Nick Clegg during his debate with Nigel Farage on EU membership last night. Photograph: Getty Images.
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To burst the Farage bubble, Clegg needs to win hearts, not just heads

Next week, the Deputy PM needs some pointed barbs, a few more jokes and a lot more passion.

The Farage balloon was in full flight last night in the LBC debate, full of hot air and poisonous gases. Apparently, 485 million people are poised to arrive in Britain from all over the continent. Eighty million Germans want to break free from the hellholes that are Berlin and Munich, eager for the opportunity to sample the delights of Hansel and Pretzel on Ham Common; 10 million Belgians, sick to death of too many Godivas and desperate for a bar of Dairy Milk, are about to jump on a cross channel ferry. And, indeed, 60 million Brits must be readying themselves to nip over the water purely for the experience of sailing back into Dover, for they too are included in his "numbers" of folk who could be about to invade this sceptered isle.

Except, of course, it’s not going to happen. It’s a big scary number and that’s why Nigel Farage likes it – because he can frighten people with it. And for me that was the theme of the debate – Nigel trying to scare people into thinking his way. What would he want people to take from the debate last night I wonder? Twenty nine million Romanian and Bulgarians could be coming? Every family on the continent is going to come here and start claiming child benefit? The churches are going to be sued over equal marriage? Factories will be closed and your jobs transferred to Leipzig? And it’s going to cost you £55m a day? None of which is actually true. But that’s hardly the point.

Because this stuff sticks. Few folk will remember the facts and figures today. But they will recall the general tenor of the debate. Farage’s sweeping generalisations and grandiose statements against Nick’s more forensic grip on the actual facts – and in an emotional vs. rational debate, it’s generally the former that gets traction. And for me, that’s the challenge Nick has in the next debate. It’s easier to look passionate wrapped in a flag extolling the virtues of fish and chips, cups of tea and lashings of ginger beer than it is when you’re explaining that its better to be part of a trading group with a GDP of $16.6trn when on your own you’re the 8th or 9th largest economy, and China is five times bigger than you.

But that’s what it will take to burst the Farage bubble. Nick needs to come armed with some pointed barbs, a few more jokes and a lot more passion. He won the debate last night. But it’s not enough just to win the head. Next week, we need to win people’s hearts as well.

Richard Morris blogs at A View From Ham Common, which was named Best New Blog at the 2011 Lib Dem Conference

Richard Morris blogs at A View From Ham Common, which was named Best New Blog at the 2011 Lib Dem Conference

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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