Morning Call: pick of the papers

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

1. War comes to Syria's quiet Christian hinterland (Independent on Sunday)

A rebel attack on Maloula is a warning for a minority accused of supporting government, says Patrick Cockburn.

2. On the trail of the ideal school, no 'love sticks' required (Independent on Sunday)

Michael Gove tells teachers as they prepare to strike over pay and conditions that their profession has never been more rewarding, reports Jane Merrick.

3. Ed Miliband can't retreat from his battle with the union bosses (Observer)

Victory for the Labour leader would be good for him, bad for the Tories and best for the way we do politics, writes Andrew Rawnsley.

4. It's still a family affair if you want to succeed in Britain (Observer)

You don't have to marry a prince to get to the top when even egalitarian Labour favours political dynasties, writes Catherine Bennett.

5. The golden age of inquisition dies with Frost (Sunday Times) (£)

David Frost's death is a reminder that the golden age of openness has passed, says Adam Boulton.

6. Now the recovery’s starting, are we all in that together, too? (Sunday Times) (£)

Ministers are being very, very careful not to utter the phrase “green shoots”, observes Camilla Cavendish.

7. We can’t pretend the world didn’t change after September 11 (Sunday Telegraph)

Our political class is ignoring the great question post-9/11: how to ensure the regions that spawned terror are stable, says Matthew d'Ancona.

8. Miliband must improve fast ahead of his crucial TUC speech (Mail on Sunday)

His efforts will be in vain if he does not recharge our economic and foreign policies, says David Blunkett.

9. Etiquette can't manage our mobile addiction (Sunday Telegraph)

Debrett's guide to using our phones politely is all very well, but we need to go cold turkey, argues Jenny McCartney.

10. KitKat for Google? Give us a break… (Observer)

Only Google executives know why they've named their new operating system after a snack owned by the appalling Nestlé, says David Mitchell.

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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