Paranoia about "operatives" infiltrates Romney's grassroots support in Ohio

“You have a Chicago telephone number and you're a Liberal. Get out or I'll call the sheriff.”

“There are 47 per cent of the people who will vote for the President no matter what,” Romney says in the now-famous leaked footage, recorded by waiting staff at a $50,000-a-head fundraising event back in May. “So my job is not to worry about those people.”

Well, he's certainly worrying now, and he's not the only one: there's some serious paranoia among Romney's grassroots support. Last week, a local reporter recommended I cover a dinner hosted by the Republican party of neighbouring Paulding County. He sent me the details of the event, and said he would call the organisers to tell them I'd be calling to cover it.

Their response was extraordinary. First, the Paulding County Republican Committee chair, one Jerry Zielke, called him back and told him they were tracing my phone. “We think he's a Democratic Party operative,” Zielke told him. “I know for a fact that the Democrat campaign is going to plant these guys, and we've had word that they're coming in to our area.”

Sure that there has been some sort of misunderstanding – or attack of paranoid delusion – I decided to pop round to the event and straighten out the misunderstanding. When I find Zielke and explain who I am, his reaction is instantaneous. “Get out. We know what you are. Get out,” he shouts at me, spitting crumbs. I asked why. “You have a Chicago telephone number,” he says with venom, “and you're a Liberal. Get out or I'll call the sheriff.”

I got out.

“Huh,” says Ron Farnsworth of the Paulding County Democrats, when I put the accusation of planting underground operatives to him. “No, heavens no, we're not doing that. Jerry Zielke is a new chairman, became it a couple of years ago. He's just new. We're... not sure what he's up to.”

It must be remembered that this was a county Republican event rather than a national one. The presidential campaign can't be held responsible every time a local officer is a bit, well, over-zealous. And it's hardly surprising their mood was less than celebratory. The Republicans are losing. Today's polls put Obama a crucial five points ahead in Ohio. Perhaps a communiqué of some kind has gone out through the Republicans trying to prevent further phone-camera hijinks, but the damage is already done for Romney.

This is not the only such accusation. A leaked video in El Paso, Colorado of a Romney campaign volunteer pretending to work for the county clerk's office in order to register Republican voters surfaced over the weekend, and local Republicans again claimed that a Democratic “operative” was behind it.

Later that week, outside a Paul Ryan town hall meeting in Lima, Ohio, a rag-tag band of Obama supporters in fancy dress - to call them 'operatives' would be a strain on even Jerry Zielke's credulity - are picketing underneath a huge Romney-Ryan sign on the side of an office building. Cars with “Obama for America” stickers drive by honking at the queue. In the sky, a light aircraft tows the message: “Admit it: 47 per cent aren't villains”.

Earlier today the Democrat campaign held a press conference around the corner at a local union hall. The theme of their bus tour is summarised on the side of the campaign bus. It says, in a big red stripe down the side, “Mitt Romney – Writing off the Middle Class”, and it quotes the Republican candidate from the video: “My job is not to worry about those people.”

There, I speak to Larry Donaldson, a retired engineer for General Dynamics. “Romney doesn't have empathy for the middle class,” he says. “He doesn't know what it's like. He proved it in that video.” While the Republicans search for Democratic operatives under the bed, they're missing the point: that they are losing any chance to make their case to the middle class, which is allowing the Democrats to construct the narrative: Romney the elitist, Romney out of touch.

Security at the Paul Ryan event is easier-going than in Paulding – no one threatens to call the sheriff on me this time – but the event is tightly choreographed nonetheless. Only one question from the floor, most of which are in the “I pray you can cancel Obamacare when you win” vein, seems to give Ryan pause in his practiced rhetoric. It is about the quote from the hidden-camera video, but Ryan brushes it aside, returning to his recurring theme of how the upcoming defence cuts will affect the area – Lima is the site of a large tank plant. (He fails to admit, strangely enough, that he voted in favour of those cuts.)

The Paulding County attitude toward the press has infiltrated a bit here, too, though. Outside the meeting, I speak to a boy of about 17. He's in a Romney-Ryan t-shirt with a Romney-Ryan badge, carrying a Romney-Ryan sign, and he's looking faintly lost.

“What excites you about the Romney-Ryan campaign,” I ask him. “I dunno,” he answers, glancing around nervously and licking his lips. “He's Republican, pretty much, I guess.” An older woman, about 60, in bright pink lipstick bustles over, demands to know what the boy is doing talking to me, then stands and glares at me, arms folded. When I ask what policies of Romney and Ryan excite the boy to badge-and-t-shirt levels, she cuts in before he can reply.

“He's interested in what happens to this country,” she says with finality. “You agree with me,” she says to the boy. It is not a question. “I raised my grandkids right.”

May I take your names, I ask. “No. That's it.” She marches off, with a suspicious look back at me.

“Sorry,” the boy shrugs as he turns to follow her. “I do what she says.”

Romney is losing - polls put Obama a crucial five points ahead in Ohio. Photograph: Getty Images

Nicky Woolf is reporting for the New Statesman from the US. He tweets @NickyWoolf.

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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