's enthralling The Real Rupert Murdoch (Saturday, 21 November, 9pm) signed up to same closed list. Charisma fizzed off Murdoch like the glare from the braid on a portrait of Elizabeth I. The programme made its objections but they smashed like moths against the wattage he was generating. His reply to every qualm was a version of Lambert Le Roux's speech in the newspaper satire of Pravda: "What I do is a natural thing . . . animals, birds, plants, they fucking well get on with it and don't stand about complaining all the time." The soliloquy always, as I recall, got a round of applause.

Like most modern biography, The Real . . . specialises in debunking, but this episode bunked like mad, even coming up with the interesting suggestion that Murdoch's assault on Fleet Street was belated revenge for the British incompetence at Gallipoli as witnessed by his father, Keith. From Keith's father, Patrick, the general moderator of the Presbyterian Church in Australia, could be traced Rupe's Puritan work ethic (if not his tittish bratloids). From his maternal grandfather, a wool trader and obsessive gambler, came the risk-taker who would stake the company on the throws of the dice at Wapping and Sky. The bad news was that he inherited not a single gene from his nice, respectable mother who, when interviewed, could not bring herself to recall the title of the News of the World.

One by one, The Real Rupert Murdoch presented the small fish her shark-like son had devoured. First to be spat out was his good friend the editor of the Adelaide News, who had criticised the Australian prime minister Sir Robert Menzies at the time when Murdoch was trying to win a monopoly television franchise in the city. Sir William Carr, proprietor of the vulnerable News of the World, was dead within months of his Australian white knight betraying his promise not to mount a takeover. Frank Giles, short-lived editor of the Sunday Times, admitted he had been forced to lie to his staff about why he was firing a number of senior executives. He was soon sacked himself - or, rather, "promoted" to editor emeritus. (The rumour was that he asked Murdoch what the title meant, and was told: " 'E' means you're out and 'meritus' means you deserved it.")

But whether Murdoch is an especially unpleasant tycoon is almost beside the point. Never mind evil, any empire the size of Murdoch's will be an enemy of the integrity of its component parts. So Star TV in Asia is forced to stop broadcasting the BBC World News for fear it upsets News Corp's progress into Beijing. HarperCollins for similar reasons junks Chris Patten's book on Hong Kong. The Times publishes a ludicrous supplement promoting the release of Fox's Titanic video.

In the programme's crowning scoop, a rare interview with Murdoch himself, the blond, svelte, freshly mistressed tycoon promoted himself as a buccaneering challenger of the establishment. But it is the establishment that now cowers before him. The Dirty Digger told an early Australian television interviewer that there was only one answer to the question whether he enjoyed power and it was "Yes". His enjoyment was vicariously exciting to watch.

Four episodes in, Nurse (BBC2, Wednesday, 9pm) is proving a work of integrity by its director, Jenny Abbott, who spent four years following eight trainee nurses. Her beautifully composed shots and her subjects' seeming mindfulness of the camera point to the difference between serious fly-on-the-wall documentary and docu-soap. Where the programme disappoints is, let's be candid, the nurses. Their serious young faces simply do not excite the screen in the way that Molly Dineen's rail-defluffers and aviary-keepers did.

The programme takes the uncontroversial view that student nurses are the ultimate victims of the NHS system, underpaid and overworked. We see them living off tins of tomatoes, pulling their jumpers over their eyes at an autopsy, dissolving in tears at the birth of a child, falling into debt. The Pakistani student this week submitted to an arranged marriage. Another accidentally fell pregnant. One of the young men is rendered literally impotent when he tries to donate sperm for cash. The camera panned from Nurse Kerry to Frank, the Alzheimer's patient she was spoon feeding, leaving us to wonder who was the madder to be confined to this existence. Like the worst sort of carer, Abbott's camera is in love with victimhood. There is only so much a viewer can take before he starts quoting Lambert Le Roux.

Andrew Billen is a staff writer on the London "Evening Standard"

Andrew Billen has worked as a celebrity interviewer for, successively, The Observer, the Evening Standard and, currently The Times. For his columns, he was awarded reviewer of the year in 2006 Press Gazette Magazine Awards.

This article first appeared in the 27 November 1998 issue of the New Statesman, How the left hijacked the family

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