Morning Call: pick of the papers

The ten must-read comment pieces from this morning's papers.

1. Britain’s perilous austerity bunker (Financial Times)

Cameron’s arguments against fiscal policy flexibility are wrong, says Martin Wolf.

2. Labour needs to do more than simply wait for Cameron to fail (Daily Telegraph)

If Ed Miliband wants to keep his lead he must be bold and address his party’s past failings, writes Mary Riddell.

3. This isn't self-determination. It's a Ruritanian colonial relic (Guardian)

The vote for British rule in the Falklands referendum dodges the point, says Seumas Milne. It's time for a negotiated settlement with Argentina.

4. There’s only one solution to the PM’s dilemma (Times) (£)

How do you appease rebels and yet pursue policies they oppose, asks Daniel Finkelstein. Appeal to swing voters – and show you are a winner.

5. Syria: don't fan the flames of conflict (Guardian

Offering support to Syria's rebels risks intensifying a tragic civil war, says Douglas Alexander. We must work with Russia for a political transition.

6. The world needs to understand Putin (Financial Times)

This conservative is no friend of a tired status quo, writes Alexandr Dugin.

7. 'Like' it or not, privacy has changed in the Facebook age (Guardian)

It's hardly a shock to learn that fans of The L Word are lesbians, writes Helen Lewis. We need to relax about online privacy

8. Could the yoke of Merkel's austerity really lead to conflict in Europe again? (Daily Mail)

Ever more citizens in the Mediterranean countries argue that for the third time in less than 100 years Germany is trying to take control of Europe, writes Dominic Sandbrook. 

9. The seeds of an NHS revolution are sown (Daily Telegraph)

Health expert Don Berwick's decree that 'no harm should be regarded as acceptable' must prove to be a turning point, says a Telegraph leader.

10. Why we went our own way on Leveson (Independent)

Private talks between the press and a Prime Minister who said he could deliver a non-statutory formula have sapped collective confidence, says Independent editor Chris Blackhurst.

Christopher Furlong/Getty Images
Show Hide image

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