The EU referendum leaflet that will haunt Clegg today

As Clegg stands in for David Cameron at PMQs, Tory MPs will seize the opportunity to remind him of his past promise to hold an in/out EU referendum.

With David Cameron still away in the US, it's Nick Clegg who will man the dispatch box at PMQs today, and we can expect the Tories to take full advantage of the occasion to remind Clegg of the days when he supported an in/out EU referendum. 

The Deputy PM now rejects a vote on Britain's membership as against "the national interest" but as the leaflet below (thought to date from 2008) shows, he was previously calling for a "real referendum" and denouncing Labour and the Tories for not doing the same. The leaflet declared:

It's been over thirty years since the British people last had a vote on Britain's membership of the European Union.

That's why the Liberal Democrats want a real referendum on Europe. Only a real referendum on Britain's membership of the EU will let the people decide our country's future.

But Labour don't want the people to have their say.

The Conservatives only support a limited referendum on the Lisbon Treaty. Why won't they give the people a say in a real referendum?

In fairness to Clegg, this pledge was specifically tied to the Lisbon Treaty and, while the Lib Dems' 2010 manifesto repeated the promise of a referendum, it suggested that one should be only held "the next time a British government signs up for fundamental change in the relationship between the UK and the EU." Since the UK is currently not negotiating a new treaty, Clegg will argue that the preconditions for a vote have not been met. But in the heat of the Commons, this detail is likely to be lost. Expect Tory MPs to bombard Clegg with questions accusing him of showing "complete disdain" for the British people and of breaking yet another election pledge. 

The Lib Dems are clear that they will not waver on the question of a referendum, with one source telling the Telegraph: "We won’t give up any government time to internal Conservative Party politics." But as Clegg knows all too well, there are few things more toxic for his reputation than his image as a man who never keeps his word. And with the Tories already in election campaign mode, no punches will now be pulled for the sake of their coalition partner's feelings. 

As I noted at the weekend, Michael Gove used his interview on The Andrew Marr Show to portray Clegg as a man too weak to support government policy (in this instance on childcare ratios) due to the internal threats to his leadership. Today, he will be assailed as a hypocrite, a liar and a scoundrel. The "Rose Garden moment" now feels a very long way away indeed. 

Nick Clegg gives a press conference at the EU headquarters in Brussels. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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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