Commons Confidential: Don't let them eat cake

David Cameron's quest for youth, plus the mystery of Ed Miliband's make-up.

Weighty issues burdening David Cameron include a descent into portliness. In a reverse of Marie Antoinette, the Tory toff pleads: “Don’t let them eat cake.” My snout says that Cameron complains whenever Downing Street apparatchiks eat pastries in front of him. Dave, or Fat Dave, as Old Etonian chums know the Prime Muncher, is losing his battle to keep off those pounds. He realises, with some justification, that extra padding with hair loss is a sign of ageing, just when he craves a youthful appeal.

No 10 staffers are desperate for Cameron’s confidante Gabby Bertin to return from maternity leave to resume her bunwatch. Dough Ball Dave prefers breakfast meetings to be food-free – an austerity policy recently objected to by one hungry Liberian emissary who’d just got off a plane from Africa.

I bring you a private encounter illustrating Barack Obama’s widening rift with Cameron over the Euroscepticism of the ConDem coalition’s Con majority. The White House wants Britain to remain part of the European Union, as does Cameron when pressed – though he never misses an opportunity to snipe at the EU.

A favourite target of Tory hostility is Cathy Ashton, the Brussels Brit who is high representative for foreign affairs. Ashton is held in higher regard in the US than in right-whinge circles this side of the Atlantic. During last year’s Nato summit in Chicago, an informant recalls, Cameron opined snidely: “We don’t see much of Cathy these days.” “That,” replied Obama, “is because Cathy’s a world leader.” Obama may not know “Jeff” Osborne but he has Cathy’s number.

The unlikely heart-throb Lord Wood, a Miliband consigliere voted prettier than the Tories’ pin-up Zac Goldsmith by Telegraph online readers, all presumably awaiting cataract operations, is the recipient of an unusual request. Wood met the correspondent’s call to vote for same-sex marriage but a second request is more problematic: “Additionally, if you knew of any male aristocrat that would like to marry me, much appreciated.” Wood wished the chap luck in his quest for an eligible male aristo and, wisely, declined to play matchmaker.

More on those lasagne by Ed “Beefy” Balls auctioned for £8,500 at a Labour fundraiser. The shadow chancellor promised to chuck in a couple of green salads and serve the dishes in a pinny. Mercifully, he assured me, with his trousers on.

Workers of the world united to save the human race at the RMT. A recording of that left-wing anthem, “The Internationale”, was played every morning at the union’s conference in Brighton.

Does Ed Miliband wear make-up? The Labour leader’s face appeared powdered at the New Statesman’s centenary bash. Mili’s abrupt “No” when your columnist asked only served to fuel my suspicions.

Kevin Maguire is the associate editor (politics) of the Daily Mirror

An artist's impression of Ed Miliband's make-up by Dan Murrell for the New Statesman

Kevin Maguire is Associate Editor (Politics) on the Daily Mirror and author of our Commons Confidential column on the high politics and low life in Westminster. An award-winning journalist, he is in frequent demand on television and radio and co-authored a book on great parliamentary scandals. He was formerly Chief Reporter on the Guardian and Labour Correspondent on the Daily Telegraph.

This article first appeared in the 01 July 2013 issue of the New Statesman, Brazil erupts

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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