Nigel Farage poses for a photograph as he unveils a new UKIP campaign poster for European Elections on May 11, 2014 in London. Photograph: Getty Images.
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Cooper and Lammy's condemnation of Farage as "racist" puts pressure on Miliband

The Labour leader is being pushed to be less ambiguous in his criticism of the Ukip leader.

In his interviews yesterday and today, Ed Miliband was careful to avoid condemning Nigel Farage as a "racist" for his comments on Romanians. He described the remark (suggesting that people should be worried if Romanians moved next door to them) as "a racial slur" but added: "I don’t think of Nigel Farage as a racist himself". After working hard to dispel the perception that Labour regards anyone concerned about immigration as a "bigot", it is not hard to see why Miliband is reluctant to attack the Ukip leader in such terms. 

Rather than denouncing Farage for his stance on foreigners, Miliband has focused on criticising him as "more Thatcherite than Thatcher", highlighting his past support for a flat tax, GP charges and the abolition of maternity and paternity leave. 

But there are many in Labour, including in the shadow cabinet, who would like Miliband to offer a less ambiguous condemnation of the Ukip leader's remarks. In interviews today, David Lammy and Yvette Cooper have both been blunter in their criticism. Lammy told the Daily Politics: "What Nigel Farage said over the weekend was racist. So I'm clear, he's a racist. I am from a background where my parents arrived here as immigrants. I remember a context in which some people said: 'You don't want these people living next door to you.' That was racist."

Cooper later told ITV News: "It's not racist to be worried about immigration or to want stronger controls, but it is racist to somehow stir up fears about Romanians living next door. So Ukip should say they were wrong on that." As the Labour figure responsible for immigration policy, her intervention was significant.

It's worth noting, however, that Lammy himself said it was not worth getting into a "pedantic discussion of the difference between a racial slur and racism." But their comments will still increase the pressure on Miliband to explain why he does not regard Farage as a racist, rather than merely why it is not helpful to do so. 

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