Drink - Victoria Moore prefers the right mug

If you work in an office, it is very important to respect others' cup preferences

What you drink is not always as important as what you drink out of, particularly when the drink is tea or coffee. My cousin considers it a form of psychological bullying to be given the blue china cup with the gold moon and stars. Her old flatmate discerned she hated it, and as their relationship deteriorated, so the number of times Claire found her morning tea contemptuously poured into that mug increased.

She and I never make tea or coffee without asking the other which cup they want. We always have a strong view on the matter. As a general rule of thumb, the cream teacups with blue dots are for coffee with late breakfasts; the Spode blue mugs rarely upset; the fish-patterned one is preferred in the mornings - but it is never safe not to ask. The right vessel can cure many ills, the wrong one provoke a flurry of bad temper.

Everyone is the same. When my boyfriend had in (London) decorators, we were surprised to see they had rootled past the chunky Habitat mugs to unearth the Leeds United ones we never use from the back of the cupboard. Were they being ironic? Chelsea supporters having a joke? We felt uneasy about it for days, in the end deciding they had simply sought out those mugs most like their own.

If you work in an office, it is very important not to get in the way of other people's cup preferences. When I began my job the first thing I did, even before filing a story, was to buy a supply of mugs. This did not deter Lady Olga Maitland, with whom I then shared an office, from commandeering the gold-rimmed white china cups and saucers reserved for the editor's important visitors for our afternoon Earl Grey. I don't know what happened. Perhaps some cabinet minister got sore at being given the second-best cups. But eventually this got us banned from the kitchen for three months. Now there is no Lady Olga, but we do have two sorts of cup and there are not enough of the nicer ones to go round. And sometimes freelancers come in.

"When we have new people," my boss whispered to me the other day, "they cannot have the nice mugs for a long time."

It has taken a while to acknowledge openly that we all prefer the thinner china cups. There is nothing actually wrong with the other kind of cup. It has blue and white stripes that are hand-painted and it cost £8.

But when my boss makes coffee he now asks, "Who wants the thick mug?" and the other two of us make a calculation taking in our respective moods and the small favours and allowances we owe each other before volunteering. Occasionally, if he has been beastly, my boss will drink from the thick mug himself to signal his remorse - or we might give it to him as punishment.

As I say, what you drink out of is important.

This article first appeared in the 05 May 2003 issue of the New Statesman, The defeat of the left

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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