Britain: not quite a US theme park

I've now been an expatriate for more than a decade. Back in 1995 - midway through my self-imposed exile in Washington, and when John Major was still in No 10 - I wrote a column on what it is like to revisit Britain: "I shake my head in wonderment over how someone called Tony Blair seems so successfully to be seducing a pliant nation," I wrote then. "I vaguely remember him in the Eighties as an up-and-coming and rather ingratiating Labour MP of the elitist, public school tradition . . . now he looks to me to be far too good to be true [and has] hijacked the chattering classes with an almost contemptible ease . . . the myth that Blair is a man of enormous substance has rapidly become a myth made fact in the lazy, silly-season-obsessed British media."

I turn up in 2000 to find that even the women of the WI have finally sussed out Blair. In Blairite Ruritania, unshirted louts wave St George's flags for Euro 2000, but end up looking pathetically parochial. Am I right in thinking that you get a better perspective of your own country when you live away from it? And, meanwhile, is the unthinkable happening with people beginning to warm to William Hague?

It is always both depressing and exhilarating to arrive at Heathrow in the early morning. First, you pick up the papers and realise with a sinking feeling that the likes of Lynda Lee-Potter and Libby Purves are still plying their platitudinous wares: somehow you think the country must have moved on, but the quantum leap downwards in the quality of the British press is what strikes one most.

Even worse nowadays is the proliferation of wannabe Lee-Purveses: acres of newspaper space being given to droves of women plumbing new depths of drivel. Perhaps it's a generational thing - I am in my forties. But it is sad when a supposed role model in her sixth decade, such as Purves, churns out a column in the once dignified Times in which she includes the words "shag culture", "spot your boyfriend's willy", "score" and "slapper". Then turn to the Daily Mail and you will find a royal "expert" writing as revelatory fact that Princess Diana suffered from a borderline personality disorder. This is not established fact, but a theory cobbled together last year by an American authoress; I happen to know the man here from whom she took the idea. Thus, in the British press of 2000, myth once again becomes fact - in this case, via the Georgetown salons surrounding me in the US.

Americans, I've long since noticed, never go abroad: they take the US with them, armed on the plane with personalised pillows, sips of bottled water on the hour, capsules of melatonin and other devices that self-help books tell them will help ward off the effects of foreigners.

Then they are affronted if the Wall Street Journal and USA Today are not awaiting them; and they expect CNN in their hotel rooms because, to them, all this is simply how life is.

This is surely why the latest Hollywood films routinely write out Britain's role in history: we are no longer the mother country that established the norms, but a Disneyland to be seen and "done" (on my last day, I spotted a Pizza Hut, a McDonald's and a Burger King within feet not only of each other, but of Windsor Castle). The US has established its own norms which the rest of us must follow. Its tourists then return with relief to their cocoons in the US, ready with tales of how they withstood the dangers of the Drumcree marches, say, while facing the perils of abroad.

Visiting Lord's on the very day when England skittled out the West Indies for 54 was, for me, one of those dreamy days when you feel there will always be an England. People are still nicer and politer to each other than in the US, and better educated, too. Interchanges in shops, buses, on the Underground or in pubs are more friendly. The food, contrary to myth, is tastier.

An image of the kind for which I still nostalgically yearn stuck with me this summer: two bottles of milk on the doorstep of a house in the close of Salisbury Cathedral, untouched and waiting in sublime innocence in the shadow of the cathedral spire.

I end with a challenge for Ken Livingstone. I found myself staying at the old County Hall - "the home of London government 1922-86", as the side of the wondrous 750ft-long edifice proudly proclaims. Much of it is now a Marriott hotel, following Margaret Thatcher's abolition of the GLC (surely one of the most infamously undemocratic moves in 20th-century British history) and the sale of the building to the Japanese company Shirayama Shokusan.

What magnificent hopes and social progressiveness once dwelt in that building! But, in 2000, I spent an hour waiting for my calves' liver there before leaving in despair. No fabled American efficiency replacing tired old Britain here.

Outside was a seething touristic slum of hot-dog salesmen, a ghastly McDonald's, a tawdry casino, the London Eye, and cheapo flats being hustled for monumental sums of money: Blairite opportunists everywhere trying to grab whatever they could from the destruction of yet another once great English institution being sold off. There's only one solution: County Hall must now be repossessed by the people. How about it, Ken?

Andrew Stephen was appointed US Editor of the New Statesman in 2001, having been its Washington correspondent and weekly columnist since 1998. He is a regular contributor to BBC news programs and to The Sunday Times Magazine. He has also written for a variety of US newspapers including The New York Times Op-Ed pages. He came to the US in 1989 to be Washington Bureau Chief of The Observer and in 1992 was made Foreign Correspondent of the Year by the American Overseas Press Club for his coverage.

This article first appeared in the 10 July 2000 issue of the New Statesman, Education, education, profit

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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