Harry Potter and the house of bored kids

The school holidays. Jesus wept. Because booking things months in advance is not exactly my strong suit, this involves schlepping back and forth between the Hovel and the family home in Shepherd's Bush. It's like the opposite of commuting, or a weird variant of it: travelling not from home to office and back, but from home to sort-of home and back.

It is odd spending the week in the home in which my three children were born and raised. I know every inch of it: I sanded half the floorboards, painted half the window frames, and there are still some sections of wall where my initial colour scheme - bold, original, yet tasteful - has not been edited out of history. Three years on, there is still some of my crap waiting to be chucked out: 18 boxes of books and stuff, 20 to 30 per cent of the total, which I would like to keep but don't have space for. (The rest is gathering dust in my parents' loft, and they say they would rather not have any more, as they don't want their house to collapse on top of them. Fair enough.)

The boxes sit behind me, hulking sullenly in the living room, as I type. It is strange leaving the place to go back to the Hovel every day: saying goodbye to the children is far less pleasant than I let on, even if I know I'm going to be seeing them the next day. The melancholy generally lasts, I have discovered, until I get halfway up the escalator at Marble Arch.

Still, it is a delight to see them. By not being exposed to a grumpy father 24 hours a day, they seem to have turned into rather splendid young people, if I may say so myself. Their mother might even have had something to do with it. And as I have never been the kind of father who says anything even remotely like "let's go camping", they do not mind if we basically slob around all day.

But there is still the problem of how to keep them entertained, to get them off the PlayStation. (Have you seen Call of Duty 6? It's a bit disturbing, frankly.) Open to suggestion, I am pleased to receive a text from their mother. "Why don't you take them out on a pedalo on the Serpentine?"

In theory, and with normal children, not to mention a normal father, or the kind of father you get in adverts, this is a perfectly good idea. And I think
it is rather nice that she is giving me ideas about what to do with them - for, like many men, I have little imagination when it comes to entertaining children, and am seized with that brain-freezing mixture of panic and shame that is what we feel when our limitations are made manifest to us.

Butterfly effect

To make matters worse, my children suffer from great inertia. Maybe they're like little balls of lightning when they're with their mother, but when they're with me they have to be scraped off the floor with a shovel.

With negotiation, it's possible to get them to play a bit of cricket in the scary park down the road, and I think I might persuade them to play a bit of poker later on, but trying to get a 15-year-old girl and 13-year-old and ten-year-old boys to agree on a common agenda is a tall order. There's also the problem of getting them to the Serpentine, getting them dressed so they can go on public transport to go to the Serpentine without causing a scandal, and prising them off the sofa so they can get dressed.

Anyway, there is a new development afoot. The youngest boy has come down and asked his sister where the first Harry Potter book is. This is quite astonishing, as he is not really the kind of boy who picks up books unless they are heavily illustrated with pictures of space. Nothing wrong with that, of course, space is cool, but by his age I was halfway through Middlemarch and could address the cats in Latin hexameters. (This is a monstrous fib.) Now, I feel, is not the time for me to start on my critique of J K Rowling's prose style.

So when Eldest Daughter comes down and says that Youngest Son is actually reading, we are both conscious of the scale of the achievement and, at the same time, its precarious nature. It's like when a butterfly lands on your arm, she says. You have to be completely still or it's all over.
This is a tricky business. There are builders noisily converting the attic. An 11-year-old cousin is staying over. There are electronic games and apps and whatnots in three or four different formats, offering the chance to do everything from killing the Taliban to playing for Arsenal. We hold our breath. The butterfly is still there.

But for how long?

Nicholas Lezard is a literary critic for the Guardian and also writes for the Independent. He writes the Down and Out in London column for the New Statesman.

This article first appeared in the 09 August 2010 issue of the New Statesman, The first 100 days

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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